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The Doctors’ Association UK (DAUK) has warned the expansion of Pharmacy First this autumn will compel pharmacists who do not have diagnostic skills to provide care that is “beyond their training” and undermine the role of GPs in diagnosing patients safely.

In a statement on Thursday, the DAUK’s GP co-lead Dr Steve Taylor said he was concerned about the addition of acne, migraine, scabies, ear infection and rhinitis to Pharmacy First because it represented an assumption on the Government’s part that minor illnesses “were necessarily straightforward”.

Dr Taylor said GPs were better placed than pharmacists to deal with the “hidden complexities of patients presenting even with ‘simple’ or ‘minor’ illnesses” because GPs “have years of diagnostic training and experience”.

Insisting his criticism was aimed at the Government and NHS England and not pharmacists, Dr Taylor said: “It is not necessarily 'simple' until after a consultation. Safe patient care is vital, as is timely treatment. Although minor illnesses can be treated and diagnosed in pharmacies, we remain concerned at moving more care to pharmacists.

“Pharmacists are experts in medicines and play a hugely important role in the NHS, but don’t necessarily have the diagnostic skills or expertise.”

The DAUK describes itself as a “non-profit, campaigning and lobbying organisation comprised of UK doctors and medical students”.

Dr Taylor urged Labour to instead focus “on properly funding general practice and community pharmacy to ensure patients can access the right advice and treatment when they need it”.

“Pharmacists should not be placed in positions where they are required or asked to provide care beyond their training, expertise and experience,” he added.

“Most pharmacists recognise this, the need for GPs and the collaborative approach to patient care. The Government must fund pharmacies and GP practices to genuinely improve access while not compromising safe care.”

CCA: Concerns about pharmacists assessing and treating ‘have not been borne out’

Company Chemists’ Association chief executive Malcolm Harrison rejected Dr Taylor’s claim that pharmacists do not “necessarily have diagnostic skills or expertise”.

“Community pharmacists are highly trained healthcare professionals who already see undifferentiated patients presenting with these conditions every day,” Harrison told Independent Community Pharmacist (ICP).

“Pharmacy First has already demonstrated that pharmacists can assess patients appropriately, provide treatment where suitable, and recognise when a patient needs to be referred to another part of the NHS. Similarly, fears raised that the service could drive inappropriate antibiotic use and contribute to antimicrobial resistance have proven unfounded.”

Harrison said he was “confident community pharmacists will continue to deliver safe, effective and accessible care for patients with these new conditions within the pharmacy first service”.

Insisting the expansion of Pharmacy First will make better use of pharmacists’ clinical skills and release capacity across primary care, Harrison added: “The pathways in the expansion of Pharmacy First have been determined by a clinical reference group. They will be underpinned by the necessary clinical governance and safety guidelines.”

Dr Taylor’s concerns about pharmacists diagnosing follows his participation in a roundtable discussion of health leaders in July, organised by the National Pharmacy Association (NPA), during which attendees agreed a draft national framework of standards for independent prescribing (IP) should be drawn up.

The NPA said that discussion “distinguished clearly between trusting a pharmacist’s knowledge of medicines and trusting their ability to assess and diagnose a patient in the first place” which attendees agreed was “worth exploring further”.

The discussion drew representatives from pharmacy as well as the Royal College of General Practitioners and the Patients’ Association. 

Concerning pharmacists don’t need to demonstrate training or competences

When asked to clarify if he supports a national IP framework given his concerns about pharmacists’ diagnostic skills around Pharmacy First, Dr Taylor told ICP: "Pharmacists prescribing is a good thing for patients with pharmacists able to switch medications, review and change when appropriate with and without the need to discuss with other clinicians.

"The question to be asked is should pharmacists have more clarity about what they should be happy prescribing and what they shouldn’t, like for GPs who have a system of green, amber and red (consultant only), when is it appropriate."

Insisiting it was concerning that pharmacists "don’t need to demonstrate training or competences", Dr Taylor added: "As I stated at the NPA roundtable event, pharmacists are experts in medicines, working with GPs at medicine management and in collaboration. They aren’t taught or trained in the same way or as extensively in diagnosis as GPs.

"This means the rollout of more conditions raises some concerns, since major conditions will sometimes present with minor symptoms. There are concerns expressed by some pharmacists and GPs about the expansion of conditions that require diagnosis.

"Migraines are complicated, skin conditions aren’t always easy to differentiate, shingles might be due to underlying conditions. It is important pharmacists are not placed in vulnerable positions and that patients still get timely access to GPs.

"Pharmacists shouldn’t be seen as a replacement for GPs but as additional options, and for the most part this will continue to be the case, but caution is needed."

NPA: It's not about pharmacists replacing other NHS professionals

The NPA chief executive Henry Gregg said Pharmacy First was "not about pharmacists replacing other NHS professionals, but providing more support to take away pressure in other parts of our health system".

"We've been clear that we believe the future of primary care is seeing pharmacists in England working in collaboration with GPs and other clinicians to provide more clinical services to patients for a number conditions with the correct governance and safeguards," he told ICP.

"They have already been doing this in Scotland safely for many years already. In Scotland, pharmacists can treat over 30 conditions, with a third of the Scottish population accessing Pharmacy First last year.

"We believe GP's and pharmacists share many of the same challenges and opportunities and need to work more closely together if we are to achieve the government's ambitions in the 10 year plan and deliver for our patients."

Gregg said the NPA agreed with GP colleagues that it was "important pharmacists only work within their competency and refer complex and more serious cases to other clinicians, where appropriate".

"Pharmacists already do this," he added. "We take patient safety extremely seriously. This is why we have been embarking on an extensive programme of research, working with others in the health sector including GP organisations, to help support pharmacists embarking on prescribing to ensure they do so safely and effectively."