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The plan for the future of pharmacy in the National Health Service is
with us and it is said that pharmacy is about to leave the crossroads,
a position it has occupied for many years. The pharmacy plan is like a
menu which is unpriced. When the prices are put in, will they be the prices
of an up-market restaurant or of a transport café?
In implementing the plan for pharmacy, the Government will seek to re-engineer
the pharmacy contract. It will be looking for value for money from a profession
which is not in a good negotiating position, a profession which has seen
more settlements imposed than negotiated. Whether the pharmacy plan will
actually benefit the profession remains to be seen. The timing of its
publication is suspicious. It has taken several years to reach this stage
but with the Government having a maximum life of around 15 months, one
has to wonder about the future of the plan. Many commentators expect the
next general election to be held within five months. A change of Government
could scupper the plan or a change of Minister could cause severe delays.
Even the same Government with a much reduced majority could cause problems.
If funds are tight, looking after pharmacy is hardly a vote winner. How
different to the situation when walk-in centres were introduced! Headline
grabbing developments could have been cheaper and more useful if pharmacists
had been consulted. Nurses working in consultation rooms within selected
pharmacies would have provided far better value. Reports suggest that
negotiations are taking place about the details and implementation of
the pharmacy plan. I would not mind having a bet that, whatever the Government
decides is ultimately imposed, little or no new money is introduced and
we finish up with most contractors much worse off than at present.
The Government was not looking for value when it launched the health improvement
programme without thinking it through. Who wants a healthy nation? It
would be in the interest of the medical profession to have a healthy nation
because it would reduce doctors’ workload. The Government would like to
see a healthy nation to reduce the amount spent on health. However, pharmacy
would lose under the current remuneration system by improving the health
of the nation. With a reduction in the number of prescriptions dispensed,
pharmacy would be on the slippery slope to economic ruin. New roles seem
attractive at the present time, but community pharmacists are still paid
mainly per prescription dispensed. It would be foolish to abandon this
principle entirely, just as it was foolish to relinquish on-cost in the
1980s.
Does the population of the United Kingdom want good health? The answer
is almost certainly "yes", but most are unlikely to make a real effort
to achieve it. The main fault with the health improvement programme is
that there are no incentives to encourage people to make the effort; long-term
sacrifices do not appeal to the masses.
Smoking is an objectionable and anti-social habit. Many workplaces do
not now allow smoking because of the legal implications of passive smoking.
Although it would not be popular politically at national or local level
to ban smoking in all public places, it may help people who are seriously
interested in stopping smoking to achieve their goal. The Government is
making some effort to help people to stop smoking, but can it really afford
this? Smokers are a soft touch when it comes to raising taxes and it is
difficult to see how the Chancellor of the Exchequer can balance his budget
without tobacco revenue. At the 2000 Unichem convention, it was stated
that smoking costs the National Health Service £1.7bn a year but that
tobacco tax brings in about £10.5bn. Other costs such as consultation
time and sick leave were built into the equation to try to claim that
all tobacco tax is spent on smoking-related illness, but I feel that revenue
easily exceeds expenditure.
Cancer is a disease that we all dread, but how many people take steps
to give themselves a better chance of avoiding it? Customers spend vast
amounts of money going on holiday and the success of the holiday is directly
related to the depth of tan obtained. In spite of health warning in the
media, in leaflets and from community pharmacy, customers are still buying
sunscreens around the factor 6 or 8 level. They should be looking more
towards factors 15 and 20-plus.
There is no shortage of dietary advice, but how many people eat the recommended
quantity of fruit and vegetables? Fish and poultry are not eaten enough
either. The average British diet is too high in red meat, salt and fat.
It might help the population if more information was given on packaged
food. Cholesterol levels are printed on food packets in the US, and I
feel it would be useful if we adopted the practice. The introduction of
value added tax on unhealthy foods might help to improve our diet.
Heart disease is a well-known killer but people ignore the advice they
are given about exercise levels. Too often a situation arises where a
person would benefit from exercise but cannot exercise because of a heart
complaint. The exercise needs to be put in before the heart attack, because
it often cannot be put in afterwards. The health of the nation might be
improved if tax relief was given on health club subscriptions. People
joining a club would join for the benefit rather than just to gain tax
relief. Obesity is a condition that can often be remedied by diet and
exercise, but too often the condition is accepted without effort.
The number one drug of abuse in Britain is alcohol. While the debate goes
on about legalising soft drugs like cannabis, there seems to be little
concern about the illness, absenteeism, violence and carnage caused by
alcohol. I do not know the answer to this problem because alcohol is socially
acceptable and spiralling taxes do not control its misuse.
Readers may have laughed about the lifestyle of the fictitious Jim Royle
in television’s "Royle Family". But is Jim Royle so imaginary? I would
suggest he is more common than the script writers appreciate. He spends
his life in an armchair while his wife and offspring see to his every
need. He controls his television by remote control and ventures to the
table at mealtimes to indulge in his unhealthy diet. His exercise takes
him to the local public house for his alcohol consumption. There are more
Jim Royles about than people imagine.
If the health improvement programme is going to have any significant effect,
there will have to be incentives for the population: negative incentives,
such as taxation, or positive incentives, such as tax relief. If the health
of the nation is going to be improved, community pharmacy has a major
role to play. There is currently no incentive for community pharmacists
to help the nation to improve its health. It is an ill wind that does
not blow anyone any good. Community pharmacists enjoy bad health! And
after pharmacists have had their benefit from the nation’s bad health,
the funeral director has his.
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