Pharmacy assisted patient self care of minor ailments: A chronological review of UK health policy documents and key events 1997–2010
Highlights
► We aim to review UK health policies focused on pharmacy assisted self care of minor ailments. ► Pharmacy management is deemed to enhance patient access to services. ► Benefits to pharmacists and general practitioners were also highlighted. ► Policies have led to new pharmacy services such as free minor ailment schemes. ► Sustained emphasis on pharmacy is key to reduce existing gaps between policy and practice.
Introduction
The NHS is the key provider of health services in the United Kingdom (UK). It is funded by taxation and is mostly free to patients at the point of care [1]. Care across the NHS is classified as primary, secondary and tertiary. Primary care services are generally the first point of patient contact with healthcare professionals comprising mainly family doctors (general practitioners, GPs), community pharmacists, dentists, ophthalmologists and health visitors [2]. Secondary care includes hospitals with tertiary care being specialist hospital centres and departments [2]. Delivery of care at the local level is managed through NHS divisions based on geographical areas, such as primary care trusts (PCTs) in England and Health Boards in Scotland.
Self care, as defined by the World Health Organisation (WHO), is ‘what people do for themselves to establish and maintain health, prevent and deal with illness’ [3]. In historical terms, self care signifies the importance of patient ‘autonomy’ and ‘independence’, which relates to people initiating actions by themselves as well as making their own decisions about care [4]. Lately, however, the definition has been refined to encompass shared models of care [5]. For example, the importance of balance between patient autonomy in decision making as well as dependence on healthcare professionals where necessary have been put forward [4]. The principles of self care, which can be applied to prevention and management of illness, are known to have arisen from a number of theoretical models such as the theory of self regulation. Self regulation models emphasise the importance of self-efficacy [6], which relates to an individual's belief in their ability to learn and perform specific behaviours; and self-management [7] which relates to adoption into practice of such behaviours. Emphasis on greater patient participation in managing their own health has been stressed in recent health service policies across the UK and beyond. Terminologies like ‘expert patient’ [5] and patient ‘empowerment’ [8] underline this emphasis.
Minor ailments are self limiting conditions requiring little or no medical intervention [9], [10]. Colds, coughs and indigestion are some of ailments defined as ‘minor’ both in the published literature [11] and community pharmacists’ practice guidelines [12]. The concept of self care applies to the management of minor ailments as it does to the prevention and management of long term and complex ailments. The level of professional support however, is known to increase with increasing complexity of illness. Much self care can involve no professional intervention.
Self care of minor ailments often require access to non-prescription medicines. The term non-prescription as per the UK regulatory classification encompasses two different regulatory classes of medicines, namely P and GSL medicines (Fig. 1). Despite being considered relatively safe, many non-prescription medicines are also known to contain potent pharmacological agents with potential for adverse drug reactions and drug interactions. Hence their use demands an equal degree of care to that with prescription medicines [15]. In order to ensure that widespread consumption of non-prescription medicines incurs minimal harm, their use along with professional advice has been deemed a rational approach to self care [16].
The need for modernisation of pharmacy and extension of pharmacists’ roles in patient care in general was highlighted by the report of the Nuffield inquiry conducted in 1986 [17]. This report summed up the position of community pharmacy as being very weak in terms of structure and funding. The report encouraged community pharmacists to move away from routine dispensing of prescriptions and to be involved in greater cognitive roles such as advice giving around self care [17]. Apart from the pharmacists, recommendations from the Nuffield enquiry were also endorsed by the British Medical Association (BMA) and Royal College of General Practitioners (RCGP) [17].
In September 1995, the pharmacists professional body, the Royal Pharmaceutical Society of Great Britain, RPSGB (now know as the Royal Pharmaceutical Society, RPS) launched a member consultation, Pharmacy in a New Age [18]. The report from this consultation highlighted that its members were keen to utilise their expertise to a greater extent, citing enhanced management of minor ailments as one of four key areas where greatest contribution to patient care could further be made. This consultation was hailed by the society as one of the ‘most successful’ RPSGB initiative with contributions received from more than 5000 pharmacists [19].
Since then a number of health policy documents have been published by the UK governments before and after the devolution of power to Scotland, Wales and Northern Ireland. However, there is a lack of review of these health policies in the context of pharmacy assisted self-care; such a review is important from both a historical perspective and for formulation of future research questions and policy needs.
Section snippets
Materials and methods
The health policy documents reviewed in this section were identified from the free public web archives located in the websites of the UK Health Departments policies [20], [21], [22], [23]. Key excerpts from the identified documents which specifically highlighted pharmacy assisted self care of minor ailments were extracted. Excerpts were summarised and ordered chronologically by one author (VP) and document interpretation checked for reliability by another author (DS). Any disagreements were
The review of policy documents and key events
The identified documents and key events are listed in chronological order of presentation.
Current facts and figures around pharmacy assisted self care of minor ailments
In line with the above policies (Fig. 2), to date, there have been more than 90 reclassifications from POM to P status, since the reclassification of loperamide and ibuprofen in 1983 [62]. Most reclassifications relate to acute minor illnesses. However, lately, medicines for long term use such as simvastatin for the prevention of coronary events and sumatriptan for the treatment of migraine headaches have also been reclassified. Treatments and advice for ailments such as irritable bowel
Conclusions
This chronological review provides a historical perspective to the evolution of policies relevant to enhanced self care of minor ailments from community pharmacies in the UK. The focus appears to be substantial which is made evident by the publication of over 30 policy documents from UK health department(s) before and after devolution. Pharmacy management would reduce patient waiting times in the GPs and increase patient access to services. Professional development opportunities for pharmacists
Conflicts of interest
None.
Acknowledgement
The research student (VP) is partly supported by the grant from Community Pharmacy Scotland (CPS).
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