Thrush - circumstances when an OTC supply is inappropriate?

[Pharmanaut]

I don't think it would be anything like a million referals, I'd say about one a day in an average pharmacy and possibly 2-3 notifications of actions we have taken that may be relevant to the GP, such as supplying thrush treatment to a diabetic or to a patient who is taking a course of antibiotics.
I'm not suggesting letting them know every time we sell a bottle of Calpol.

I do accept that time is a big issue for all of us but I'd say confidence is a bigger one. Are we willing to record our professional interventions and subject them to the scrutiny of another health professional?

Record them all the time with our software.
Patient intervention, prescription intervention and interaction intervention.
All actions noted.
Mostly prescriber isn't involved - we speak to the patient (or parent).
Sometimes its not the patient in the shop - no problem, the patients representative calls them up on their mobile, hands it to us and we get more background information.

Just another day in the pharmacy.

[stevesdonna]

Assuming this person was over 16 and under 60 it is such a 'grey area' and (not wishing to sound sexist) a female pharmacist would have a great deal more sympathy I think. Like so many areas of pharmacy these days it seems to be the onus is on the pharmacist. Do you let the patient suffer overnight to avoid any recriminations? Or do you sell the product.... knowing that the GP will prescribe it anyway.

[WalkeRx]

On behalf of diabetics everywhere, can I just ask you to remember the reason why we come into the pharmacy to start with - to get treatment

NHS prescriptions are free for us, we could of course go to a GP if we wanted to wait for an appointment. In my case, I'm under the care of a hospital diabetes centre so my GP isn't too heavily involved with my diabetes. As I would be more prone to thrush than others, surely it should be acceptable to sell such treatments? A lot of diabetics, myself included, are aware if our levels aren't where they should be - a brief spell of illness could have been all that was needed to start the problem.

As suggested above, recurring thrush or symptoms that do not disappear following treatment could be signs of poor control and should be referred - perhaps this should be delivered as counselling by the pharmacist when selling treatment to someone? Surely this way is more preferable than limiting your professional judgement?

[weeneldo]

Why wouldn't you supply them a product to at least shorten their suffering? Its not a licensing issue, its not contraindicated in DM, there's no interaction and it'll take a few days to get a GP appointment. Thrush can be really horrible for people, so we can at least help keep the horrible symptoms at bay while they're waiting to get the cause addressed.

[roper]

I was mainly confirming that I had not overlooked a licensing issue as the (Asda) staff member was adamant that she had been trained to refuse the sale. Thanks for all your replies.

[WalkeRx]

the (Asda) staff member was adamant that she had been trained to refuse the sale.

I think my MCA training may have identified diabetics with thrush as customers needing referral to the pharmacist, rather than outright rejection. Perhaps some confusion here. I think it's a grey area, especially if training providers differ their opinions.