The pharmacist will see you now

Twice a week, Stephen Inns sees patients with high blood pressure at his office in a medical practice in southern England. Usually he conducts a few quick tests, asks them how they’re doing and adjusts their medicines if necessary.

Inns isn’t a doctor; he’s a pharmacist.

He is one of fewer than 100 pharmacists across Britain recently given permission to prescribe drugs for patients and provide basic care, without relying on a doctor. The move is part of Britain’s attempt to expand its healthcare system by allowing medical professionals such as nurses and pharmacists to treat patients.

Though many countries are slowly loosening the rules on non-doctors giving out medicines, none has given pharmacists as much power as Britain has in its effort to increase services and cut costs in a financially overburdened health system.

In 2006, Britain expanded the powers of pharmacists to treat patients once they took a training course. Though the number of prescribing healthcare professionals other than doctors remains small, their ranks are growing -- and the government hopes they will someday become the norm.

Last week, Britain issued a new government strategy to strengthen the role of pharmacists even further. According to the proposal, pharmacists will be the first port of call for certain ailments -- colds, minor stomach and skin problems. That will save doctors 57 million consultations a year, officials said. In the near future, the government hopes pharmacists will routinely screen people for vascular and sexually transmitted diseases, as well as give vaccinations.

“If done properly, this is a good idea,” said Brian Edwards, emeritus professor of healthcare development at the University of Sheffield. And if a doctor’s attention is needed, pharmacists can make the referral, he added.

To qualify as an “independently prescribing pharmacist,” Inns took a nine-week course. He also needed about 30 hours of experience treating patients under a doctor’s supervision.

Inns can prescribe any medicine (except controlled drugs like morphine and codeine) for any condition he is qualified to treat -- he specializes in cardiovascular medicine.

Since November, Inns has worked alongside eight doctors in a medical practice in Winchester, seeing patients two afternoons a week. He isn’t required to have doctors sign off on his treatments, unless there’s a problem. These days, he guesses he has to ask for a doctor’s advice only once a week, if at all.

“It was quite weird at first to treat patients,” Inns said. He is responsible for the practice’s nearly 1,800 patients with high blood pressure. “Patients had never come across a pharmacist that could prescribe medicines before.”

Some doctors say pharmacists are particularly well-suited to treat patients with chronic problems, since treatment is relatively straightforward and involves lifestyle advice and drug-juggling.

Setting limits is also crucial.

“Stephen has got a very strict delineation of what he’s allowed to do and what he can’t do,” said Dr. Simon Hunter, a general physician who trained Inns and works with him in the Winchester clinic. “His skill is manipulating medicines. He doesn’t make diagnoses.”

Letting pharmacists and nurses prescribe medicines, according to a policy statement from the Department of Health, is part of the government’s plan to modernize the health system, by eliminating barriers between professions and allowing patients easier access to drugs.

But some doctors worry that may give patients the wrong message. “The problem is the public sometimes sees the practice of medicine as the giving and taking of pills only,” said Dr. Jim King, president of the American Academy of Family Physicians. “Availability of medicines may be a bad thing if you’re not careful.”

King worries that the British system, which offers free healthcare to all, might make it too easy for pharmacists to make mistakes.

“The whole idea of determining what medication a patient needs is the ability to diagnose a medical condition,” King said. “That’s where all the years of medical and residency training comes in.”

But as Britain’s cash-strapped system tries to treat the crush of patients with chronic problems such as heart disease and diabetes, making more use of healthcare workers other than doctors may be essential.

“This shift in the pattern of work is perfectly proper,” Edwards said. “A doctor will provide the initial diagnosis, but then a nurse or pharmacist can monitor their care.”

Critics argue that this is just discounted medical care. Pharmacists and nurses make less money than doctors, a big potential savings for the British government.

Independently prescribing pharmacists earn $89,894 to $119,830, while government doctors typically make $179,776 to $239,701.

In the United States, pharmacists can write prescriptions if they have a “collaborative” agreement with a physician. Under such arrangements, pharmacists with extra training can monitor patients on medication, or make dose changes without the doctor’s approval, but only according to a specific work plan supervised by doctors.

In Britain, it is too early to say what impact the increased responsibilities of pharmacists, nurses and others have had on the health system.

“This is new territory for all of us,” Hunter said. “There is always a risk that a pharmacist could miss something in a patient. But that risk is there for anyone, even a doctor.”