Can you really get all medicines for children free in a pharmacy?

The following message has been widely shared on Facebook over the last few days.

It could have been an accidentally wonderful way of spreading the word about minor ailments services- something that pharmacies, CCGs, and PCTs have been struggling to do for years. Sadly, however, it hasn’t quite had that effect- it’s very inaccurate and is likely to lead to a lot of disappointment for patients and pharmacists alike. As with all things, if something sounds too good to be true, then in all likelihood it is.  Hopefully, this post might clear up some of the confusion caused by the original status.

The purpose of a minor ailments service (MAS)

Far from being a free way to stock your medicines cabinet, MAS’s are in place to reduce unnecessary GP appointments. They’re a convenient way to access medicines and advice for those who would otherwise see their GP in order to get free items on prescription as they can’t afford to buy medicines. As such, it’s not about the patient asking for specific medicines. Services are designed so that the pharmacist can sit down with the patient and give them advice about a minor condition. Yes, they can provide some medicines as part of that consultation, but only where the pharmacist deems them necessary in response to symptoms.  Many of the conditions covered are self-limiting, and will go away of their own accord without you having to use any medicine at all.

Local Schemes for Local People

Unless you’re in Scotland or Wales, MASs are commissioned according to local needs, by CCGs. Not all areas with have them, and of those that do, there may be wide differences in how they are run. For example, to access some schemes, you may have to be referred by your GP. Others, you might be able to just pop into your local pharmacy and ask for the service. Some areas may stipulate that only people from that town or county can use the service, whilst others allow it for out-of-townies. There are currently 70 individually commissioned MAS across England, some of which cover multiple areas. They might all have different names and different scopes. 

 

The logo of the Think Pharmacy First scheme,  available in some areas of North East England.

The logo of the Think Pharmacy First scheme,  available in some areas of North East England.

"All" medicines?

Nope. It’s not even available for all minor ailments. There will be a selected list of things that the pharmacist can deal with under the scheme, and again these will change depending on local needs. It might be things like headlice, hay fever, sprains and strains, conjunctivitis etc. The average number of indications covered by each service is 16. 

Even if an ailment is covered by the service, not all medicines will be available under the scheme. Only evidence-based, cost-effective medicines will be available. You won’t be able to get branded medicines (like the Calpol and Piriton bandied about in the original post) because this doesn’t represent a rational use of the service. I was lucky enough to be involved in the setting up of Think Pharmacy First, the minor ailments scheme that originally covered Newcastle and which now also covers quite a few other areas in the North East, and I remember the discussions we had about what we were going to include on the formulary. We checked robust sources for primary care management and made sure to remove anything that we considered irrational or which had no evidence to back it up. The post mentions plasters, but I very much doubt that these will be widely available- it’s a minor ailments scheme, not a first aid service.

Is it just Boots, or is it all pharmacies?

Even within an area with an MAS, not all pharmacies will offer the scheme. The original post seems to suggest that this is something only Boots offer, but in actual fact any pharmacy can participate. 34 MASs require the pharmacist themselves to provide the service. in 29, the pharmacist or an appropriately trained member of staff can undertake it. Some areas will require pharmacies, or individual pharmacists, to be accredited before they can start offering the scheme. So, if you do feel that you could benefit from using an MAS, its best to phone your local pharmacy first to check if they do deliver it.

Anyone can use the scheme, right?

MASs are there primarily to help those with a low income, who struggle to pay for medicines. Depending on the local scheme, others may be entitled to use it too, for example those over 60 or all children, but this is likely to vary. To use my local as an example again, the Think Pharmacy First scheme is available only to adults who are entitled to free prescriptions on the grounds of low income and their children along with all people aged 60 or over.

They very much ARE allowed to advertise it.

I’ve no idea where this nonsense about not advertising comes from. We had four foot, bright yellow and green window stickers made up for the launch of the Think Pharmacy First scheme, and I remember spending about an hour trying to remove air bubbles from it once I put it up. I did local press stints to advertise the scheme widely, with photoshoots and everything. The scheme was advertised in local council newsletters, in schools, and goodness only knows where else. For years, even after I left community pharmacy, I would get annual phone calls from people saying “Hey, I saw you in the paper the other day!” CCG websites and pharmacy websites have plenty of information about the schemes. They aren’t a dirty secret that we pharmacists keep to ourselves because we’re mean. If anything, they help us pharmacists demonstrate our worth, and we have long been campaigning for a good quality, robust national scheme to reduce all these inequalities.

There’s one obvious reason why these schemes probably aren’t that well known, and that’s budget. It’s nothing to do with not being able to advertise, it just comes down to cold hard cash. Some of these schemes are woefully underfunded, and as such they sadly get left to limp along.

It might take a while

We pharmacists tend to be very busy, and we usually have about 30 different things to do that all need doing immediately. An MAS consultation is a lot more in depth than a usual Over the Counter sale- it usually takes 10-15 minutes, in the consultation room, discussing the problem and any possible treatment. The paperwork then takes the pharmacist a good deal of extra time. Therefore, if you do use an MAS service, please do so patiently. If you need a medicine quicker and you aren’t willing to wait for a consultation, or you don’t want to answer any questions, it is probably best to buy a medicine over the counter instead.

Misuse

We’re all constantly bombarded with Daily Mail headlines about prescription fraud and the likes. Now, I don’t buy into any of that overblown rhetoric, but I, and probably any other community pharmacist you will speak to, can reel off many an occasion where people have taken the mickey out of a minor ailments service. Some people seem to go completely wild when they realise they can get something free. I’ve had numerous people ask me to hand them the formulary list so that they can mark all the products they’ve decided they want. Others used to demand to “self-prescribe” themselves whatever they fancied that day, which used to drive me mad and which used to lead to a stern talking to from myself. It’s just not in the spirit of the thing- its about accessing the pharmacist’s expertise and skill in treating minor ailments, rather than a shopping list. I fear the wording of the FB post in question may be leading people to think otherwise.

Overall

It’s a really handy, worthwhile scheme, and more people should definitely know about it and access it when need be. But they also need to know how variable it is and its limitations.

If you have any other questions about your local scheme, try having a lookie at your local CCG’s website. If in doubt, ring your local pharmacist and they should be able to tell you what’s available. 

 

 

reference: PSNC briefing 006/15: Analysis of Minor Ailments Services in England, Feb 2015