Harry McQuillan: NHS England guidelines could mean unhealthy outcomes for the most vulnerable

At ­Community Pharmacy Scotland, we respond to various consultations on proposals which affect our members and their patients. These proposals ­cover a wide range of topics and vary in their potential impact. Recently, we have responded to calls for views from organisations like the Scottish Government and the Department of Health on ­regulatory changes, drug reclassifications and the potential effects of Brexit on health and social care.

Harry McQuillan is chief executive of Community Pharmacy Scotland
Harry McQuillan is chief executive of Community Pharmacy Scotland

However, we believe an NHS England ­proposal could have the most impact on the people of Scotland if the same principles are adopted here.

If approved unchanged, this would create guidance for English NHS organisations which would direct healthcare professionals not to ­routinely treat 33 minor conditions on prescription.

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Instead, patients would be told that their condition will clear up on its own or that treatment would have to be self-funded. Ailments such as head lice, hay fever, mild dry skin, ­indigestion and heartburn would all fall under the new guidance.

Hay fever is one of the ailments under consideration for new guidance

When the NHS across the UK is facing unprecedented budgetary pressures, the quoted £136 million potential ­savings may appear attractive. But it is our belief that the unintended ­consequences of implementing this guidance are too great to be ignored, and may even cost the NHS more in the long term.

Whilst the guidance is not intended to be a blanket ban on prescribing, and has some patient group exclusions, it does not sufficiently protect those on low incomes or with poor health literacy. It also fails to address the psychological and economic impact of leaving some of these ­conditions untreated as some will be forced to do.

Something as simple as dandruff can have a significant impact on a person’s confidence and the symptoms of a bad cold might prevent someone from going into work if they could not afford symptomatic relief.

We also believe that, as time passes, people will become familiar with seeking and selecting over-the-counter treatment in the first instance.

Hay fever is one of the ailments under consideration for new guidance

This is no bad thing, but for those for whom price of treatment is a major factor, this may drive them to outlets where there is no associated consultation, assessment or recommendation of product, never mind basic training to pick up patterns of ill health and warning symptoms.

We agree with the view that these conditions are not best dealt with by GPs, but feel that patients should not be left completely without support. This is absolutely crucial in ensuring the best health outcomes for all.

Community pharmacists are ­ideally placed to provide this ­support, and in Scotland this is delivered via the Minor Ailment Scheme (MAS), whereby eligible patients are able to access a consultation in their local community pharmacy and will be given advice, with treatment or referral provided on the NHS if appropriate. Thankfully, the current direction of travel appears to be completely the opposite of NHS England’s approach, with a pilot to test giving access to all Scottish citizens and widening ­conditions which can be treated now reaching a one-year milestone.

The results will inform a potential national rollout which will further contribute to ­narrowing health ­inequalities across the country. ­However, NHS England’s consultation is generating a lot of interest and the perceived significant short-term ­savings may lead some health and social care organisations to investigate the same approach.

We have highlighted our concerns and will continue in all our work to ­promote equity of care across the country through our ­network.

At a time where the difference in healthy life expectancy between the most affluent and most deprived ­areas can reach 18 years, there is no place for actions which make access to care more challenging.

Harry McQuillan is chief ­executive of Community ­Pharmacy Scotland.