Ask your chemist

THE days when your friendly local chemist would chat with you about the weather while making up the prescription your GP gave you are long gone. These days pharmacists are being increasingly seen as the professionals they are - highly qualified people with years of training and experience who can offer sound advice on a range of health problems.

More and more, they - rather than your overworked GP - are the first port of call for those with minor ailments.

To ease the pressure on GPs the Government is keen to expand the role of pharmacists even further: allowing them to issue repeat prescriptions without referring to a doctor, and even to prescribe certain medicines themselves.

All of which makes a damning new investigation by the consumer magazine Which? even more worrying.

Undercover researchers posing as patients visited 84 pharmacies in England, Scotland and Wales, asking for basic advice and medication. And at 35 of the pharmacists they visited, Which? claims, the advice they got was unsatisfactory or just wrong.

The 'patients' acted out four different scenarios - asking for something to treat a bout of diarrhoea; asking for the morning-after emergency contraceptive pill; posing as women on the pill asking for St John's Wort to help them sleep (St John's Wort can make the pill less effective); and asking for low-dose aspirin to reduce the risk of heart attack or stroke

The advice they were given was then assessed by an expert panel of professional pharmacists.

The Which? report claims that if the researchers had been real patients they could, as a result of the 'poor advice' they were given, have been taking the wrong medicine, suffering from serious untreated infections - or even facing the possibility of an unplanned pregnancy.

The worst advice was given to those who claimed to be suffering from 'traveller's diarrhoea'. The scenario was that they had returned from a trip to Malaysia a few weeks earlier, and were suffering persistent diarrhoea. This is a condition that may need treatment with antibiotics, claims Which?. Failure to visit a doctor could lead to delays in treating a serious infection.

But of the 21 pharmacists visited, only seven referred the patient immediately to a GP. Fourteen sold 'patients' inappropriate treatments and in four cases staff failed even to ask about symptoms.

"Bad advice is so widespread it's impossible for consumers to have confidence in what pharmacists or their assistants tell them," says Which? editor Malcolm Coles.

"While we welcome the Government's plan to extend pharmacists' roles, if it wants us to rely more heavily on them it is vital they are properly equipped to provide correct information about medicines and offer general health advice."

Strong stuff. In the wake of the report, the Royal Pharmaceutical Society of Great Britain has already promised to investigate. "It is extremely disappointing that the service provided in some of the pharmacies appears not to have matched up to expectations," a spokesman said.

Officially the Government has welcomed the society's response. Privately, however, officials at the Department of Health grumble that the Which? report was based on a "tiny" sample. Just 84 of the country's 20,000-plus pharmacists had been visited, a spokesman pointed out - far too few to justify the kind of sweeping statements made in the report.

Officials also point out that without knowing exactly what information the bogus 'patients' did or did not give to the pharmacists they visited, it is hard to judge the quality of advice given.

Nevertheless, the Which? report has acted as a timely wake-up call.

So how sure can you be that when you visit your local pharmacy you are going to be given the right advice?

And how confident can you be that giving pharmacists a bigger role to ease the burden on GPs is in the best interests of patients, and not just of an overworked health service?

Elliot Goran of the Badger Hill pharmacy in York says pharmacists, like other professionals, do sometimes make mistakes - not with the actual dispensing of medicines, which they are very good at, he insists, but very occasionally with advice.

Nevertheless, he stresses, they get it right 99 per cent of the time, and provide a valuable community service. "I genuinely do believe that we're doing a very good job," he says.

Part of the problem, says Alan Maynard, professor of health sciences at the University of York and chairman of York Health Services Trust, is that often patients don't get to actually see the pharmacist.

"The tradition is to lock the pharmacist up in the back of the shop counting pills, so that typically the patient will be dealing with a shop assistant, whose skills and understanding of the pharmacological properties of what's being sold are less than complete."

He says this is an issue because almost any drug can be harmful if used inappropriately.

Mr Goran insists that even when a patient is not dealt with directly by a pharmacist, there are strict protocols and regulations in place to minimise mistakes.

A counter assistant who is asked a question to which he or she is not sure of the answer, for example, should refer it up, either to a dispenser or ultimately the pharmacist.

He remains very much in favour of pharmacists being given a wider role. "We are under-used," he says. "I have a degree which, in my case, I finished more than 20 years ago. The knowledge base is there and so much of it is just not being used. It is a total waste of talent."

Despite his reservations, Prof Maynard agrees. Done properly, he says, expanding the pharmacist's role will increase patients' access to health care and reduce the pressure on GPs. But it must be done properly, with an emphasis on better training so assistants can ask the right questions.

York GP Dr Sarah Bottom also favours pharmacists' skills and experience being put to better use. She says York has plenty of "cracking" pharmacists who are knowledgeable and play a vital role.

"We GPs have people coming to us for utterly trivial stuff so that they can get prescriptions rather than having to pay for it," she says. "If pharmacists could give a free prescription for some minor ailments we could give more time to patients who really need us."

But she also fears pharmacists are being put in an "invidious' position by the Government. If they are to take on a more significant role, she says, they must be given proper training and extra funding to allow them to do so.

"They have never been asked to diagnose. They are essentially self-employed small businesses, and they are going to be asked to spend quite a lot of money (for example, on setting up consulting areas to ensure greater privacy). I'm not sure they have been given the money to do it."

The Government insists that they have - £3.5 million every year for training pharmacists, and an extra £1 million this year to train pharmacists' technicians and assistants.

That's not very much, however, when you consider that there are six million visits to a pharmacist in this country every day. Everyone agrees that patients should ask more questions and give more information when they visit their local chemist. That way, they can do their bit to ensure the medication they receive is right for them.

Making the most of your pharmacy

You may not be asked all the questions you should be asked when you pop in to buy medicines, Which? says - so you are more likely to get good advice if you volunteer as much information as possible. Here are a few tips:

Tell the pharmacist:

What your symptoms are

How long you've had them, whether you've had them before - and what you think caused them

About any other medication you are taking (including herbal remedies)

If you're pregnant or might be pregnant

About any other conditions, illnesses or allergies you might have

Ask the pharmacist:

What the medicine does, how it works, and why you need to take it

How long you will need to take it for, and how quickly it should work

How often and when to take it

Whether you should avoid any other medicines, food, alcohol or activities such as driving

About any possible side effects

Finally, if you're at all unsure, says the Department of Health, ask to see the pharmacist rather than merely an assistant. And remember: ALWAYS read the information on the packet before taking any medicine.

Updated: 10:10 Wednesday, February 04, 2004