The Pharmaceutical Journal Vol 267 No 7170 p545-548
20 October 2001

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Letters to the Editor

The Profession (3 letters)

Malaise affecting the profession

From Mr D. R. Kaye, MRPharmS

The Broad Spectrum article by John Wilson “There but for the grace of God ...” (PJ, 13 October, p504) clearly illustrates the malaise affecting the profession.

Instead of focusing on the problems with dispensing the prescription he should be considering its appropriateness.

My first thoughts were: Why is the patient on bendrofluazide if they have gout? The nifedipine m/r should be twice daily though is probably not an appropriate drug in heart failure. The allopurinol could be taken once daily to aid compliance, but is the dose appropriate or has the patient got renal impairment? The dothiepin should be taken at night to reduce the risk of falls and aid compliance, although dothiepin would now be considered less appropriate for a patient with heart disease.

Until these are the first thoughts of all pharmacist on considering this prescription, it is no wonder that the public do not hold the profession in high esteem. Instead of dispensing the prescription while the patient waits impatiently, the pharmacist should be asking the patient how they came to be on these tablets, checking that the patient has had their blood pressure and cholesterol checked recently, and explaining why they would need to contact the prescriber about their medication. Once the prescription has been corrected, the pharmacist could then explain the treatment and potential adverse effects while a technician dispensed the prescription and handed it to the patient. This is how to avoid the “fast food” mentality.

Of course the problem could have been averted if the pharmacist were based in the surgery. The risks associated with poor clinical checking are far greater than the risks with the technical check.

David Kaye
Swinton, Manchester

Cannot work for charity

From Mr C. Cheung

I write as a final year pharmacy student, looking forward to practising pharmacy.

With all the recent correspondence regarding pay and working conditions, I would hope that my degree entitles me to greater rewards than that of a retail manager. With no disrespect to Christopher Anton (PJ, 6 October, p462) and other health care colleagues, they are not responsible for the overall quality and provision of medicinal products, and therefore, not liable to have their careers cut short by a single mistake.

Additionally, I have no doubt that the majority of the public regards the pharmacy profession as being well paid. However, this same majority also believe that pharmacists are no more than glorified “shopkeepers”.

Mr Anton suggests that pharmacists should retrain if they are not satisfied with current levels of pay, but why should we? I do not see anything wrong with increasing incomes to motivate those individuals who have no fondness for the job.

The last thing the profession needs is an excuse for talented and highly skilled people to switch careers, given that there is a “crisis” in retaining and recruiting pharmacists.¹ Conceivably, if earnings were raised to levels in line with “City” workers, not only would the exodus of pharmacists be reduced, but it may also be an inducement for other professionals to become pharmacists.

We are all aware that other professions are able to command higher rates of pay, as well as better benefits, so the question must be: why is pharmacy prepared to disillusion and devalue the skills of its dedicated members?

Personally, I believe pharmacists are not mercenary, yet they cannot afford to work for charity. Rather we would wish to be in an environment that recognises the invaluable contributions that we make towards society, and be appropriately rewarded for it. “Thanks” and a pat on the back are appreciated, but a well-paid salary is also welcome.

Chi Cheung
The School of Pharmacy,
University of London

Heartened about the future for pharmacists

From Mr P. Farley, MRPharmS

Earlier this year I went to a Guild of Hospital Pharmacists meeting which was billed as the use of robots in pharmacy. I came away feeling surprisingly heartened about the future, especially the future of pharmacists in hospital — in stark contrast to the sentiments expressed by correspondents to The Journal from the community.

But why was I heartened? During the closing moments of the presentation other achievements which flowed from the changes in the department were enumerated. The ones which rang bells in my head were:

1. A pharmacist now attends all of the post-take medical rounds, irrespective of the time of the round. Staffing permitting, this will be extended to surgical rounds.

2. Half of all pharmacist interventions were documented after those rounds — which were outside the normal working day.

The time is rapidly passing when pharmacists will be paid for buying, storing and distributing drugs. These are the basics of a pharmacy service. They are where we start from. They are what has to be excellent. Hospital staff, especially senior managers and auditors, may well continue to judge the performance of a pharmacy using criteria involving such things. But pharmacists are now much too hard to recruit and retain, to waste on such tasks, which largely can be successfully undertaken by technicians and assistants, perhaps even with assistance from non pharmacy colleagues.

Pharmacists will in effect be paid for their intellectual contribution to patient health care; to provide the scientific basis for the practice of the art of medicine.

As a profession we will have reinvented ourselves when others become aware that the intervention of the pharmacist changes for the better the outcome of the patient’s current medical/surgical treatment. Such a reinvention is only made easier by the changes which are currently ongoing within the health service.

The presentation from St Thomas’s on robots exemplified one way in which the change to science-based practice is moving. The pharmacist has to be there at the time when the critical decisions about patients’ care are being made. But they have the most impact when the sum total of the knowledge available is not as large as usual, ie, when the team is not up to its usual strength, when it is stretched, or out of hours.

I am not advocating that we should all work evening and weekend shifts. But there has to be a recognition within individuals in the profession that they should be the experts on drugs, instead of just hoping that everyone else will believe they are, because they say it so often.

Peter Farley
Sutton Coldfield,
West Midlands

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