The Pharmaceutical Journal Vol 267 No 7173 676-680
10 November 2001

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Letters to the Editor

Primary care pharmacy

Community and primary care contributions needed

From Mr N. H. E. Dixon, MRPharmS

I would like to add to the community pharmacist/primary care pharmacist debate. I do not wish to discuss the advantages and disadvantages of whether patient review is best carried out in the GP surgery or in the community pharmacy. Ultimately the quality of the work will depend on the quality of the pharmacist and of the systems in place.

However, if a primary care group decides that it will only employ pharmacists who work exclusively in doctors' surgeries, it is acting to deskill those of us who work in community pharmacies. If community pharmacists do not use their clinical skills then they are forgotten, and this has a knock-on effect in the quality of dispensing services.

We are fortunate that our own PCG has chosen a mixed model and seeks to employ its own pharmacists and contract with community pharmacists on a sessional basis. We have much to learn from each other and from exposure to other health care professionals.

Problems arise in deciding what a suitable fee for this work should be. I have spoken to health care administrators, some of whom cost a service in terms of gross employee salary. In actual fact this is a fraction of the cost. To this basic cost must be added the employer's National Insurance contribution, pension, management of the employee (10 per cent of salary), holidays, sickness, maternity, travelling expenses, training, office space, desk, telephone, access to secretarial services, computer access, appointment systems, other auxiliary staff — I am sure this list is not exhaustive. Once the true cost for the employee has been established, the amount of contact time needs to be estimated and I think this unlikely to be more than nine sessions a week. A salary of £32,000 costs well in excess of £30 per hour contact time. In some cases PCGs have made decisions to employ their own pharmacists as a result of anticipated cost savings without fully understanding what those costs will be.

I firmly believe primary care pharmacy needs contributions from the employed sector and from contractors. The costs of employing both are similar.

Noel Dixon
Stanley, County Durham

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