Over 70% of doctors oppose the switch of Flomax (tamsulosin). The vast majority saying that there is a risk of pharmacists missing underlying issues. I passionately believe that Pharmacy have a critical role to play in providing care on the high street. Having done much work with pharamcists as a group, I also know that they themselves worry about missed or underdiagnosis.

The reality is there are huge sways of the population who do not present to Drs, who do not recognise symptoms as problematic until pointed out to them and are either in denial or too scared to present to a Dr. Men in particular are great avoiders. Switch provides an opportunity for patients to enter the healthcare system in an accessible, non-scary and anonymous way. If I were a betting man I suspect brands like Flomax being available over-the-counter will encourage them to open a dialogue with healthcare professionals, recognise that actually what they thought was normal is not, and who knows get seen earlier by GPs not later when Pharmacy refers on. Certainly I know from previous switches that there has been an increase in prescriptions, suggesting more patients presenting in surgery too. I think Drs should be asking themselves some critical questions such as “who do we trust more, Pharmacists or patients?” “Do I welcome that they are in the system somewhere or nowhere?” Its time to accept patients decide and the more access points to health they have, the more knowledge we can give them, the better for all.

Mixed reactions come from pharmacy itself, however. On paper the industry are largely positive but seem reluctant to practice on real life customers. This is not the proactive response that government and industry had hoped for.

Some believe it is too much, too soon, to expect pharmacists to accomplish a GP consulting approach. The first and biggest hurdle may be acceptance. To quote a pharmacist I recently spoke to: “If I had wanted to be a GP I would have become one”.

But the cost of switches must be recouped. So are we doing something wrong? Pharmacists know that switch products have met stringent risk-benefit criteria – I believe so. They value the training on offer – yes. Should we be more aggressive – less trusting of their professional instincts, less patient?

I don’t think a macho upbringing makes strong people. So we need to think hard about support. While the NHS is the main driver of change, we cannot expect that our responsibilities end with branded training. Instead, we’re going to need to co-create opportunities with government and pharmacy to build the secure, confident community practitioners of the future. Watch this space.