From Mr G. S. Phillips, MRPharmS
SIR,—Mrs Helen Remington, I know, is a well-respected member of the secondary care sector of our profession. It is a shame, then, that her letter "Agreed future" (PJ, December 18/25, 1999, p980) betrays as much about her ignorance of the financial structure and daily practice of community pharmacy as it does her insight into the profession's future.
I have consistently supported the New Age philosophy, both in these columns and elsewhere. I share her belief that the future of pharmacy is about pharmaceutical care, not the supply function, so I will not dwell further upon the issue. Like her, I am not resistant to change - but I am left wondering which ivory tower Mrs Remington inhabits.
In recent weeks, in the midst of "millennium madness" and the heavy burden of colds and influenza, both my qualified dispensing technicians were too ill to work. One of our senior medicines counter assistants came to the rescue, unpacking the medical orders and assembling the easier prescription items under my supervision. This, or a similar scenario, must arise in virtually every pharmacy at some point in the year. But since my assistant is neither a trained nor a registered dispensing technician, Mrs Remington would not allow it. Does this make me (in Mrs Remington's words) "resistant to change"? How would the work of my technicians be improved by their registration? Why should I want my own professional body to become the registration authority for what may well be a competing interest?
How can the Society possibly represent pharmacists' interests while at the same time representing the interests of pharmacy technicians?
That Mrs Remington sees the fight to retain resale price maintenance on medicines as "protecting the old ways of working" I find not merely astonishing but, frankly, a betrayal of her community pharmacy colleagues. Does she understand the basis of community pharmacy finances? The relative profit contributions from over-the-counter sales and National Health Service dispensing income? Our consequent reliance on the OTC side of the business for long-term viability?
We rely upon the income from the sale of medicines to subsidise the professional services that we provide to the NHS. Moreover, should resale price maintenance be lost, even Mrs Remington must accept that it would be impossible to provide pharmaceutical care to a consumer who never enters a pharmacy to seek advice or purchase a medicine for self treatment because of a perception that it is always cheaper to purchase medicines from the supermarket. For a senior member of our profession publicly to undermine the profession's agreed stance on RPM at such a delicate time is politically naive and unhelpful to say the least.
It would appear that there is no early possibility for the community pharmacist to have access to the NHSnet, let alone the electronic patient record, which somewhat undoes Mrs Remington's argument about patient registration.
I, too, firmly believe that community pharmacists have the potential to shape medicines management in primary care, and I am delighted to be involved in the Pharmaceutical Services Negotiating Committee working group on that very subject. However, we will achieve nothing for the profession by taking side-swipes at each other from positions of ignorance or prejudice.
What is clear to me is that the Council of our professional body would be much the better if a few more experienced but pragmatic pharmacists were to sit upon it.
Graham Phillips
Harpenden, Hertfordshire
Mrs HELEN REMINGTON replies: While working on the Council it is constantly apparent that politics and professionalism sit side by side. It was ever thus I suspect. The politics may differ but I am glad Mr Phillips and I are at one on the professional future.
Training to task and proven competence are the basic tenets of safe working practices. I cannot believe anyone can disagree. Certainly Mr Phillips has assessed the capabilities of his medicine counter assistant and applied them in a discretionary way.
Everything we do at the Society has to be viewed carefully to ensure that public interest is put first. All policy decisions and battles we choose to fight must have the patient/public at their core. It is the business of others to put forward the financial interests of pharmacists.
Registration of technical staff is only necessary if their responsibilities mean they must be regulated. In the hospital sector this is clearly the case now. If dispensing assistants in the community have limited responsibilities then regulation may not be appropriate. The debate is yet to be had. Dispensing assistants in the hospital sector are assistant technical officers (not qualified technicians), and there is no case being put for their registration. The key to this is risk assessment linked to responsibility. Where this is high then it seems to me that registration (by someone) is a necessary element to clinical governance in the profession of pharmacy.