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Why I’m in a strop about Lloyds’ strep throat service

By Dr Livingstone

21 Nov 2018

Lloydspharmacy’s new sore throat service isn’t necessary, says The Pharmacist’s grumpy GP blogger Dr Livingstone

You’d be forgiven for thinking that the decision by LloydPharmacy to launch a private sore throat service must be a no-brainer. After all, a near-patient test that accurately detects Streptococcus group A, thereby enabling you to provide antibiotics to the few who need it, has to be a good thing, right, particularly in an area where GPs are notoriously indiscriminate in their prescribing?

Throw in the added benefit of reduced GP appointments, increased footfall in your stores and a welcome financial boost for pharmacy, and you realise you’d have to be a raving contrarian to object. Which is where I come in.

Because, as so often is the case in ‘self-evidently’ great ideas, a dig below the surface may reveal some unforeseen consequences. Consider, for example, the following facts:

  1. Most cases of sore throat, regardless of cause, are self-treated without either pharmacist or – thank the Lord – GP involvement.
  2. Also regardless of cause, 85% of cases resolve spontaneously within one week. Yes, that’s right. Even if they’re streptococcal.
  3. Over 10% of children ‘carry’ strep in their throat without it causing any problems. So a positive test is not proof that the strep is the cause of the symptoms.

4 The effect of antibiotics in a genuine strep throat is simply to reduce the duration of symptoms by less than a day. And they probably have a negligible influence on potential complications in people who are otherwise well.

5 NICE guidance advises, therefore, that even when a strep infection is suggested/‘proven’, antibiotics should only be ‘considered’ – a nuance that I suspect will be lost in the busy and commercial environment of the pharmacy.

In short, the service medicalises and monetises a symptom that is self-limiting and barely influenced by treatment. True, GPs don’t currently handle it well, and the scheme may reduce unnecessary antibiotics.

But the more logical and powerful approach would surely be to educate the public that, in most cases, their sore throat doesn’t need the services of GP, pharmacist or, indeed, anyone.

Ideas like this do the opposite: the surrounding publicity will stoke demand. And, when, as inevitably happens, the scheme is dumped because of economics or to accommodate some other bright new idea, who are those hordes of pharyngitic punters gonna call now they’ve been primed for test and treat? Throat-busters, of course – which, by default, means me. And that’s why I’m in a strop about strep.

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