There is a lot of discussion on the use of non evidence based products in community pharmacy. I agree that evidence based therapies and medication are our first line treatment recommendations.
Certainly pharmacy stock holding contain a lot of non evidence based products compared to those held for sale with evidence. This has led me to question what are the changes required for pharmacy to survive in the community.
Over the years I have reduced my stock holding of alternative products, homoeopathy has completely been thrown out of the pharmacy. The herbal products and the vitamin supplements held are those that I have seen give a positive health outcome to the clients who have visited me over 15 years. This total elimination of non evidence products has not happened for two reasons. Firstly, there are commercial pressures. Secondly, there are a hand full of clients who seek alternative therapies – these are the ones I want to see visit pharmacy so that an informed choice is made; and most importantly they are not misguided into stopping using their prescriptive medication.
So? What are the changes that need to be made?
- Renumeration
- Policies
- NHS contracts
- Increase of EBM products available for sale
- Guidance on the use of CAM alongside EBM
- Clinical trials for CAM
There are two great forces that would change how we work in community. The biggest is the way we are remunerated. OTC sales is how we survive currently. We have been hit massively with reduction of payments for our dispensing role. The services we are meant to embrace has had little uptake, and again the greatest income earner, currently, being is NHS Health Checks; which in my opinion lowers the profession as the guidance on referrals are ridiculous. Not forgetting that with the check we don’t even have the tools to screen for Type 2 Diabetes with an Hb1AC monitor. The second, which works alongside, is the number of products available. We need to see a vast shift of products from POM to P to enable us in community to commercially gain from EBM, enabling us to survive without holding non evidence products.
So, until changes are made, many community pharmacist (to be honest all) will continue to sell non evidence based products.
My recent twitter battle has made me readdress how I promote my profession, alongside alternative products. I am happy to say that I misjudged how promoting alternative therapies commercially could prevent the progression of pharmacy in the future. I will carry on using the products I have seen benefit in, within my clinics. There are many consultants that use unusual dosages of pharmaceutical products daily, without the evidence to back up such uses. Again this is where professional judgement is made with the knowledge they have gained within their field, expertise and experience of positive health outcomes from the use within their daily practice.
However, the professional bodies and leaders need to implement the changes to pave the future of pharmacy in the right direction, without conflicting or double standards towards the medics.
Below is a prescription we deal with each month from a local GP. There isn’t any justification for prescribing this, but commercial pressures have forced community pharmacists to dispense without questioning. It’s not just about money … it’s about losing a regular client by questioning a product their GP sees as a benefit to their health.
It’s not just pharmacy that need addressing, its the whole system that needs to change.
