I wish to comment on Adam Pattison Rathbone’s blog ‘Could pharmacists be part of the A&E problem?’ (
The Pharmaceutical Journal 2015;294:385).
I would like to share a recent experience of mine that illustrates how the pressures on out-of-hour GP services and accident and emergency departments are caused by issues more complex than inappropriate pharmacist referrals.
Recently, a parent brought his five-year-old daughter to my pharmacy for advice. Her father had been informed by the school that she had developed four red itchy spots on one of her wrists.
After questioning and establishing that there were no other spots or symptoms, I was fairly confident that we were dealing with a fairly straightforward localised allergic reaction to insect bites or plant material.
I prescribed Eurax (crotamiton) cream under the minor ailment service as she was not suitable for hydrocortisone cream because of her age and gave her father appropriate advice.
The following morning, the father showed up with the child (who still had the same number of spots) to present a prescription prescribed by an out-of-hours surgery. It was for clobetasol 0.05% cream (a potent topical steroid), 500ml Dermol 500 lotion and 150ml chlorphenamine 2mg/5ml liquid.
This highlights that, despite counselling on the self-limiting nature of the child’s condition and absence of any other symptoms, the fact the spots were still there after 24 hours meant that the parent decided to take the child for an out-of-hours consultation. The resultant prescription probably, in his eyes, justified the visit.
So despite the most appropriate action and counselling given by community pharmacists, unnecessary visits to out-of-hour surgeries and A&E will still occur.