Pharmacists have been holding pharmacy back for long enough

Pharmacists have held back pharmacy for too long.

In 1978, David Ennals, who was secretary of state for social services, commented to a member of the then PSNC that he could buy 200ml of Magnesium Trisilicate from his local pharmacy (over the counter) including a profit margin and VAT at significantly less than the drug tariff price.

The government was paying pharmacy more for this preparation than pharmacy was charging the public.

Let that sink in…….

It is a fact that all innovation in pharmacy in the last 30 years has been opposed by pharmacists. Turkeys seeking to vote for Christmas should seek consultancy services from pharmacists. However, they shouldn’t expect a rapid response as first the arguments would rage about who would pay for training and backfill before the hourly rate per shift torpedoed the initiative very early in the gestation period.

Moving forward to the mid-1990s and the first practice pharmacists emerged.

Community pharmacists derided them as “Barefoot doctors”, a term I still struggle to understand. It got worse when the Crown report of 1999 recommended a prescribing role for non-medical clinicians. Whilst howling with indignity and derision that mere nurses had achieved such a role the majority of uptake was from hospital pharmacy.

Community pharmacists were very slow on the uptake. Admittedly this was not helped by needing to locate a mentor but, those that did and continued to push contained a large number who;

a) went on to exploit the commissioning agenda of the day and help run locally commissioned services (medicines management and substance misuse spring to mind) for sensible rates of remuneration and,

b) were first in line when the recently announced practice pharmacist roles were announced.

To this day there are many who still refer to them as barefoot doctors. Back then there was an emergence of websites on which pharmacists articulated their day to day concerns. In the main these sites were dominated by locums who apart from discussing ways to invest their exorbitant fees, inflated dramatically due to the 2000 “Fallow year” when no new pharmacists graduated due to the degree course increasing from 3 to 4 years, railed against the indignities of having to work with accuracy checking technicians (ACTs).

ACTs were a godsend to the profession. Releasing pharmacists from the drudgery of the final accuracy check so that they could spend more time with their patients. This became of more value as the 2005 contract in England introduced advanced
and enhanced services which could be developed to meet local need.

In Scotland, at the same time, a national minor ailment scheme was introduced and subsequently a scheme enabling pharmacists to support patients with long-term conditions. Services which could bring more money into the business, make the job more satisfying and help decent pharmacists prove their worth to negotiate better terms and conditions for the high achievers.

The comments on websites were astounding.

“Not on my watch” was only one of the strident statements frequently typed in fury. These pharmacists, not all locums, were happier checking boxes of tablets than developing themselves to be better.

Contractors were no better.

The 2005 contract came in at a time when some blockbuster molecules were coming off patent and large profits were being made from the supply role. It was easier to go with the flow and when commissioning bodies sought to develop new services using pharmacy they were frequently discouraged. I was present at a meeting after hours in a decent venue with decent sustenance provided where a local doctor sought a new model of substance misuse provision which he wanted to develop through pharmacy. He wasn’t the commissioner but was seeking support for his model which had the backing (and funding) of the commissioners, a representative of whom was there. He was humiliated as pharmacists insulted his client group (patients remember) and slagged off the commissioners for having no interest.

They could not see that funding, training, support and opportunity were all on display in that room that night. Funnily enough, opportunity diminished after that as commissioners sought solutions that didn’t involve pharmacists.

Flu jabs was another such issue!

A real opportunity to raise our profile as providers of healthcare in our communities. What else do we believe ourselves to be? However, all over social media came the backlash. “I didn’t train for 5 years to do a nurse’s job” was a frequent refrain.

Emerging community pharmacy models involve the provision of a video consultation with a remote pharmacist and any medication required will be sent by courier.

And so we come on tot he topic of the day – ‘remote supervision’.

Senior officials in our profession have been besieged on social media by individual pharmacists DEMANDING statements opposing “remote supervision”.

At a time when surgical operations have been performed remotely for over a decade (remember Lord Darzi? He was a surgeon who was also Health minister in 2007 whilst pioneering robotics in remote keyhole surgery), the current Health secretary Matt Hancock has put technology at the forefront of his strategy and in England Keith Ridge the Chief Pharmaceutical Officer has for the last 2 years asked pharmacists to investigate legislative barriers to hub and spoke dispensing.

What makes anyone believe a statement from any leadership body will have any effect?

Particularly when many elected representatives can see the way the wind is blowing and are seeking creative solutions using technology which may have to embrace such developments like remote supervision.

Gifted pharmacists across the country have withdrawn from social media as a consequence of the vilification received when announcing initiatives to deliver pharmacy services to remote communities at a distance.

I do wonder when we will all move on and catch up with technology. I also wonder when pharmacists will stop holding pharmacy back.

It’s time to move on.

This article was written by our new anonymous blogger ‘The Grouchy pharmacist’.

Next up?

Pharmacogenomics. Brace yourself for the “I didn’t do a five-year course of study to be a lab technician” backlash!