From Mr L. W. J. Chapman, MRPharmS
SIR,—Having recently read the paper by Sheila Woolfrey and colleagues (PJ, January 15, p109) entitled "Can community pharmacists provide a clinical pharmacy service to community hospitals?", I was amused by three things:
1. The mystery of why the medications of patients at discharge from hospital are changed in 90 per cent of cases by the time three weeks has passed by. (From what I remember it is most likely to be their GP who makes the changes, or else the outpatients' department).
2. The fact that nothing is mentioned about providing remuneration for the luckless community pharmacists who are expected to provide the clinical services. (Do they not know that pharmacy companies employ the minimum of qualified staff because that is what makes economic sense? How then will a busy community pharmacist with a prescription line up find time for local hospital unpaid employment, however "prestigious"? It seems to me that only a community pharmacist whose business is on the rocks will be reasonably able to find the time - and who will oversee his premises while he is away at the hospital?)
3. The comments about 15-minute unpaid counselling sessions with clients who can barely remember what you said half an hour later, written sheet adjunct notwithstanding.
I am amused because it is better to smile than to weep, and I am very thankful that I am a retired pharmacist. Respect for a pharmacist is demonstrated first of all by adequate remuneration for services rendered. Any other consideration has no worthwhile, practical value in the real world. It is this last item that is usually missing in pharmacy. The NHS system itself demands a lot of a pharmacist's "free" time.
Leonard Chapman
Toronto,
Canada
Dr SHEILA WOOLFREY states: I would make the following comments.
1. As Mr Chapman may know, general practitioners are often in charge of caring for patients in community hospitals, as is the case in this hospital.
2. Mr Chapman is quite right in raising the issue of appropriate service funding. However, as we stated in the paper, funding for the study was obtained from the NHS "Seizing the opportunities" development fund and matched by the health authority. A fee structure was agreed and the community pharmacists were appropriately recompensed. It was beyond the remit of the paper to discuss the issues surrounding future recurrent funding for pilot schemes.
As pharmaceutical care is provided by pharmacists for patients (whether in primary or secondary care), we do not feel that the standard of care provided in any one sector is any more "prestigious" than another.
The current changes in the Health Service will mean that new ways of funding services will develop, away from the current terms of service. As a result we feel that it is entirely appropriate to develop and explore models examining alternative systems for the delivery of appropriate pharmaceutical care.
3. The role of the community hospitals has changed considerably over the past few years and they now treat medical, surgical and paediatric patients as well as the more traditional respite patients. As many community hospitals are remote from their district general hospitals they may have limited access to pharmaceutical expertise. Many patients currently treated have a high level of morbidity and mortality and as such have much to gain from this effort to develop a locally provided clinical pharmacy service. These patients should not be allowed to fall between the primary/secondary care divide as appears to happen at present. Input at this time may well save time and admissions later.
The NHS and pharmacy is changing, whether we like it or not. We believe that this is a move towards true integrated medicines management. The project has the specialist with the greatest knowledge of medicines management - the pharmacist - at the core, rather than merely as a supplier of drugs.