May 19, 2024

MedicalCentre

Great Health is a Choice

DR ELLIE CANNON: When to visit a pharmacy with an illness… and when you should visit a GP like me

It is, arguably, the biggest shift in healthcare since Covid ushered in a radical – and controversial – new era of remote GP consultations. From today, high street pharmacists will get new powers to dish out prescription drugs, make referrals and basically be the first port of call for seven common illnesses.

From now on, you don’t need to see a doctor if you have symptoms of sinusitis, a sore throat, earache, an infected insect bite, impetigo, shingles or a urinary tract infection (UTI).

It’s not that we GPs are being lazy (although there will be the predictable comments below this article claiming so). And it doesn’t mean you are no longer allowed to see a doctor.

But these are straightforward issues that you simply don’t need a GP or nurse appointment to sort out.

It’s a sea change, but I’d like you to view it as empowering: the more we learn to look after our own basic health needs, with some expert support from a pharmacist, the better.

According to the Government, more than nine in ten pharmacies – total of 10,265 across England – will be offering the service from now on

It’s a drum I have been banging for much of the two decades-plus that I have spent in medicine. The move will also, it’s claimed, free up more than ten million GP appointments, which means we’ll have more time to see more patients with more complex problems.

Despite this, as with any shift in the way healthcare is delivered, the new rules will also cause worry.

And there are other important developments, such as pharmacists now being permitted to provide ‘emergency’ supplies of a wide range of drugs, if you have a repeat prescription and run out.

With this in mind, I’ve tried to answer the questions I’ve been asked most about the scheme over the past few weeks.

Q: How can I be sure the new system is safe – and isn’t there a chance my problem could be misdiagnosed by a pharmacist?

A: This is probably the biggest concern I’m hearing. Pharmacy First means, from now on, patients in England will be able to get assessment and treatment for seven common ailments.

These are infected insect bites and impetigo in everyone but babies under 12 months, sore throats in over-fives, earache in children between one and 17, sinusitis and shingles in over-18s, and simple urinary tract infections in women aged between 16 and 65.

These are problems most of us are pretty well versed in, but for details on the symptoms of each, please see the panel below.

If you think you have one of these seven illnesses, you can simply turn up at a local pharmacy and ask to be seen.

If the pharmacist can deal with your problem, you won’t need a GP appointment or a prescription for any medicines handed out.

As I have told my own patients, this change doesn’t worry me in the slightest – it builds on a system that was already in place, in which patients had to call 111 and be  referred to a pharmacist for treatment.

Pharmacists are experts in medicines and well placed to offer clinical advice for these uncomplicated problems. But, in addition, very clear care pathways – guidance on best practice – have been drawn up by the NHS for each of the seven illnesses.

These have been made with input from a wide range of experts and have been approved by the Medical Director at NHS England, Sir Stephen Powis, and Chief Medical Officer, Professor Sir Chris Whitty.

The pathways set out clear instructions for instances when the pharmacist should refer on to a doctor. Of course, there is always a chance of misdiagnosis, no matter which medical professional you see, but a great deal of thought has gone into this, and I believe it’s very safe.

Q: Are you really trying to tell me a pharmacist is as good as a GP at diagnosing and treating these problems?

A: In a word, yes. Pharmacists are not shopkeepers. Like most GPs, I’m endlessly emphasising how important it is for people to utilise them for medical treatment.

The fact that people don’t and instead try to get GP appointments or worse, turn up at A&E, is massively frustrating, as it hinders care of those who really need it.

In October, NHS data showed emergency departments are seeing a rising tide of patients turning up with minor problems – more than 230,000 attendances last year for earache, and almost 350,000 with sore throats, which is ridiculous.

I hope we can get as many of these people as possible to realise a trip to the pharmacist will get them the immediate care they need.

Q: Will I have to stand at the counter and tell a pharmacist about my painful and possibly embarrassing symptoms?

A: No. Participating pharmacies will provide private, confidential consultations in a separate room. You just have to go in and say something general like: ‘Can I have a consultation with the pharmacist in private,’ or something more specific such as: ‘I think I have sinusitis, can I have a consultation.’

All the staff working in the pharmacy will know that anyone with the seven conditions can be seen in a private consultation. So this should spare any embarrassment or uncomfortable situations.

Q: What if I don’t want to see a pharmacist about my problem?

A: There is nothing stopping you making a GP appointment for any one of these problems – although we might well tell you that you needn’t have waited to get the exact same treatment.

The beauty of Pharmacy First is you won’t need an appointment and likely won’t need to wait long. For something like a UTI, which can be very uncomfortable but is really easy to treat, this is a blessing.

For the last few years many pharmacies have run minor ailments services as well as treated high blood pressure and other issues. Since last year pharmacies have been offering women contraception without a GP.

These schemes have been an unmitigated success.

By ring-fencing seven new conditions that can be treated on the high street, it may alleviate some of the pressure on GPs and reduce wait times for patients.

Q: What will happen in a consultation – and if I get offered medicine, what will I have to pay?

A: During a consultation, the pharmacist will ask about previous medical history, allergies, any medicines you are taking and the symptoms that are bothering you. They might also ask for consent to check patient records they can access.

For some conditions, the pharmacist may request to perform an examination, such as using an otoscope, which is a device that lets us look into the ear canal, if earache is the problem.

They will be able to recommend the best course of action. If they recommend a prescription medicine, such as an antibiotic, you won’t need a prescription – but you will be charged the same as you’d pay for an NHS prescription, which is £9.65.

If they recommend an over-the-counter medicine, you’ll pay for that as normal. They may recommend coming back to the pharmacy for a follow-up appointment and depending on the situation instruct you to see a doctor, call NHS 111 or even go to A&E should symptoms worsen. 

A record of the consultation will be made and shared with your GP.

Dr Ellie Cannon is a supporter of the new Pharmacy First scheme... and answers your questions about it

Dr Ellie Cannon is a supporter of the new Pharmacy First scheme… and answers your questions about it 

Q: I understand there are other changes – pharmacists will be able to give out other medications too, such as asthma inhalers, without a prescription?

A: Sort of. Basically, if you’ve run out of a medicine you regularly take – it could be an asthma inhaler, an antidepressant, diabetes drugs, the list is extensive – and you are unable to see a doctor to get a prescription before you need to take your next dose, the pharmacist will be able to offer an emergency supply.

This service has been around for a few years now, and it was brought in to save people from turning up at A&E asking for their repeat prescriptions. Prior to this week, you had to call NHS 111 and get referred first, but now you can simply turn up at the pharmacy. You will be charged a regular prescription fee for any medication provided.

Q: Can I do this remotely, by phone or video call?

A: Some advice can be given by phone: if you need an emergency supply of some kinds of medication, for instance.

However if you want treatment to be provided by the pharmacist for one of the seven conditions, you need to either go into the pharmacy or, if it’s possible, have a video consultation. They need to be able to see you in order to make a proper assessment.

Q: I heard some people are worried pharmacists will hand out antibiotics inappropriately. Fair point?

A: There is no reason to think this. Alongside the care pathways developed, which stipulate when medication is needed, pharmacists are carefully trained in when it’s necessary to prescribe antibiotics and when it’s not.

Antibiotic prescriptions are carefully monitored by the NHS, and if spreadsheets are your thing, these data are publicly accessible via the NHS Business Services Authority website.

Q: How do I find a pharmacy doing all these new things?

A: According to the Government, more than nine in ten pharmacies – total of 10,265 across England – will be offering the service from now on, so it should be as easy as popping into your nearest one.

But if you call NHS 111 or use the nhs.11.uk service, or call your GP, and it’s suspected you have the symptoms of one of the seven conditions, you’ll be given a list of local pharmacies to choose from.

It’s important to note, Pharmacy First doesn’t include GP practice-based pharmacists, who have a wider remit to assess and prescribe. You’ll still need an appointment to speak to or see one of them.

Eight in ten people live within a 20-minute walk of a high street pharmacy and many branches are open at more convenient times than GP surgeries, such as during the evenings.

Q: Will pharmacies just end up being deluged with people seeking help, like every other NHS service seems to be?

A: Many of us doctors have wondered about this. Pharmacists are trained to master’s degree level, which takes four years. And one of the problems we may have with this is that there is a lack of them.

Roughly 5,000 pharmacists have left community pharmacy to work in GP surgeries in the last couple of years to be a part of the widening healthcare workforce, since there is a shortage of GPs.

Industry bodies have suggested this may mean there aren’t enough pharmacists in actual pharmacies to staff the service. I suppose we’ll have to see how it pans out.

For some conditions, the pharmacist may request to perform an examination, such as using an otoscope, which is a device that lets us look into the ear canal, if earache is the problem

For some conditions, the pharmacist may request to perform an examination, such as using an otoscope, which is a device that lets us look into the ear canal, if earache is the problem

THE SEVEN CONDITIONS… WHEN TO SEE YOUR PHARMACIST, WHAT THEY CAN OFFER, AND WHEN TO SEEK FURTHER HELP

EARACHE IN CHILDREN AGED ONE TO 17

This is a common problem – especially in young children. Earache or ear pain can affect one or both ears, and while it can be uncomfortable and even distressing for youngsters, it’s usually not serious.

Most earache can be treated at home with simple painkillers (under-16s shouldn’t take aspirin, as it causes unusual side effects in younger children). But if symptoms don’t improve within a couple of days, then seeking advice from a pharmacist – rather than going to your GP as a first port of call – could be a good idea.

Under Pharmacy First, children aged between one and 17 can go to their pharmacist to have their ears examined if they have been suffering from earache.

Chief executive of the Association of Independent Multiple Pharmacies Leyla Hannbeck says: ‘The pharmacist will look into your ear with an otoscope, which is a tool with a light on the end that helps healthcare professionals see inside the ear canal.

‘If it’s something they feel they can treat such as a build-up of earwax, they will deal with it in the pharmacy. If it’s something that requires a doctor, such as a burst eardrum, they’ll refer you.’

When examining your ears, the pharmacist will follow a set of instructions to find out the most suitable treatment, which could include antibiotics if a child has been unwell for more than three days.

ACUTE SINUSITIS IN OVER-12s

Under the new service, people aged 12 and over can visit their pharmacist to work out whether their stuffy nose has turned into sinusitis.

The condition causes the sinuses – which are cavities in the face – to become inflamed, which can lead to painful headaches and a blocked feeling in the nose.

Sinusitis can often clear up on its own, but it is worth paying a visit to the pharmacist if symptoms haven’t got any better after ten days.

Ms Hannbeck explains: ‘The pharmacist will ask questions about how long you’ve had a headache for or whether you’ve got a bad taste in the back of your throat. Based on the answers to those questions, they will be able to decide what treatment is best.’

Pharmacists will be on the look out for signs of a more serious infection that can’t be managed with rest and painkillers, such as a fever or a sharp pain in the jaw or teeth.

In these cases, the pharmacist may offer a strong steroid nasal spray, or antibiotics if these do not work.

SORE THROAT IN ADULTS AND OVER-FIVES

Sore throats normally get better within a week without much intervention – NHS advice is to gargle warm, salty water (half a teaspoon in a glass is enough), stay hydrated and rest.

If symptoms don’t improve in this time, or worsen, then a pharmacist may perform an examination and recommend a range of over-the-counter medicines including paracetamol or iburpofen, lozenges containing local anaesthetic, antiseptic or anti-inflammatory medicine.

Ms Hannbeck says: ‘There are loads of things for a sore throat your pharmacist can give you over the counter.’

In serious cases, where sore throat is accompanied by a fever, extremely swollen or clearly infected (white) tonsils, patients may be offered antibiotics, although generally these aren’t needed and only help if there is a bacterial infection.

If all of these approaches don’t ease symptoms, a referral to a GP will be made. The normal rules apply: if there is difficulty breathing, swallowing (or extensive drooling in children, which is a sign of this), wheezing or making a high-pitched noise when breathing (called stridor), or if symptoms continue to deteriorate, then seek emergency medical help.

But in most cases, sore throats will go away by themselves and can be managed with medicines you can easily buy from your pharmacy.

SHINGLES IN ADULTS AGED 18 AND OVER

Shingles is an infection that causes a painful, blistered rash – usually on the chest or stomach.

The first signs are often a tingling or painful sensation, with a rash usually appearing two to three days afterwards. The blotchy rash appears on one side of the body only – and if it’s on both sides, or all over, it’s unlikely to be shingles.

It can affect people of any age, but it’s more common – and more severe – in over-70s.

Now, if you think you have the infection, you can visit the pharmacist (you can’t spread it to others easily). The pharmacist will perform an examination to confirm a diagnosis, and might offer antiviral medication to help clear up the condition.

These drugs are most effective if started within three days of the rash first appearing.

‘We may also be able to give you a cream to help the itchiness,’ Ms Hannbeck adds. Paracetamol and cool compresses (a bag of frozen peas wrapped in a towel) can also ease the discomfort.

It takes about a month for the shingles rash to heal, and the pain can last longer.

If symptoms go rapidly downhill or do not improve after seven days of treatment, the pharmacist will refer you to a GP.

IMPETIGO IN ADULTS AND CHILDREN OLDER THAN 12 MONTHS

Impetigo is a skin infection that’s highly infectious, but not usually serious. It causes red skin sores that burst and crust over. Anyone can get it, but it’s more common in young children.

The sores – which can look a bit like cornflakes stuck to the skin – are often on the face but can also occur on the limbs. They can be itchy and sometimes painful.

If you or your child might have impetigo, it’s advisable to seek medical advice which can now be from a pharmacist, who will provide the same treatment as a GP.

Ms Hannbeck explains: ‘The pharmacist will perform an examination to assess the severity of the condition and if needed, offer antibiotic cream or tablets.’

Another treatment is hydrogen peroxide cream, which is an antiseptic that works as well as antibiotic creams in less severe cases.

If the pharmacist suspects that the infection has spread deeper into the body, a referral to A&E might be made. It’s important to stay away from school or work to avoid spreading the infection, keep sores and blisters clean and dry and cover them with loose clothing or gauze.

If the impetigo keeps coming back, an appointment with the GP might be recommended.

INFECTED INSECT BITES

Insect bites or stings are not usually serious and will get better in a few days. However, in some cases, bites can become infected or trigger a serious allergic reaction.

It’s normal for insect bites to be painful and for a small, red lump to appear on the skin.

Patients are advised to wash the skin with soap and water, and told not to itch the area, as this can increase the risk of an infection.

Previously, pharmacists have been allowed to offer over-the-counter antihistamine drugs as well as low-strength topical steroid creams both to reduce itchiness.

Under the new system, pharmacists can now prescribe antibiotics if they believe the bite has become infected.

A pharmacist will look to see if the bite has become hot to the touch, painful, tender or full of pus, which would suggest an infection.

‘We would also want to check whether the patient got the bite overseas,’ says Ms Hannbeck.

‘If we suspect the bite could be a tropical disease, like malaria, we would refer the patient to a specialist.

‘However, if that isn’t a risk, and the bite appears infected, we’d now be able to offer the patient an antibiotic to help clear the infection.’

UNCOMPLICATED URINARY TRACT INFECTIONS

Urinary tract infections (UTIs) are bugs which can affect the urinary tract, bladder, urethra or kidneys.

The uncomfortable (but not usually serious) condition primarily affects women, and can cause a burning sensation when peeing, the sensation of needing to pee more often than usual, and sometimes a high temperature.

For older, frail people, a UTI can be a serious health problem because it can trigger delirium: memory loss and sudden changes in behaviour.

Pharmacists can now offer a short course of antibiotics to women between the ages of 16 and 64 who are experiencing UTI symptoms that significantly impact their daily life.

‘We’d first take the patient into a private room and check their symptoms so we know we aren’t dealing with an unrelated condition, like a sexually transmitted disease, which they’d need to see a GP about,’ says Ms Hannbeck.

‘However, UTIs are so common that they are quite straightforward to diagnose, meaning most pharmacists can confidentially make a call there and then whether to prescribe antibiotics or not.’