Health care policy is once again encouraging patients to use their community pharmacy for the treatment of self-limiting conditions. As a demand management strategy it serves the interest of many stakeholders. For politicians it represents an opportunity to reduce the drugs bill by shifting cost to the patient. It makes better use of pharmacists' expertise. For GPs it offers potential for reducing practice workload. For patients willing to choose the pharmacy route it reduces the time they have to wait for treatment.

A number of different models for testing these assumptions are being tested. However if patients are to be encouraged to use the pharmacy in place of the general practice one fundamental barrier has to be addressed - the patient's prescription exemption status. If patients do not pay for their prescriptions they will be less likely to use any scheme substituting one practitioner for another if they incur costs they would not have incurred when accessing their medicines through the GP.

In August 1999 the 'Care at the Chemist' trial was established as part of a 10-month feasibility study to explore whether and to what extent a number of different self-limiting conditions could be transferred from general practitioner to community pharmacist management. The trial involves one general medical practice and eight community pharmacies ranging from small independents to large multiples, in a deprived area of Merseyside. Twelve conditions have been included, from coughs and colds to thrush. Under the trial the community pharmacist is able to advise patients on treatment and 'prescribe' suitable products from an agreed formulary. This model of service delivery is unique in that patients who are exempt from prescription charges continue to receive their medicines free when accessing treatment through the pharmacy.

From quantitative data collected before and during the trial 36% of eligible patients have used the pharmacy scheme to date. Further quantitative data will be presented which describes the extent to which particular conditions can be shifted from general practice to community pharmacist management. Qualitative interview data with users and non-users of the scheme will also be presented to shed light on which patients favour community pharmacy access and why, and what sort of barriers exist in implementing such a model of service delivery.

The paper will also describe some of the key development issues which need to be considered if such services are to be rolled out on a larger scale, to a Primary Care Group level for example. This model described offers one option for the involvement of the pharmacy profession in a new NHS, but the paper concludes by advising some caution in light of lessons learned from this study. The type of minor ailments for transfer, the type of general practice involved, patient expectations about health care and their sometimes unspoken reasons for consulting the GP, all impact on the feasibility of a demand management strategy that involves professional substitution of the kind described.