The Pharmaceutical Journal
Vol 268 No 7183 p137-140
2 February 2002

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Letters to the Editor

Locums (2 letters)

New roles have precipitated management shortages

From Mr P. Robinson, MRPharmS

With reference to John Wilson's views of pharmacies run by locums (PJ, 5/12 January, p14), I have to say that the problem is caused by a huge expansion of bureaucracy. Locums, by and large, do not have to cope with many of the long-term problems that come with permanent management.

Staff management, premises management, initiation and monitoring of change, starting up new roles, information technology, forward planning, staff training, administration, recruitment, and all the other little trifles of the job are not generally within the remit of locums. The multiplicity of such responsibilities, which are almost beyond the ability to satisfy, is the reason why nobody wants to do the job.

In addition, since locums are usually in one place for a relatively short time, they have much less chance of becoming embroiled in the long-term difficulties that managers have to face, such as maintaining good relationships with local doctors, building reputations with customers, maintaining branch logistics and so on.

If a locum pharmacist can earn more money than a manager, enjoy the freedom of the self-employed and not get involved too much in all of the above responsibilities, it is no wonder that he or she will be tempted to do so.

The situation is greatly aggravated, if not entirely caused, by the Royal Pharmaceutical Society's "Pharmacy in a New Age" initiative and employers' response to it. These two factors together have placed an intolerable burden upon branch management that is near to compromising patient safety and staff sanity. When Mr Wilson relates the locum problem to the difficulties involved with developing new roles for pharmacists, he is missing the point. It is the very work involved in trying to satisfy phantom new agendas that has precipitated management shortage and caused an explosion of locums in the first place.

In one point I do agree with him. How is all this in the interests of patients?

Peter Robinson
Leeds

Problems with PGDs affect the Isle of Wight

From Mr M. T. Bland, MRPharmS

I read with interest the recent "Broad Spectrum" contribution by John Wilson (PJ, 5/12 January, p14) and sympathised fully with his comments. Like him, I have no instant solution to the problem of continuity of service when pharmacies are run by a succession of locums because contractors are unable to attract permanent managers. Regrettably, the relentless downward annual trend in dispensing remuneration can only exacerbate the current situation and worsen the delivery of service.

I write, however, concerning one particular view promulgated by Mr Wilson, namely emergency hormonal contraception (EHC) supplied against patient group directions (PGDs). With the scenarios that he describes, this can produce many problems and anomalies. There is a net deficit of pharmacy locums available to work and who are resident in the Isle of Wight (IOW) and many vacancies are covered by pharmacists travelling to the Island from Hampshire and beyond.

The IOW Health Authority in the past initiated a PGD on EHC and a list of trained and approved pharmacists exists. Patients and practices are aware of this and routinely appear at pharmacies to seek supply. Often all the pharmacies in a locality can be staffed only by mainland locums unable to supply against the PGD but prepared to sell the product. Patients are, however, unwilling to purchase on such occasions. This leads to referral back to the GP and reflects negatively on pharmacy.

To complicate matters further, the IOW Health Authority has recently merged with Portsmouth and South East Hampshire HA thus providing free EHC supply (sometimes) in one part of the HA area and not in another — truly postcoded PGDs within one health authority.

It ought to be within the realms of possibility for those overseeing the PGD either (i) to offer an additional training course for the accreditation of those locums who regularly commute to the IOW to work or (ii) to offer a distance learning package on the paperwork trail required having seen evidence that the pharmacists have completed an approved EHC course. This would then allow patients to access free EHC without the present-day hassle that they often experience.

The problem will, no doubt, increase in the future as primary care trusts develop further PGDs and such cross-border inconsistencies will occur more frequently. Mr Wilson's other concerns will still need addressing but, at least in this area, a start will have been made to put the patient at the centre of medicine's supply.

Mike Bland
Chandler's Ford, Hampshire

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