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The process of getting access to a prescription medicine is about ensuring that people who have medical needs have access to the medicines they need to treat or manage any conditions they have.

The typical pathway for a prescription outside of Pharmacy First is to contact the GP or healthcare professional who made the initial prescription to ask them to provide a repeat prescription.

This can take time, however, and in some cases where a delay in receiving a prescription supply could lead to serious or life-threatening consequences, a pharmacy may be able to provide an emergency supply.

What Is An Emergency Supply?

An emergency supply is an exemption to the laws surrounding supplying prescription-only medication written into the Human Medicines Regulations 2012.

The Human Medicines Regulations covered a range of subjects but they were primarily focused on the supply of prescription medicines outside of the typical pathway of a doctor prescribing and a pharmacy supplying, such as paramedics and midwives.

It also allows pharmacists to supply emergency supply of prescription medications, a power that has proven to be life-saving since the law was put into place and empowers pharmacists.

An emergency supply of medication is typically no more than a 30-day supply of a given medication, the smallest full course of treatment in cases where a prescription cannot be directly split, or a five-day supply in the case of the epilepsy drug phenobarbital.

When Can You Request An Emergency Supply?

It is at the discretion of a pharmacist whether they provide an emergency supply, but anyone who feels that they have an immediate need for their medication can ask for it.

Typically, at that point, the pharmacist will provide a mini consultation to ensure that there is an immediate need for the medication and it cannot wait until a prescription can be obtained via a GP.

As well as this, the medicine needs to have been prescribed previously. It does not necessarily have to be part of a repeat prescription for this to be the case and proves that you have had the

medicine before and it is safe for you to have it again.

Finally, the pharmacist needs to be sure that the dose requested is appropriate for the person to be given.

Pharmacists will base their decision on their training, guidance and the consideration of the consequences of not supplying the medication. Prescription medicines must be dispensed safely and responsibly to avoid potential side effects, but this must be balanced with the consequences of not having this medication.

This emergency supply can be provided by any pharmacy, so if one does not have the particular medication available, it can be provided by any pharmacy in the area which does by following the same system for requesting an emergency supply.

If it is not available at all, then a pharmacist should give advice on the next step to receiving medical care, which may include visiting the accident and emergency unit of a hospital to ensure that an urgent supply of medication is provided as soon as possible.

The end of January marked a year since the Pharmacy First service was launched in the United Kingdom, and polling undertaken by YouGov confirms the satisfaction seen by the people who attended over 2m consultations during the first 12 months of the service.

According to the study by YouGov published in The Independent, 78 per cent of those surveyed want Pharmacy First to be allowed to provide additional prescription treatment for conditions outside of the current seven.

This highlights the vital importance of Pharmacy First and the network of pharmacies which make it possible, and links into larger plans to bring healthcare closer to where people live.

Pharmacists are keen to treat more conditions, and people have found it useful to receive treatment outside of working hours, reducing time spent off work, and the benefits to the healthcare world as a whole could be significant.

Will it happen, and what treatments are likely to be included in any expansion?

What Is Pharmacy First?

Launched in January 2024, Pharmacy First was an extension of the community pharmacist service, which allowed specially trained pharmacists to provide treatments for minor illnesses or approve urgent repeat prescriptions.

The Pharmacy First service took this a step further and allowed community pharmacists to treat seven common conditions completely, allowing people who would otherwise have to wait for a GP’s appointment to receive the care they need now.

These include:

• Middle ear infections (up to 17 years old)
• Impetigo
• Infected insect bites
• Shingles
• Sinus infections (sinusitis)
• Sore throats
• Uncomplicated urinary tract infections

People who need treatment can be referred to a community pharmacy for treatment by a GP, urgent care services or the NHS 111 service.

They can provide advice, self-care and some prescription medicines according to a strict clinical pathway undertaken by a trained community pharmacist. They can also refer you to another doctor, specialist or hospital if they spot any red-flag symptoms.

It has been overwhelmingly supported, and people who have accessed Pharmacy First services have found it a helpful lifeline, particularly during times when a pharmacy is open but a GP’s office would ordinarily be closed.

Which Treatments Could Pharmacists Treat In Future?

The will is there for pharmacists and the desire is there from patients for more treatments to be provided, but it would require some approvals for this to happen.

The YouGov survey itself suggested that any potential expansion of Pharmacy First could include treatments for chest infections and skin conditions, although it was not specific about which ones.

Many pharmacists provide advice and over-the-counter medication for viral chest infections since they eventually clear up on their own and treatment focuses on easing symptoms. An expansion of Pharmacy First might allow for the prescription of antibiotics for bacterial chest infections.

A dermatology service would help to soothe fears and ensure that people with skin conditions receive the treatment they need quickly, either directly by the pharmacy or via referral to a specialist.

Other conditions that have been suggested include eye infections, migraines and conditions linked to other parts of the healthcare system, such as toothache and lower back pain.

Winter is the prime time for viruses and many people spend much of the colder months tucked in bed fighting off illnesses.

One of the most common bugs during this time of the year is the respiratory syncytial virus (RSV) but many people do not know a lot about it.

Find out what RSV is and what the most common signs are by reading on.

What is RSV?

RSV is, as it says on the tin, a respiratory illness that affects the windpipe and lungs. It is particularly common between November and February, spreading mainly through sneezes, coughs and touch.

While many might disregard RSV as an annoying cough, it can be very serious in children, and frequently causes bronchiolitis in infants. This accounts for around 20,000 hospital admissions for babies under the age of one.

That is why pregnant women are offered a vaccine to protect their babies once they are born, lowering the risk of severe bronchiolitis by 70 per cent in an infant younger than six months’ old.

What are the signs of RSV?

Unlike a common cold or flu, which often has other symptoms like a runny nose, RSV is characterised mainly by its cough.

Other symptoms include wheezing and shortness of breath, with babies often suffering from fast breathing or being unable to catch their breath.

It is also dangerous for the elderly, and results in hospitalisations of 9,000 or so people over 75 years old every year in the UK. This is because it can flare up existing lung conditions and cause pneumonia.

This is why the vaccination is also available for adults between 75 and 79 to protect them from these potentially dangerous outcomes.

How to tell the difference between RSV and other viruses?

One of the difficulties with diagnosing RSV is that it can appear similar to other viruses that usually occur during winter, including the common cold, flu and Covid-19.

According to the National Foundation for Infectious Diseases, however, patients with RSV often suffer from wheezing, whereas this is rare for the other viruses. This is the biggest tell-tale sign that it is RSV.

What’s more, while sufferers may sometimes have a fever, this nearly always happens if you have the flu.

It is also rare to have a sore throat with RSV, unlike with the cold or Covid-19, and patients do not usually have fatigue, whereas they have a high chance of feeling depleted with the other viruses.

Aches are also a rarity among patients with RSV, though they are common with the flu, and frequently occur with Covid-19 and the cold.

Treating RSV

RSV typically goes away on its own within a week, so the best thing patients can do is take medication to relieve their symptoms.

They can speak to their local pharmacy, who can recommend medicines for fever and pain management that they can buy over the counter.

Anyone with RSV should also make sure they drink plenty of fluids to avoid becoming dehydrated.

If the patient is a child or elderly person and the symptoms appear to be getting worse, they are not eating much, they are showing signs of dehydration, they have a temperature of below 36C, and they are having difficulty breathing, it is advisable to call NHS 111 for urgent care.

The general relationship between doctors and pharmacists is that doctors prescribe and pharmacists dispense, and that separation is central to how the medical system has historically worked.

There are exceptions to this, most notably with the Pharmacy First service that allows trained community pharmacists to write prescriptions for seven relatively common and uncomplicated conditions without needing to consult a GP first, which can help patients get relief quicker.

As well as this, there are some rural areas where there are dispensing doctors who both prescribe and dispense at the same time, but they are typically only able to as a last resort to avoid a pharmacy desert.

However, whilst pharmacists cannot prescribe outside of certain exceptions, they can offer over-the-counter medications and advice. In some very specific cases, they can even amend a doctor’s prescription.

How Can A Pharmacist Change A Prescription?

There are very strict conditions where pharmacists can amend a prescription, with each NHS trust having a published policy for exploring the scenarios where a pharmacist can amend a

prescription without talking to the prescriber first.

There are a lot of different examples, but they can typically be grouped into a few common amendments.

Generic Substitution

Probably the most common reason for a change in prescription is a like-for-like swap from one version of a drug to another. Often this is a switch from a brand-name drug to a generic version once it becomes available.

This is a common and highly publicised practice, which often explains why a prescription might look different, as some manufacturers prefer certain types of manufacturing techniques, so the type of pill, colour or size might be different.

However, the dosage will be the same and generic medications are legally required to have precise tolerances.

With that said, there are certain types of medications which cannot be substituted in this way due to a lack of a like-for-like substitute.

Form, Type And Direction Alterations

A pharmacist cannot alter the dosage without consulting the prescribing doctor. However, what they can sometimes do is alter the way in which a medication is dispensed.

This can mean switching a liquid medication for capsules, or substituting two smaller tablets for one larger one when a dosage has stabilised.

This is done for a variety of reasons following consultation with a patient. For example, some people find it easier to remember to take just one pill rather than two or find it easier to take

capsules over other types of pills or liquid medication.

They can also, in some cases, change the rounding of doses for medications based on the weight of a patient in order to make it easier to measure and easier to take.

This is often known as compounding and works under the rule that anything that makes a prescription easier to follow is beneficial.

Therapeutic Substitution

A much rarer situation is where a pharmacist swaps one medication for a different drug that provides the same effect and is in the same drug class.

This is typically done in the case of shortages or where there are different formulations of the same medication, as is the case with statins.

This will rarely be done without consulting a prescriber first, however.

A critically underappreciated aspect of prescription medicine dispensed by a local pharmacy is how it tastes when it is ingested.

The simple explanation for this is that, in the words of Mary Poppins, a spoonful of sugar really can help the medicine literally go down.

Whilst taste is not, nor should it be the first priority when it comes to medication compared to active ingredients, efficacy, therapeutic index and safety, its importance should not be discounted, and it can have a profound effect on health outcomes.

The reasons for this are both quite simple and relatively complex, as are the reasons why not everyone bothers.

What Makes Pills Bitter?

Part of the reason for the often-awful tastes of medication, which usually manifests in uncomfortably bitter tastes on the palate, is the ingredients they are made from.

A lot of medicines that are regularly used, such as aspirin and medical cannabis are bitter because of their active ingredients, which usually derive from roots, barks or leaves of plants that themselves taste bitter to ward off animals.

In some respects this is important in medication as well; as the dose makes the poison, retaining that bitter taste helps in a small way to reduce an overdose.

Does Taste Even Matter?

The taste of medication is not a priority for manufacturers, doctors and pharmacies, because it is more important for a given medicine to work rather than taste nice. There are therefore two hugely differing schools of thought on matters of taste.

The first and most common argues that whilst some medicines such as ibuprofen and other sugar-coated pills are necessarily sweetened to avoid irritating the stomach, flavour additives to pills and liquids could potentially interfere with the function of the medicine or cause unexpected side effects.

As well as this, taste is a matter of taste, and having to produce life-saving prescription medicines in a range of flavours could take time and money away from the ultimate purpose of a medication.

Furthermore, in some cases, it is simply not possible to fully mask certain bitter tastes, although generally in those cases attempts will be made to at least reduce the effects.

On the other hand, one of the biggest barriers to positive healthcare outcomes is adherence. According to the National Institute of Health and Social Care Excellence (NICE), up to half of all long-term medical prescriptions are not taken as directed, and a big barrier to this is the taste of medicines.

Typically, when people taste something they do not like, it creates a negative reinforcement that can make people reluctant to try it again regularly, at least unless they get a taste for it. Whilst a spoonful of sugar or honey would literally help in a case like this, it still creates a potential barrier to care.

This is a particularly major problem for children, who typically have more sensitive taste buds when it comes to bitter tastes and thus could be easily repelled by bitter-tasting medicine that feels and tastes worse than the disease.

As well as this, creating a positive connection between medicine through taste can help to improve the mental well-being of a person taking them, and in turn improve potential outcomes.

Health is about more than simply fighting diseases, and many pharmacy services exist that not only prescribe medicines to help with conditions diagnosed by a doctor but also help to encourage a better quality of life.

These include, but are far from limited to, providing travel advice and vaccinations, microsuction to help with earwax build-up, sexual health services, support and therapy to help stop smoking, as well as advice and treatment to help people looking to lose weight.

That latter service, in particular, requires a holistic approach. Injectable and oral weight loss medication typically needs to be taken in conjunction with health and lifestyle changes in order to be effective in the long term, and that often means exploring whether diet and lifestyle habits might be doing more harm than good.

A good example of this is soft drinks, which have surprised people in the past with the level of sugar they contain and can contribute to a number of health conditions if consumed too much.

This is a huge change from how many soft drinks, including some of the most popular in the world, were originally sold as medicines. How was this even possible?

The Ideal Brain Tonic

One of the most commonly known parts of Coca-Cola’s history is that it contained cocaine, although in levels that may never be known due to the secrecy surrounding its formula.

However, what is perhaps less known or less appreciated given what we know now about the health effects of an abundance of sugar and caffeine is that Coca-Cola was first sold as a health drink, advertised as “the ideal brain tonic” for curing headaches and exhaustion.

In reality, it was one of many ‘patent medicines’ available on the market that sold themselves as panaceas and cure-alls, typically using a mix of alcohol and cocaine in order to make people feel better.

Patent medicines were neither patented (usually they were protected under a trademark) nor were they medicines as we understand the concept today, often relying on deliberately opaque ingredient lists, aggressive marketing and outlandish claims.

Coca-Cola was doing what Daffy’s Elixir and the infamous Mrs Winslow’s Soothing Syrup did at the same time, with several of the same ingredients. Coca-Cola was different as it did not contain alcohol, but it did still rely on coca leaves around the time cocaine was understood to be the dangerous and addictive drug it is.

Similarly, Pepsi would be initially sold as an indigestion cure, with the name coming from “dyspepsia”, an alternative term for a stomach upset. It even received the slogan “Delicious and Healthful”.

Outside of the patent medicine era of the 19th century, arguably the most famous example of a soft drink marketed as a medicine was Lucozade before it transitioned to a sports drink with the help of Daley Thompson and Iron Maiden.

Initially known as Glucozade and absolutely not to be confused with the diabetes medication gliclazide, Lucozade was sold as a health drink to help children who were nil-by-mouth when undergoing operations.

This led to an association with health that endured until the late 1970s and a greater understanding that sugar and its energy-providing qualities were not inherently good.

Because of how strong and long-lasting the healthcare system has been in the UK, including the NHS, hospitals, chemists and GP clinics, it is sometimes difficult to see that the modern pharmacy system as we know it came as the result of a lot of very unusual events.

The Great Plague of London, the last and worst of the bubonic plague epidemics in the UK, led to apothecaries taking care of people who could not leave whilst physicians escaped to safety.

This led to a dispute about the role of apothecaries, The Rose Case and the slow development of what became general practice.

However, a surprisingly pivotal moment in the history of medicine involved a bag of sweets, a widespread case of adulteration causing inadvertent poisoning and a man named Humbug Billy.

The Ballad Of Humbug Billy

In the 19th century, very few medicines, drinks or food were subject to quality standards, with the only major exception being beer. As a result of this, adulteration was extremely common and got worse as cities grew ever denser.

In the world of confectionery, it was even worse; using an adulterant such as gypsum, alum or chalk was seven times cheaper than using sugar by volume, so it became very common to mix sugar with adulterants and hope nobody would notice.

One such confectioner was Joseph Neal of Stone Street Bradford, who tended to use powdered gypsum, justifying it by saying that everyone else did.

He made peppermint lozenges for sweet stall owner William Hardaker, better known as “Humbug Billy”.

The week before the fateful poisoning, Mr Neal had run out of gypsum, often known as “daft” in the Bradford trade, and sent his lodger to go pick some up five miles away in the town of Shipley.

When he arrived, the usual druggist Charles Hodgson was unwell so his apprentice took the order for gypsum instead. Only instead of five kilograms of “daft”, he accidentally took powder

from an identical barrel containing arsenic trioxide.

This led to Mr Neal making the lozenges, feeling ill, and delivering them to Mr Hardaker. He got a discount due to the different colours and sold them at the Saturday market.

The result was 200 people falling ill and 20 people dying; each sweet contained between twice and four times the lethal dose of arsenic. It caused vomiting fits and abdominal pain similar to those found during the cholera pandemic.

Ultimately, whilst Mr Hodgson, his apprentice and Mr Neal all stood trial, all were found not guilty, the judge deciding that none of them had a case to answer for.

Mr Hodgson was not involved at all, his apprentice was simply following orders and genuinely did not know the difference, and Mr Neal worked in good faith that Mr Hodgson had supplied him with what he ordered.

The poisoning, the deaths and the fact that nobody faced prosecution led to calls to stop similar poisonings from occurring, being the public cause celebre that led to several changes in the law, most notably the Pharmacy Act 1868 that limited dangerous drugs and poisons to be sold only by qualified pharmacists.

If you are planning an overseas trip, a trip to the travel vaccine clinic may be in order, so you can get the jabs needed for wherever you are going, should they be required. But sometimes, you may need medications for other concerns – like altitude.

Of course, many destinations won’t require you to get a jab at all. After all, there won’t be any tropical diseases to contend with if your next holiday involves skiing in the Alps.

However, some adventurous people like to climb mountains on foot or even using ice axes and crampons, rather than chair lifts or cable cars. Sometimes, that and a trip to the tropics will be combined.

Climbing mountains brings its own health requirements, of course. You need to be fit and also know your first aid. But one thing you need to be particularly prepared for with some overseas mountains is high altitude. This is not a thing you can practice for on any British mountains, as even at 4,000 ft there will be no problem getting a good lungful of air.

However, at higher altitudes, the atmospheric pressure gets low enough that each breath draws in too little oxygen and you start to struggle. This is where altitude sickness becomes a risk. Your body can adjust to this by making more red blood cells, which helps process oxygen more efficiently, but most people struggle to adjust quickly.

Sometimes, the rate at which you are ascending is such that your body will struggle to keep up. The consequences can be more than shortness of breath; nausea, dizziness, fatigue, headaches and insomnia can all be a problem.

For elite climbers who take on the highest mountains in the world, the approach is to take much longer to acclimatise. But for a holidaymaker paying for guides to help them up a mountain, this is too costly and time-consuming. However, help is at hand through a drug that was never actually designed to help mountaineers – Diamox.

Diamox was actually invented to treat glaucoma, which it does by blocking the production of a protein called carbonic anhydrase. This stops the build-up of fluid, which is good news for glaucoma sufferers. But it also helps acidify the blood, speeding its flow through the veins and thus delivering oxygen faster.

Therefore, while your body may have to make do with less oxygen, it is delivered faster to your organs, helping you cope with breathing in less of it.

Consequently, it is often given to people who are going to take on mountain challenges, such as trekking to Everest Base Camp or Kilimanjaro, the highest mountain in Africa and also, at 19,540 ft, the tallest free-standing peak in the world, as well as the highest you can walk up.

Kilimanjaro is a popular climb, but with ascents taking over around a week, the adjustment time is short and Diamox is often necessary to get people to the top.

Being located in Tanzania, it is also a prime example of an adventure where you will also need some vaccinations, with yellow fever certification required upon entry. You should have some antimalarial tablets too.

It may seem odd that a drug designed to stop your eyes from suffering excess fluid should help you cry tears of joy on a lofty foreign summit, but Diamox really can make the difference.

A lot of caution and care is taken when a doctor prescribes a medication and a pharmacy orders said prescription to be delivered to your door, as ensuring the right medicine in the right dose is vital to treating any condition.

There is an adage, originally attributed to Paracelsus but has changed many times over the years that says that “the dose makes the poison” (Sola dosis facit venenum in Latin).

The idea is that too much of a medicine can be harmful or even potentially deadly, whilst in some cases trace amounts of poisons can be beneficial. In modern medicine, this concept is known as the therapeutic index.

Another way this is described is that whilst we need water to live, too much will cause us to drown.

There are some very literal examples of this in action, but one of the most famous is how a rat poison became a commonly prescribed medication that saved the life of a United States President.

The Paradox Of Warfarin

Often described incorrectly as a blood thinner, warfarin is an anticoagulant that helps to break down blood clots where they already exist and prevent future ones in people who have replacement heart valves, irregular heartbeats or conditions such as thrombophilia.

This exact property makes it one of the most carefully controlled medications prescribed, and the dose can change depending on diet, other medications and other illnesses. Otherwise, it could either be ineffective or cause too much bleeding.

This exact property is why warfarin was initially produced, marketed and sold as rat poison in 1948, working remarkably well for the purpose.

However, the main purpose of the drug changed dramatically after a potentially tragic incident in 1951.

A man who had been inducted into the United States attempted to take his own life by swallowing several doses of warfarin. However, after being given vitamin K, a known antidote also known as phytomenadione, the young soldier made a complete recovery.

This near-tragedy managed to provide a lot of medical information on the effects of warfarin in the human body and led to several doctors wondering whether it could be as effective as dicoumarol as an anticoagulant.

Both originated as a byproduct of mouldy sweet clover and by 1954, both were approved for use to treat a range of heart and blood conditions, which led to warfarin’s most famous patient.

United States President Dwight D. Eisenhower suffered a heart attack in 1955, just two years after he was sworn in, and there were concerns that he might be unable to serve the entirety of his first term, let alone a second one.

Ultimately, he was prescribed warfarin, and made a remarkable recovery, allowing Ike to run for president and win in an even bigger landslide in 1956, serving out the remainder of his term with few health issues.

He would remain on warfarin for much of the rest of his life, dying at the age of 78 in 1969, but also being a very prominent example of how medication cannot be judged on its first use or first appearance.