From Mr J. D. Glassman, MRPharmS
SIR,-I would like to take issue with Mr Barry Shooter (PJ, April 22, p 621) on the subject of prescribing by pharmacists.
It is not possible to separate the professional status of a community pharmacist from the trader status in the conventional pharmacy. This is a situation that has built up over many years, and is unlikely to change, whatever the views of some pharmacists, including Mr Hemant Patel.
It is the choice of each independent proprietor pharmacist to sell whatever goods he or she considers appropriate for their pharmacy, providing it falls within the Code of Ethics. Even the Code of Ethics has a change of opinion, depending on changing circumstances. I remember the time when the sale of disposable syringes was frowned upon, but since HIV and AIDS have raised their ugly heads, the sale of syringes is now considered acceptable. Likewise we are now advised not to sell citric acid to drug abusers, while it remains freely available at the local grocery shops.
Many years ago there were letters in these very columns condemning pharmacists for selling stockings and tights, and lowering the tone of their pharmacies. The fact is that we need to sell a wide variety of goods to stay in business, and this situation will not change in the foreseeable future.
Alongside the sale of a wide variety of goods in our pharmacies we still act as professional pharmacists. We provide a highly efficient, cost-effective distribution service for medicines, both dispensed and sold over the counter. This service is highly valued by our customers and other members of the health care team. That we are taken for granted by many and insufficiently remunerated by the Government is not doubted by all in the pharmacy profession.
Community pharmacists have been counter prescribing since time immemorial. In my opinion, what Hemant Patel is trying to do, is to institute a protocol where community pharmacists have this service formally recognised, extended and remunerated.
There will be pharmacists who, for reasons of their own, will not wish to take part in this protocol. This is their decision and we will respect it. But we must not let this minority hold back the rest of the profession in what many see as a giant leap forward.
In East London, the surgeries are clogged up with patients with minor ailments, waiting to see their general practitioners. Community pharmacists can easily treat these conditions. Why do people wait in the surgeries for hours? The answer is simple. They cannot afford to buy the medication, or they do not want to spend the money.
In East London we have the greatest deprivation in the whole of the United Kingdom: the highest rates of teenage pregnancies, and about the highest rates of everything else, from coronary heart disease to HIV, AIDS, asthma and diabetes.
For a family where the children suffer from head lice, the cost of perhaps four or five bottles of malathion lotion is a considerable sum when taken from the weekly Social Security payments. This is why the surgeries are full.
Community pharmacists need a protocol to be able to prescribe and supply medicines for minor ailments on the National Health Service free of charge to those in relevant categories laid down by the Department of Health. We need to be adequately remunerated for this service. This will relieve the pressure on GPs and allow them to give quality time to patients with more pressing needs.
Most community pharmacists are familiar with the Saturday morning scenarios: emergency supply requests, with no money to pay for medication because those making the requests are exempt from NHS prescription charges.
Among the most common requests are from patients seeking emergency hormonal contraception. At present, we have to refer them to the accident and emergency department at the local hospital, where the waiting time can be anything over three hours. Is this what A&E departments are for? Do we want nurses to perform this role in walk-in centres? Community pharmacists are quite able to prescribe this product and to give the necessary counselling. We have the wide distribution of pharmacies, open at convenient hours, and the patient will not have a prolonged wait in a crowded waiting room.
The prescribing of EHC could open the door for pharmacists to prescribe a wide range of medicines on the NHS, improving our professional image, and providing a new source of remuneration. I think we should back this initiative without reservation.
In East London and the City health authority area, the local pharmaceutical committee is currently promoting this role for community pharmacy with the health authority and the primary care groups. The feeling is that this is the way forward for the profession, and most GPs are supportive of the initiative. The consultative documents for "patient group directions" have been circulated for comments, and if enacted will enable such schemes to be implemented.
Mr Shooter is wrong on this subject. Remuneration for dispensing will not improve substantially, however hard our negotiators work. The trend has been downwards for too many years, and this situation is repeated world wide as health care costs spiral upwards. Prescribing by pharmacists will not compromise our independence. It is not inappropriate. We are doing it now and we should seize the opportunity of expanding this role when we have the opportunity.
Jeffrey Glassman
Secretary, City and East London Local Pharmaceutical Committee