Is it time to extend the Minor Ailments Service in Scotland?

Pharmacy has grown from dispensing medicines into something bigger in recent decades (image from francesco_rollandin via openclipart)

Harry McQuillan, Chief Executive of Community Pharmacy Scotland, was on top form yet again in The Scotsman this week as demonstrated through this article here. Out of all the pharmacists or representatives of the pharmacy profession across these islands, I honestly think that Harry has succinctly and effectively put the potent and positive case for pharmacy playing a greater role within the provision of healthcare within the national media.

The one major issue that popped out at me was the Minor Ailment Service. Since 2006, it has been a service provided by community pharmacies across Scotland that has come to the benefit of patients looking for advice or medicine to treat a minor ailment such as a common cold or athlete’s foot. In recent times, the pharmacy profession south of the border have begun to discuss about the possibility of rolling out a similar service for patients and Scotland was certainly not forgotten or kept out of mind. That suggests to me that we’ve done something right north of the border when it comes to making use of the autonomy gifted to us community pharmacists in Scotland when it comes to treating minor conditions.

But it’s been nearly ten years since this service was launched and it can be competently argued that now is the time to take things to the next stage. In 2011, prescription charges were axed by the Scottish Government and now general taxation covers the bill for medicines via the money that Scotland is allocated through the Barnett Formula. But whilst patients in Scotland do not have to pay for their prescriptions any longer, why is it that only that some people in the country qualify for the Minor Ailments Scheme and not all?

At a cost of £4.75 million in 2013/14 (ISD Scotland), over two million items were dispensed through the Minor Ailments Scheme across Scotland. By the 31st March 2014, 895,800 people were registered with the service in Scotland – this represents nearly one fifth of the national population. At such a number where a service is reaching out to many people and with the service providing value for money, it can be strongly argued that treating minor ailments is more cost effective and efficient within community pharmacies than other healthcare settings and it’s success is unquestionably apparent. Pharmacists have clearly demonstrated that they have made use of the enhanced autonomy gifted to them and made it work for the benefit of their patients and their professional responsibilities. It is also a critical source of reimbursement which matters to contractors as they have to operate as business’, so why would extending the service be deemed such a threat to over the counter sales and to their overall income?

Or would taking the service further be a step too far? The global estimated value of the over the counter medicine market works out at approximately £63.6 billion (based on a conversion from the quoted figure of €80 billion within this article in Deliotte). Unfortunately, I wasn’t able to find a estimate for Scotland so I have worked out based on an approximate population share of 5 million people that the market could be worth an estimated £45 million. I don’t know if that is accurate in real life or not, but let’s just utilise this figure for argument’s sake. To what extent would expanding the Minor Ailment Scheme have on the overall sales figures of over the counter medicines? If the service became universal then without doubt anyone could technically walk into their local pharmacy and seek treatment for a minor condition without needing to hand over a penny. Community pharmacy contractors need to have a steady stream of income on a consistent basis in order to survive as a business and in a continuously difficult economic climate any potential loss of income isn’t good news whether it comes through reduced over the counter sales.

Too often I read week after week in the pharmacy press about pharmacists being able to do this and pharmacists being potentially able to do that. I don’t think that these stories emerge, because the journalists who write them haven’t got anything better to talk about, because I genuinely think that isn’t really the case. But we need less talk, more substance, real action and positive results – that way we can get things going and continue to allow progress to flourish in terms of changing the way healthcare is delivered for the benefit of patients, improved job satisfaction of pharmacists and to enhance efficiency of costs for NHS Scotland.

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