From Mr G. W. Walker, FRPharmS
SIR,—What a crazy world pharmaceutical politics has become! While the Council produces its soporific document on clinical governance (PJ, September 25, p479), those of us attempting to provide patients with a clinical service, in the form of dispensed prescriptions, struggle daily to obtain supplies of generic medicines. As I search the United Kingdom to track down 500 tablets of bendrofluazide 2.5mg, I have to conclude that Lambeth is indeed an ivory tower.
All the documents that the Society can produce will not give the profession the least bit of credibility if those of us at the sharp end cannot deliver the service that patients expect from us. We are very good at producing paper but, at the moment, pretty ineffective at delivering our core service. While it is probably right for our politicians to be producing and debating high flown papers (remember Pharmacy in a New Age) few of them really achieve significant change. Meanwhile, back at the bench there are up to 20,000 foot soldiers trying to do their best for patients.
For the past few months we have been spending significant amounts of our daily round attempting to ensure continuity of supplies for our patients’ prescriptions and seeking to be reasonably paid for them. At this, our hour of need, we could reasonably have expected the Society to be giving us total support. But I have not seen a single word: talk about "communicate, communicate, communicate" (PJ, September 18, p423).
Before writing this letter, I transmitted my daily order to one of Europe’s largest wholesalers. The following items were out of stock: aspirin dispersible 300 mg, aspirin dispersible 75mg, cuprofen 400mg, co-codamol tablets, Lyden cream rinse, Ferrograd C tablets, Dramamine 50mg tablets, Gaviscon 250mg tablets and metformin 500mg tablets.
These did not, of course, include the items that seem to be permanently out of stock, ie, bendrofluazide 2.5mg, lormetazepam 0.5mg, indomethacin 25mg, and penicillamine 125mg.
Over the past six months, almost every item of the generics list, ranging from penicillin V to warfarin 5mg tablets, has been out of stock or unable to be supplied by the manufacturer. One does not have to read clinical governance (in bed) to appreciate that there is no way we can convince the mass of patients that we are offering an effective service if we are unable to provide basic medicines, and I include over-the-counter business, where the shortage of analgesics has been disastrous.
In the midst of this débâcle, where has the Society been? What has it done to help? As far as I can see, Council members have been too busy knifing each other in the back to have any concern for patient care. That has been left to the much maligned membership to have had to develop their own PR in order to hide the mess.
So who is to blame for the current situation? I am satisfied that community pharmacy is, for once, blameless. Independents and multiples do not go out looking for trouble, and shortages on prescriptions mean big trouble. That then leads to the wholesalers. But can they really increase profits by not supplying the generics we require? I think not. So the buck must stop with that grey group of companies who produce the generics, and their excuses will not hold water while generic prices rise in tandem with supply shortages.
The Department of Health has to carry some of the responsibility as a result of the apparently inept way in which it negotiated the patient pack initiative, which some manufacturers are blaming for the price increases.
But, as a community pharmacist who cannot tell from one day to the next if he is going to have any dispensing stock of bendrofluazide 2.5mg tablets, I have to lay the significant portion of the blame on our Society. The lack of PR support has meant that each one of us has had to fight his own daily battles without any central support. I do not believe anyone at Lambeth has even recognised there is a problem.
It would be wrong to end this comment without referring to the Category D list. This means simply that if you are purchasing stock at higher than the basic price you should also endorse the manufacturer and price - as if we had not got enough work to do. Perhaps someone else will write on that topic.
Graham Walker
Totnes, Devon