A pharmacy professor has called for an end to the pharmacists’ monopoly on selling some drugs, arguing that it is time for a two tier system where medicines are either prescription or non-prescription.

Writing in The BMJ Professor Paul Rutter at the School of Pharmacy, University of Wolverhampton, says evidence is lacking that having a category of drugs that can be sold only by pharmacists or under their supervision (“pharmacy medicines”) has benefits.

He cites the recent case of oral diclofenac that used to be available in the UK as a non-prescription drug sold exclusively under the direction of a pharmacist.

Its reversion to a prescription only drug at the beginning of this year because of a “small but notably increased risk of cardiovascular side effects” implied that “doubt exists that pharmacists (and their staff) can supervise sales to consumers appropriately,” argued Rutter.

If pharmacy is to hold a monopoly on selling some medicines it needs to show value to consumers in terms of health outcomes, when compared with consumers purchasing these drugs without restriction, he argues.

Without credible evidence to support the pharmacy medicines monopoly – namely, that pharmacy intervention improves patient outcomes – “it is only a matter of time before a two tier system of prescription or non-prescription drugs becomes the standard model, as in the US,” he writes.

Such a system is easy to understand: access to medicines is obtained either with a prescription or from any retail outlet. “This is less confusing for consumers and increases accessibility, but it still allows pharmacies to sell drugs and gives them a chance to demonstrate their worth,” he concludes.