GPs to judge which patients deserve an NHS prescriptionBMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k404 (Published 01 February 2018) Cite this as: BMJ 2018;360:k404
All rapid responses
I would like to thank Dr. White for showing interest in my letter. To address her first point, I wonder would GPs prefer judging every patient's eligibility to have an NHS prescription? Or would GPs rather have the national formulary to determine patients' eligibility, and help only the eligible patients to apply for special authority access? To me, the latter option creates less workload and more job satisfaction for GPs. I believe any caring healthcare professionals would find satisfaction when their deprived patients receive their much-needed benefits, as it follows the bioethics principle of beneficence.
Dr. White's second point seems to agree that GPs are not legally covered if a patient suffers ongoing illness due to the lack of a NHS prescription. That has illustrated my concerns about the current situation in the NHS.
Finally, Dr. White questioned where the salaried primary care pharmacists are coming from. In my letter, I have already referenced an article from the BJGP. There are other articles available that describe where these pharmacists come from, and the advantages of having them in GPs' practices in addition to community pharmacies. As an ex-pharmacist myself, I feel more comfortable to educate patients when I work closely with physicians and understand the diagnosis and management plans, compared to when I receive only prescriptions of drugs in a community pharmacy.
Competing interests: I have received salaries from working as a pharmacist and medical doctor, but I am not paid to write this letter.
This is an important and controversial issue, but it seems that the suggestions in this letter have not been fully considered. Dr Yeung suggests a national formulary, but says that "the GP could help the patient apply" for access to non-formulary medicines, without seeming to realise the conflict between this and the acknowledgement that GPs are overstretched. I can only start to imagine the workload, with even more challenging consultations and patient complaints, that this would engender.
Dr Yeung asks if GPs would be legally covered if ongoing illness was suffered due to the lack of a NHS prescription - if a GP has advised a medicine would help, and it can be proved that its lack was related to the prolonged illness, I cannot see how the answer can be anything other than "no" under current NHS GP contractual arrangements.
Finally, I am not sure where the "salaried primary care pharmacists" mentioned are coming from, or who is going to pay their salaries. Community pharmacists, whether running their own businesses or employed by larger pharmacy providers, already contribute to the education of patients about their medicines, whether prescribed and dispensed or bought over the counter.
Competing interests: No competing interests