Head start

Pharmacists itching for a wider role are being given their chance in Nottingham.

For the first time, they are to be able to prescribe head lice treatments during a three-month trial organised by Nottingham health authority in a bid to reduce its drugs bill and to free GP time.

If the scheme works, the idea may be extended to other conditions that are comparatively minor but distressing and painful, such as urinary tract symptoms like cystitis and thrush.

The trial is being mounted on the eve of the publication of the report of the government's review of prescribing, supply and administration of medicines, set up in the wake of pressure for more nurses to be allowed to prescribe and concerns about legality.

The review's chair, June Crown, was speaking this week to a conference organised by the Patients Association, which broadly supports encouraging people to go to a pharmacist rather than a GP for less serious ailments.

But Karen Jennings of Unison's health team believes the Nottingham trial is in danger of breaching the Medicines Act, which at present allows only doctors to prescribe.

'There is a range of professionals whose expertise has developed beyond the legislation of the Medicines Act and pharmacists are one of those. Nurses are another group,' she points out.

But until the Crown report is out, she thinks it is 'not advisable' to extend prescribing to new groups.

Richard Slack, Nottingham HA's consultant in communicable disease control, does not think it is a problem. Pharmacists will be prescribing treatments already available over the counter, rather than prescription-only medicines. The pilot will allow pharmacists to provide lice treatment free, which otherwise could happen only with a doctor's prescription.

He says there are two key reasons for the HA starting the pilot, which is being financed out of its existing prescribing budget.

'GPs are fed up with having to write prescriptions over and over again,' Dr Slack says. 'And the HA is worried about insecticides being over-prescribed.'

Parents turning up at GP surgeries will be advised by practice nurses or receptionists to go to one of 32 participating pharmacists instead.

The pharmacist will not examine children's heads, but will advise parents how to wet comb to produce proof of head lice.

The HA will pay pharmacists pounds3 for the first consultation to issue insecticides and counsel families on prevention, diagnosis and treatment. The pilot covers a population of 120,000, a quarter of the HA area.

Dr Slack says that head lice infestation was selected for the initial trial because there is little danger of other conditions being overlooked.

'We won't miss anything serious,' he says. 'We have given the pharmacists training so they know that an itchy head does not necessarily mean that the child has head lice.'

Dr Slack forecasts that the HA will break even through reductions in the annual pounds100,000 insecticides bill. The HA says that people develop a natural immunity to lice if left untreated, and there is no real health risk or lasting effect.

The Nottingham trial is being broadly welcomed despite doubts about the ability of pharmacists to diagnose. Local health visitor Ginny Klein says it is an 'excellent project' which should be extended to the whole of Nottingham.

'There are GPs who will not prescribe head lice lotion, and it is expensive if you are on benefit,' she says. 'There is a big head lice problem in Nottingham and some families are using lotion almost on a weekly basis.'

Excessive use is not advisable, Ms Klein points out. But that information may not reach some parents who used to get free head lice lotion from school nurses and health visitors until local trusts stopped the practice about two years ago.

The subsequent pressure on GPs to prescribe lotions is one of the reasons for the new trial, which is being watched with interest by the Royal College of Nursing.

Its assistant director of nursing policy, Pippa Gough, says the trial should not be about shunting costs from one budget to another, but providing parents with accessible and swift treatment in a supportive setting.

'The Nottingham project appears to provide that,' she says. 'But it should not be treatment centred. There needs to be a broad strategy so that everyone approached by a parent is giving the same advice.'

But Roger Kline, director of labour relations at the Community Practitioners and Health Visitors' Association, has doubts about going to a pharmacist. His daughter Laura is about to start school.

He says: 'As a parent, I want to be sure that the people doing it know what they are doing. You can't expect them to pick up things that a school nurse would, like other skin complaints. Seeing a school nurse is an opportunity to talk about other things.'

His colleague, professional officer Sue Botes, also has concerns. 'The best way to deal with head lice is to educate parents so they can do it when combing children's hair in the morning as a matter of routine,' she says.

The Nottingham trial could be just replacing the 'nit nurse' with a 'nit pharmacist', who would give advice and treatment only after signs of infestation had been spotted. Parents need to know what they are looking for and what to do, she says.

George Rae, chair of the British Medical Association's prescribing committee, says 'pharmacists are looking to their future, trying to expand what they are doing'.

'I don't see any difficulty if there is proper discussion between local doctors and the local pharmacies about protocols. To then move forward to trial would seem to be eminently sensible.'

He accepts that success depends on the consumer response. 'Patients will vote with their feet. Patients have their choice. If they want to see a GP, they will go to see a GP. But trials like this can bring about a culture change.'

Such a change would be welcomed by patients' watchdog the Association of Community Health Councils for England and Wales.

Director Toby Harris says: 'Pharmacists have always had a broader role than simply dispensing drugs. We would welcome the extension of their role as a source of advice and information for patients.'

He sees giving advice and prescribing treatments for head lice as 'part of their natural role', particularly if it is designed to produce 'less hysteria and more responsible attitudes towards this problem'.