PROPOSED CHANGES TO MEDICINES CLASSIFICATION

By Trevor Gore?????????? 26th June 2024

‘Betrayal of the profession’ screamed the headline of one pharmacy publication . So, what has incensed the world of pharmacy?

Well, the Royal Pharmaceutical society (RPS) is considering whether to drop its longstanding opposition to the self-selection of Pharmacy-only (P) medicines. This is a debate that has been simmering for over a decade when in 2012 the newly formed General Pharmaceutical Council (GPhC) decided that the prohibition on selling P medicines from open display should no longer apply within the standards for pharmacy premises.? The RPS has proposed? 3 options to be considered.

Option 1 – Maintain the current position that P medicines must not be accessible to the public via open display and advocate for this position to be reconsidered by the GPhC and pharmacy owners

Option 2 –?Evolve existing policy so that P medicines should only be accessible to the public by self-selection if certain conditions are met

Option 3 – RPS policy should be changed to support the availability of P medicines?by self-selection with guidance and advice provided to pharmacy owners to enable this.

Now whilst this has exorcised many, it should not come as a surprise. Boots and others have for a number of years been ‘trialling’ open selection of P meds. As with all proposed changes there are arguments for and against. Yes, it could possibly make access to medicines easier for consumers and also allow them to become? more informed by reading the information on the box to see if it is suitable. However, P meds are there for a reason. To protect the public, and many of the public are really not well informed on what constitutes a P med. It might be the ingredient or the size of the pack. (Packs of 16 paracetamol are GSL whereas 32s are P), or a recent POM to P switch such as the contraceptive Lovima. So, all P meds are not the same.

The underlying assumption of the change is that the pharmacist will still be able to interrupt the sale of a P med to offer advice as and when is necessary (in the Boots trial the sale must be rung through at the pharmacy counter) so there will still be safeguards (hopefully).? If this is the case, what is the point?

There probably is a commercial argument for allowing open selection. Indeed, the RPS says in its submission “ it will provide a way for pharmacies to increase their over-the-counter sales, to maximise business”. But it will probably be a short-term gain, and there will inevitably be a call for successful P meds to be made even more accessible by switching to GSL. Some switches work well and others less so, and its not an exact science to predict what will happen. But I can predict what happens to prices/margins when items become ‘normal items of commerce’

Sales prevention officers (a term I coined many years ago to describe pharmacists) seem to want to have their cake and eat it. Asking for more POM to P switches, (but often failing to support them leading to the feeling among manufacturers they are too risky) but decrying P to GSL switches as pharmacists are the guardians of the public with regards to medicines. Occasionally there is a POM to GSL switch, bypassing pharmacy completely (think the antihistamine Allevia), which seems to have been a success.

Another consideration is the ‘impression’ a P med gives to the patient. It is special, it’s in the back, in a draw, it’s at the pharmacist’s discretion. We are all being urged to use pharmacy more, and the Pharmacy 1st scheme exhorts us to bypass the GP for 7 conditions. But if I went to have my sore throat looked at by a pharmacist and they thought an antibiotic wasn’t needed, but just took something off the shelf. Would I feel slightly ‘conned’ than if the pharmacist had given me one of their special ‘extra strong’ remedies?

Of course, this all may be academic. We don’t know what, when, or even if anything will change, but it certainly has stirred up the profession.

The views contained above are mine and do not reflect those of the H & B A.

Trevor Gore - Is Founder and Director of Maestro Consulting, Self Care Forum Trustee, an Associate Director at the Institute for Collaborative Working (ICW). ? As a Senior Consultant, Trevor continues to work with The Consumer Healthcare Training Academy and XPotential and is advisor to The H&BA.

?