The news that pharmacist prescribing "is on the cards as soon as Parliamentary time allows" (PJ, March 18, p424) fails to bring me unalloyed joy. I note that we will be able to prescribe (under "patient group directions") along with such groups as health visitors, paramedics and laboratory technicians. Oh, hooray! Now I know that my hard-earned qualifications from nearly 40 years ago are to be put to good use. As far as I can make out, we will then be privileged to issue repeat prescriptions and adjust dosages - subject, of course, to a directive from a doctor or a dentist. The magic letters "PGD" will open to us a cornucopia of new opportunities. PGD somehow seems reminiscent of the British Board of Film Censors' "parental guidance" classification.
Mr Wiseman is a locum pharmacist and freelance writer, now semi-retired, from Cobham, SurreyThe great paradox of community pharmacy is that, as our opportunities for making sick people better have improved enormously with the conversion from POM to P of so many useful medicines, the respect in which the profession used to be held has declined almost to extinction
My dictionary defines "to prescribe" as "to lay down authoritatively for direction; to ordain; to set out rules for". In a medical context the same authority definition is "to order or advise the use of - to give medical directions". Funny. That is what I though I had been doing for a lifetime in pharmacy.
The great paradox of community pharmacy is that, as our opportunities for making sick people better have improved enormously with the conversion from POM to P of so many useful medicines, the respect in which the profession used to be held has declined almost to extinction while that of the general practitioner - despite the regular criticisms of the National Health Service, despite limitations on prescribing, despite the near impossibility of getting an appointment - has remained as high as ever.
As a fresh-faced schoolboy, my main motivation in choosing a career in pharmacy rather than in any other branch of medicine was the manager of a local pharmacy. A tall, distinguished figure in a long white coat, he dispensed charm, expertise, sympathy and advice on all matters to the whole community. Like Uncle Poderevo in H. G. Wells's ‘Kipps', he "talked to me of theology, he talked of politics, of the wonders of science and the marvels of art, of the passions and the affections, of the immortality of the soul and the peculiar actions of drugs". And my mentor was not a proprietor, but the manager of a small chain, with which he spent his entire professional life.
Has this paragon vanished from the scene? Not entirely, although it is becoming increasingly difficult to identify one as the "oldies" retire or are carried off by the grim reaper. Until a year or so ago, I carried out locum duties for one 90-year-old pharmacist of whom a local general practitioner was heard to admit: "If there were more pharmacists like Mr . . . I would be out of a job." Tomorrow I shall attend a pharmacy that I previously owned and sold some 15 years ago to a contemporary. Dispensing will be light as the premises are nowhere near a surgery, but my time will be spent counselling patients with every ailment imaginable. Everyone brings their troubles to this pharmacy and few leave unsatisfied. The owner drives a very large car!
Contrast that with the comment of a bright young pharmacist employed by a large multiple for whom I stood in very recently: "All I am is a pill-pusher." Is this the best future for our young graduates can look forward to? Is the attitide of one pharmacy graduate who was already planning a future outside the profession before qualification typical?
What has brought about this sad state of affairs? A changing world? Lack of leadership? A divided profession? Commercial acuity? Undoubtedly it has been a combination of all these things and others. When one has seen, as I have, a pharmacist-owner counselling a patient with a cigarette dangling from his fingers, one begins to despair.
Having been forced to abandon our role, our profession is desperately searching for a replacement portfolio: New Age pharmacist, PACT pharmacist, pharmaceutical adviser . . . on and on goes the list. Sure, a number of colleagues have found permanent niches where the work is no doubt rewarding, financially and professionally, and fulfilling. But is this the only future for community pharmacy?
I joined a healing profession and I do not think we are ready for the scrap heap just yet. Technology may have changed the nature of medicine and patient expectation - but the illnesses I see every day have scarcely changed in my lifetime. Twenty years ago, we did not have access to ibuprofen, loperamide, non-sedating antihistamines, hydrocortisone, H2-receptor antagonists, antifungals . . . ; the list gets longer and our effectiveness should be increasing exponentially. As access to the GP becomes more difficult, surely our part in the healing cycle should be enhanced, not diminished. The local pharmacy is close and accessible and no appointment is required. How often can we sell an item which will clear the condition, cost the patient less than a prescription charge and, incidentally, make us a profit?
Whatever may happen to the specialised aspects of the profession, I suspect there will be an increasing need for a ready source of advice and medicines. The old "Ask your pharmacist" campaign had some effect, but it is bound to be least effective when matched with inimicable surroundings, cluttered with toys, novelties, sweets and many other non-pharmaceutical items. (One pharmacy I attend even offers a cheque cashing and mortgage service.) Add to this a scruffy pharmacist in jeans and a tee-shirt, and what impression is being given to the customer?
Forty-odd years ago, my luminary, faced with the instruction from his superiors to sell portable radios in the pharmacy, refused to have anything to do with such items - but retained his job. An elderly locum in my own pharmacy, ex-proprietor of one of the most prestigious pharmacies in London's West End, complete with stiff, white collar, waistcoat and his own portable typewriter (in the days of hand-written labels), would refuse to discuss the cost of a private prescription as "I never negotiate prices". What would happen to such independently minded persons these days?
Where, really, did we lose it all? Is it still possible to restore some essence of dignity to our daily round? Am I being ridiculously over-optimistic in hoping that it is not too late? But it needs a radical rethink by every person employed in the local pharmacy. Are decent overalls for the staff out of the question? Would a lick of paint help? Do your staff (or you) work in any old garb? Is your pharmacy warm and well-lit?
Perhaps it is time we followed the example of the dentists, who have now adopted the appellation "Doctor", a term inextricably linked in patients' minds with the prescriber. My aforesaid dictionary defines the word as "a medical practitioner". If we cannot be so described, then what are we here for? Is it to be a PGD prescriber?