Trending now: The prescribing landscape is changing

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The prescribing landscape is changing and a new army is emerging, but is pharma saluting them?


An excellent Practice Manager recently showed me her monthly prescribing report from a leading medicines management system. She can see trends across the practice’s prescribers, notably; GP partners, salaried GPs, GP trainees, practice nurses and pharmacists. That’s five different classes of prescribers in an average size practice.

An intriguing discussion followed around how the variation and consistency could be explained by a range of factors, given the knowledge, experience and roles of all concerned. The clearest trends reflect how patients see specific clinicians, now that practices stream their activity according to role and specialist skills.

The practice pharmacist, for example, has a workload heavily orientated to patients with complex co-morbidities and poly-pharmacy. Also of note, one of the GPs saw most of the children and another concentrated on female sexual health work. Meanwhile, few roles vary more than practice nursing, especially in respect of role titles and level of prescribing.

The practice had also administered 870 flu vaccinations on a single Saturday. Most of those injections were administered by healthcare assistants (HCAs), with a practice nurse working alongside as a supervisor. These are the same HCAs that are the main point of contact for a whole series of patients. Their feedback, practical preferences and patient engagement is clearly influential in the prescribing choices of their senior colleagues.

I see very few pharma companies producing material customised to the various primary care roles and even fewer who have woken up to the significance of HCAs. There are some honourable exceptions with early efforts to provide support to pharmacists in practice, but even those companies are in catch-up mode.

For a patient with a reasonably stable heart disease, COPD or type 2 diabetes, the HCA will be the main person they’ll see in primary care and one of the few with time to have a sensible discussion. I wonder what they say when patients ask them about side-effects, adherence, titration and practical stuff around the shape, size and taste of medicines?

Some are doing vocational training, but many are not. In any case, what does that training actually say about medicines?

The NHS provides no centrally structured training, development, networks or resource for these ‘new’ key staff. There are major opportunities here for pharma to work positively with people who could directly influence effective use of medicines. This new army grows by the day – it’s time for you to get out of no man’s land and start understanding their territory.   


David Thorne is Chair, Washington Community Healthcare and Non-Executive Director, City and Vale GP Alliance. Go to