Remote consultations

Remote consultations are permitted for all conditions except acute otitis media in the Pharmacy First scheme in England. This is controversial and some hold the view that prescribing antibiotics in a remote consultation should only occur in extreme circumstances – particularly given the need for AMS. 

Although remote consultations can be useful in many conditions, there are a number of limitations when dealing with infections. The patient’s temperature cannot be taken (unless they have a thermometer and can do it themselves), and examination may not be satisfactory (e.g. looking at the throat either by the patient/carer, or by using video or photograph). 

It is also difficult to holistically assess the patient and fully understand how unwell they may be. The reason for a request for a remote consultation is also important. In general, if the patient is not sufficiently well enough to attend the pharmacy in person, this may suggest that they might need a medical assessment.

Improving consistency

With community pharmacists now authorised to supply antibiotics via PGDs, the importance of consistency of patient experience is clear. Pharmacists are increasingly trusted by the public as decision-makers about when antibiotics are needed. The challenges in not prescribing antibiotics have been extensively researched over the years and this has enabled evidence-based consultation elements to be designed and tested. 

Drivers of antibiotic use by GPs include diagnostic uncertainty, the fear of unforeseen complications, and belief (often misplaced) that patients are demanding them and not wishing to cause upset. These drivers are likely to potentially affect community pharmacists too, while delayed access to GP appointments could cause additional undue pressure.