More than nine in 10 pharmacists oppose the self-selection of pharmacy (P) medicines, a recent survey by the Pharmacists' Defence Association (PDA) has found.

This comes as the PDA has launched a report making a case 'against the liberalisation of P medicine sales'.

Last year, the the General Pharmaceutical Council (GPhC) confirmed that it no longer prohibits the 'facilitated self-selection' of P medicines.

This refers to setups 'where people can pick up P medicines themselves without having to ask a team member to either get it for them or open a cabinet', according to FAQs published by the GPhC. 

Following that, the Royal Pharmaceutical Society (RPS) said it was considering whether to maintain its current position that that 'pharmacy medicines must not be accessible to the public by self-selection'.

In July 2024, the PDA launched a survey of its members to hear their views on the topic.

Of the 1,323 respondents, 93% opposed the concept of self-selection, with the top reasons given being:

  1. That it would be difficult to supervise (selected by 94% of respondents)
  2. That patients might select medicines inappropriately (96%)
  3. The risk of argument or violence if a pharmacist refused to sell a patient a self-selected P medicine (87%)

It set out more information in a report published today: ‘Beyond Convenience. Protecting Patients: The Case Against Liberalisation of P Medicine Sales’.

1. Difficulties in supervising P medicines

Currently, P medicines can only be sold under the supervision of a pharmacist, and are generally not placed on open display but rather behind the counter, to be selected by the pharmacist during a consultation with a patient.

The Responsible Pharmacist (RP) is responsible for ensuring the appropriate sale of P medicines within the pharmacy premises.

If the pharmacist had to leave the pharmacy premises for any reason, or if the RP felt they could not confidently supervise appropriate sales, the sale of P medicines would need to be suspended immediately.

This can be done 'with little difficulty' when the medicines are not on open display, the PDA said.

But 'in the event of a sudden change in staffing level in a pharmacy, it may not be possible for the RP to remove the sale of P medicines from open display and bring them back to a restricted area', the PDA said.

And currently, sales can also be easily suspended when needed for any other reason, such as when pholcodine-containing cough and cold medicines were withdrawn from the UK market at short notice in March 2023.

But if P medicines were on more open display, sales would be 'harder for the responsible pharmacist to monitor', one respondent to the PDA survey said.

'Lately some counter assistant training is below par, and I have concerns they will permit the sale without referring to the pharmacist. It will be impossible to monitor while we are doing all our "extra" services e.g. vaccination and Pharmacy First and are not in ear shot,' they added.

2. Potential for patients to self-select inappropriate medicines

If medicines were displayed openly, patients 'may make a quick decision based on visual cues', which can 'often be misleading', rather than 'an in-depth understanding of the medicine's specific benefits', the PDA suggested.

And it warned that placing the selection process with the patient rather than the pharmacist could risk 'undermining the pharmacist's clinical responsibility and placing the patient at risk of inappropriate medicine use'.

The PDA drew parallels with P medicines on open display and the selling of medicines online through asynchronous questionnaires, suggesting that both limit the opportunity for consultation with a pharmacist.

It suggested that reduced consultation with a pharmacist might lead to more 'sinister symptoms' being missed.

And it highlighted the need to ensure that medicines were safe to be taken in conjunction with other medicines or conditions a patient might have, particularly in older patients, those with polypharmacy, or children.

The PDA also raised concerns that the commercial interests of retailers may be placed above patient safety or clinical effectiveness, such as through promotional displays or the use of loyalty-card or own-brand offers.

3. Risk of argument or violence if sales refused

Allowing patients to choose a specific medication before consultation with a pharmacist, as well as a lack of clarity around which medicines require pharmacist intervention, could lead to more strained and difficult conversations between pharmacy teams and patients, the PDA added.

'There is a reason P meds exist, as some of the medications can be abused. And this will be very difficult to take the medicines off the patient's hand if they want it. This will create a lot of friction and tension between pharmacy professionals and the public, as well as even violent behaviour,' one respondent to the PDA survey said.

The PDA also highlighted increased risk of shoplifting if higher-risk medicines were on more open display.

Three-quarters of respondents want profession-wide consulation

Following the announcements from the GPhC and RPS last summer, 'there has been no meaningful dialogue or collaboration with other pharmacy organisations to discuss the implications of the proposed policy changes', the PDA said.

And it warned that the term ‘facilitated self-selection’ had 'caused confusion and considerable alarm within the profession'.

It added that 77% of PDA members responding to the survey thought 'decisions about making P medicines available on open display should be made following consultation with the wider profession'.

PDA chair Mark Koziol said the report 'demonstrates why consumer convenience must never be given priority over patient safety'.

And he suggested that the 'unique expertise of pharmacists with medicines' was more important than ever 'when so many hospital beds are currently filled with patients suffering with adverse drug reactions'.

GPhC: 'Key safeguards' must be in place

Roz Gittins, chief pharmacy officer at the GPhC, said the regulator 'fully agreed' with the PDA 'that pharmacists play a crucial role in protecting patients by providing expert advice, ensuring the appropriate use of medicines, and preventing potential drug interactions'.

'Our position continues to be that open display of P medicines is not compatible with regulatory requirements without key safeguards being in place,' she said.

'This includes ensuring continued compliance with the current legal requirement for pharmacist supervision, and assurance that where facilitated self-selection is available, that the systems and processes ensure patient and public safety.

'We will continue to check for associated compliance as part of our usual regulatory processes, including during inspections of pharmacy premises.'

RPS plans to publish evidence review on P medicine sales

Also responding to the PDA report, Professor Claire Anderson, president of the RPS, told The Pharmacist: 'The GPhC inspection approach only enables the facilitated sale of P medicines under certain conditions, with assurance of key safeguards being in place.

'This practice has prompted RPS and other organisations to review areas of work related to the sale of P medicines. As the professional leadership body for pharmacists in Great Britain, RPS plays a key role in setting professional standards which help prioritise patient safety while supporting pharmacists and their teams in safely meeting regulatory standards.'

She added that the RPS 'has conducted its own systematic evidence review of the literature and call for evidence, led by the RPS’ science and research team'.

'This publication is planned for peer review and serves as the basis for supporting our elected members in making recommendations for next steps, ensuring that patient safety remains at the heart of practice,' she said.

The PDA report comes as the Medicines and Healthcare Products Regulatory Agency (MHRA) has encouraged medicines manufacturers to apply for product reclassification from prescription-only (POM) to P.

This could include medicines that treat short-term sleep issues, allergies, pain, skin problems, digestive disorders, women's health and oral health.