Community pharmacy
The Profession
Emergency contraception
Working hours
Patient packs
Advertising
Pricing
The Society
The Journal

The Profession

Working for nothing

From Mr C. Morris, MRPharmS

I am glad that Andrew Bellingham (PJ, March 24, p391) does not believe that pharmacists would expect to be paid for extra record keeping. It is exactly this attitude which keeps pharmacists at heel as everyone's whipping boys. No other profession expects to do anything for nothing. The reason pharmacists are not treated as professionals by most people in the street is because we are seen as shop staff. We need to work on our professional image and you do not do that by volunteering for every job and saying, “We'll do that for nothing”.

Secondly, I do not know if Mr Bellingham has ever had to do any dispensing for drug addicts. In a shop with 10 addicts (I have worked in some that have up to 40), writing batch numbers as well would amount to a large increase in work, especially as most branches make up the next day's items on the previous afternoon.

Finally, Shipman was only caught when a pathologist raised her concerns over the number of bodies coming in. Up to that point Shipman was under no suspicion. With full audit trail capabilities the case would not have come to a head any quicker.

Are general practitioners, as part of this “audit trail” push, going to submit to random personal car and house searches? I do not think they will stand for that. Doctors are professionals who do not let the whole medical profession be tarred with the same brush without a fight. Maybe other professionals could learn from their example?

Chris Morris
Newquay, Cornwall

Where is the leadership?

From Mr G. Hall, MRPharmS

The first study into adverse events in British hospitals has now been published.¹ The study showed that:

• 10 per cent of patients admitted to acute hospitals experienced an adverse event
• A third of these events led to a moderate or greater impairment
• About half of these adverse events were preventable
• The cost to the National Health Service of the preventable adverse events is approximately £1bn per year in additional bed days

Earlier studies in the United States² have shown that a large proportion of adverse events are medicine-related.

Recently there have been two medication errors in hospitals resulting in patient deaths. These events have, quite rightly, made it to the main news bulletins and add to the public concern as to safety within the National Health Service.

These incidents have occurred against a background of the worst recruitment crisis in hospital pharmacy since the mid 1980s. The Government, by treating pay negotiations with cynical contempt, has made the recruitment crisis worse. Other NHS staff succeed in pay negotiations because of public sympathy. A better understanding of the vital role hospital pharmacists play in preventing medication errors would give negotiators a stronger hand in pay talks.

So why have our leaders not seized this opportunity to raise the public profile of pharmacists in drug safety and to explain directly to the public that their safety in hospital is compromised if full clinical pharmacy services cannot be provided?

This is not a missed opportunity yet. These unfortunate incidents will continue to occur and be well reported since problems with the NHS are considered newsworthy. My challenge to the public relations apparatus of the Royal Pharmaceutical Society is two-fold:

1. Grasp opportunities such as these to raise the standing of the profession in the public mind and to highlight the genuine problems being faced in recruitment
2. Explain to the membership of the Society why these opportunities are not being taken

Is the public to get all their information about the profession from Trevor McDonald? Let us see the public relations machine of the Society on television portraying the profession in its role as guardians of public safety with regard to medicines.

Leadership and imagination are what we need from the Society, and some representation for all branches of the profession.

References
1. Vincent C, Neale G, Woloshynowych M. Adverse events in British hospitals: preliminary retrospective record review. BMJ 2001; 322:517–9.

2. Leape LL, Brennan TA, Laird NM, Lawthers AG, Localio AR, Barnes BA et al. Incidence of adverse events and negligence in hospitalised patients: results of the Harvard medical practice study II. N Engl J Med 1991; 324:377–84.

Graeme Hall
Principal Pharmacist Clinical Services, Leicester General Hospital

JEAN-PIERRE MOSER (head of public relations, Royal Pharmaceutical Society) states:

The Society's public relations unit works hard to promote the positive aspects of pharmacy to the media and to deflect unfair criticism when it occurs.

On the issue of safety of medicines, the unit only last week arranged for the Society's chief scientist, Professor Tony Moffat, to take part in an expert panel discussion on the Radio 4 programme You and Yours. This is not an isolated example but part of an ongoing programme of proactive work.

The PR unit is also in the process of producing a hospital pharmacy publication that has the endorsement of the Guild of Healthcare Pharmacists and will be used to highlight the important contribution to health care made by this sector of the profession.

To help maximise the impact of the pharmacy message, the PR unit also looks to work in partnership with other pharmacy organisations and health-related bodies, as evidenced by the recent “Be clear about your medicines” campaign, run jointly with the National Pharmaceutical Association and the Doctor Patient Partnership. This campaign attracted national news coverage and continues to gather support through an early day motion in the House of Commons.

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Emergency contraception

Why are we ripped off?

From Mr F. N. Barash, MRPharmS

The National Health Service price for Levonelle-2 is £5. The pharmacy price for Levonelle is £11.06. So we have the same product with £6.06 difference.That is £6.06 per consultation ripped off from every willing pharmacist. Dick Turpin was no less subtle. What kind of profession are we?

F. N. Barash
Manchester

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Working hours

Proper breaks needed

From Mr G. Hanson, MRPharmS

I read with some alarm the details of the normal working of Jonathan Brocklebank (PJ, March 3, p282. He states that after his “four 11.5 hour shifts with no breaks” that he is in no fit state to update himself on anything. That is hardly surprising. I just wonder at what point in his 11.5 hour stint does he become unfit to carry out his professional duties competently and becomes a risk to the safety of his patients and customers?

I know that this type of working is becoming the norm when supermarket pharmacies rely on running their dispensaries on agency locums. Are these safe practices and why does the Royal Pharmaceutical Society condone them? Surely pharmacists should have a proper break rather than a furtive sandwich or even lunch in the dispensary.

Graham Hanson
Ipswich, Suffolk

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Patient packs

Not horses, but a donkey

From Mr R. I. Hughes, MRPharmS

Our Norwegian colleague, Stein Lyftingsmo, writing from his combined hospital and community pharmacy in Elverum, has expressed his incredulity at some of our bizarre dispensing practices together with his concerns not only for our professional standards but also for our professional standing (PJ, March 17, p358).

He has highlighted a grave disparity between the UK and continental Europe, in our attitudes toward security and safety in handling patient packs. It is quite obvious from his words that our practice of “snipping and snapping” is unheard of in Norway and in Europe in general. His polite reference to two  horses suggests to me that we are still riding a donkey.

Mr Lyftingsmo had travelled to England in order to observe UK progress in implementing the patient pack initiative and in order to attend meetings of the active study group brought together by www.patientpacks.com. The group is gathering evidence and studying the impact of packaging and labelling design upon safety in the handling of medicines at every station between manufacture and administration.

Pharmacists' observations or comments upon this subject will be welcome at enquiries@patientpacks.com, or they may be sent to my own address.

R. Idris Hughes
Plas Engan, Trefriw, Sir Conwy, Gwynedd LL27 0JZ

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Advertising

Knocking copy?

From Dr C. Stillman-Lowe, MRPharmS

I was surprised by the advertisement placed by Smithkline Beecham Pharmaceuticals for Seroxat recently in The Journal. The copy read “2p or not 2p That is the question. Treating a patient with everything that Seroxat 20mg has to offer, will cost just 59p a per day. Or, you could save a whopping great 2p a day by prescribing citalopram 20mg. But then, they would not be getting Seroxat, would they? Any further questions?”

This seems to what is referred to as “knocking copy”, and suggests that making relatively small savings could influence prescribing decisions by health professionals treating mental illness, rather than an assessment of clinical need. I would like to see a justification for this approach from the manufacturer which labels itself as “partners in psychiatric care”.

Catherine Stillman-Lowe
Reading, Berkshire

Mr IAN BELL (marketing manager — Seroxat, GlaxoSmith- Kline) replies:

GlaxoSmithKline acknowledges Dr Stillman-Lowe's concerns regarding the Seroxat advertisement “2p or not 2p, That is the question”. This advertisement was intended to be informative as well as amusing to the reader and was not meant to be disparaging to other products. We are aware that the cost of medicines is a very real issue to prescribers but cost, of course, is only one aspect of rational drug selection. Clinical need of the patient, as Dr Stillman-Lowe points out, is of the utmost importance.

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Pricing

One price for all

From Mr M. H. Franks, MRPharmS

By accident I have received an order destined for a hospital for diprosone ointment 30g. As I was packing it up to return to the wholesaler I noticed it had been charged at 90p a tube which seemed rather low. The C&D price list says diprosone ointment costs £2.41. So this represents a discount of 62 per cent.

So we now have Schering Plough giving hospitals 62 per cent discount to promote its products and Schering adding 100 per cent to over-the-counter Levonelle (PJ, February 3, p146).

The Government is always wanting to save money on the NHS so I suggest a good place to start would be to make manufacturers charge hospital discounted prices to all NHS suppliers. There should also be a ban on one group of pharmacists receiving lower prices than others. There should be one low price for all.

M. Franks
London N6

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The Society

More power than ever

From Mr P. Robinson, MRPharmS

If our “colleagues” succeed in amending the disciplinary procedures and introduce competence-based practising rights as they have suggested, the Royal Pharmaceutical Society will have more power over its members than it has ever had in its history.

I imagine that the imposition of such power will be relished — and not just with the raising of standards in mind. There is the worrying prospect of being over-controlled and excessively regulated by a central body that has a low electoral mandate. Although the responsibility for administering the system will be delegated, and to all appearances distanced from the intervention of the Council, it is nevertheless the Council that will set the criteria by which cases are brought before the committees in the first place.

In other words, the future policy of the Council will dictate the sphere of influence of a statutory machinery that is becoming increasingly more pervasive and virulent.

It is surprising that the concept of “pharmacist informer” has not been considered. If we are all encouraged to inform the Investigating Committee about colleagues who consistently under-perform, we shall contribute to the raising of standards in a most effective manner. This approach, I believe was once asked of theatre staff with a view to identifying incompetent surgeons.

Just how extensive and threatening do we want the influence of an unrepresentative and arrogant Council to become?

Peter Robinson
Horsforth, Leeds

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The Journal

Commendably disinterested

From Mr D. Shenton, MRPharmS

Since I am quick to complain, let me be quick to approve. Your article on Private-Rx (PJ, March 24, p402) was enlightening, different, balanced, and apparently commendably disinterested.

David Shenton
Staines, Middlesex

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