From Mr A. B. McCoig, MRPharmS
SIR,—Dr Goodyer and colleagues (PJ, October 28, p650)
appear to be puzzled why your letters columns are not jammed with reactions
from pharmacists on the latest document issued by the Government on the future
of pharmacy. I welcome an opportunity to put forward some reasons why this debate
may not warrant detailed comment at this time, at least from a community pharmacy
viewpoint.
Let me reassure Dr Goodyer and colleagues that we have all read this document
and are still considering the implications in their broadest sense. There have
been initial guarded and qualified responses issued by our representative organisations,
which have, on balance, tended to draw positive summaries. I would support these
initial findings.
However, many community pharmacists may mirror my own feelings that, in one
sense, we are hindered in being able to deliver the full range of services put
forward by the Government because of the financial and traditional cul-de-sac
we occupy. Historically, all financial commitments and investments have been
entered into on the basis of carrying out the current contractual obligations
under the National Health Service. For the overwhelming majority of pharmacists
who are supported by bank loans and overdrafts, the continuation of the present
dispensing service will be needed to keep the bailiffs from their doors unless
a worthwhile alternative is put forward to replace the existing contract. The
document indicates that a change is necessary in the way pharmacists are paid
for existing and new pharmaceutical services but is deliberately vague about
those items of service that will be “rewarded” and those that will
be reduced. Broad hints are there for our interpretation but this part of the
document conveys, on balance, the feeling that some form of imposition is likely
to impact on the community pharmacist and this can only be translated as a threat.
The recent statement made by Mr McKeon from the Department of Health reinforces
this view (PJ, October 28, p638).
The other restriction many pharmacists will not be able to shake off easily
is the internal design and layout of their pharmacies. When private consultation
areas were first mentioned and considered desirable, some did actually start
to make provision and floor space available in spite of the total absence of
NHS funding for such a facility. I know of many that are underused or have now
been turned over to other uses. At that time, it would appear that some community
pharmacists “jumped the gun”, hoping that providing such an area would
result in some sort of health authority funding, or at least compensation. Now
it would appear that such an area would be recognised and considered to be necessary
for providing more than the basic pharmaceutical services. Once more, we are
left to wonder whether or not this item will be funded in some way or do we
wait until we see the small print on the financial details? If we are to take
on the role of medicines manager for many of our patients, and there are few
who would argue against this, then we will need to sit down in the pharmacy
and talk with them on a one-to-one basis. The same applies to other types of
roles such as smoking cessation and health promotion in general. Again, there
are no details about how our time and space will be funded other than the threat
of stripping money from our colleagues who cannot provide such facilities.
Fundamentally, I see this document as recognising that which we should be doing
without actually providing an adequate, fair structural and financial framework
to achieve the aims and goals set out. The whole publication has been written
almost as a wish list and if one considers the possibility that there may be
another government at Westminster in the timeframe needed for implementation,
then it is understandable why many community pharmacists are keeping their heads
down. Until we are confident about new resources and the inevitable contractual
obligations that will be attached, the visible fine line between “retail”
and “practice” will remain blurred in community pharmacy.
I suspect that most community pharmacists will wait for further announcements
from the DoH before they rip their pharmacies apart in preparation for the bright
new future and engage in the debate requested.
Andrew McCoig
Secretary,
Croydon Local Pharmaceutical Committee, and
Chairman,
London LPC Forum