Pharmacists: taking charge of minor ailments and unlocking prison health

It has been estimated that minor ailments account for as much as a third of GP consultations. This is equivalent to 300,000 consultations every day. Moreover, research suggests that minor ailments and injuries account for between 30 and 40 per cent of attendances at accident and emergency departments. Transferring minor ailments in the community from GPs to pharmacists has been shown to reduce GP workload for those ailments and such schemes have been shown to be well received by patients who use them. Indeed, the success of minor ailments schemes has led to the Government pledging support for such schemes in the report “Building the best — choice, responsiveness and equity in the NHS” and the development of the role of pharmacists has more recently been recognised in a report “Choosing health through pharmacy” and in the community pharmacy contract which includes minor ailments schemes as an enhanced service. Furthermore, a comprehensive review of the literature has shown that patients expressed a high level of satisfaction with the level of services provided by community pharmacists. The Home Office was responsible for the health care of prisoners until April 2006 when that responsibility was transferred to the NHS and, in particular, primary care trusts.The stated aim of prison health care has always been one of equivalence, that is, prisoners are to have the same access to services provided to patients in the NHS. This represents a potentially huge challenge given that prisoners exhibit a high rate of mental illness and are more likely to abuse drugs and alcohol than patients in the general population. Furthermore, a recent study has shown that numerous factors, including distrust of “the system”, provide a barrier to prisoners seeking medical help for such mental distress which only serves to compound the problem. Health care for prisoners has been traditionally provided by doctors (medical officers) and nurses. Pharmacy services in prisons were the subject of a joint prison service and Department of Health report in 2003, although there appears to be little information available on the role of pharmacists in managing patients in prisons. There is, however, some evidence that prisoners with skin problems value services provided by a pharmacist. In the report on pharmacy services for prisoners, it is recommended that pharmacists provide services for prisoners with minor ailments as done in the wider NHS.This allows medical staff to concentrate on more serious problems, which is an onerous task, given that evidence suggests that prisoners in the UK are likely to consult doctors three times more often than a demographically equivalent community population. There appears to be little information published on the health care of prisoners. A literature review of prison health care found that the main issues are mental health, substance abuse and communicable disease. It also identified women and older prisoners as groups whose health care needs are different from those of the wider prison population. A second review on the primary care nursing of prisoners extended the list of prisoners with additional health care needs to include those from ethnic minorities and younger prisoners. However, the reviews did not uncover any specific information about the role of pharmacists in the management of patients with minor ailments, even though this role is well established in the community. The remainder of this article describes the range of conditions that I have seen and activities I have undertaken over a period of 33 months while working at Her Majesty’s Prison Hull, a local category B prison that holds approximately 1,000 prisoners and contains a mix of remand and sentenced prisoners.