The Pharmaceutical Journal
Vol 268 No 7184 p172
9 February 2002

This article
Reprint
Photocopy

PDF* 40K

Comment

Life for pharmacists was grimmer in the past; let us grab today's opportunities

By Ray Sturgess

Faced with derisory financial rewards, it would be understandable if pharmacists in the National Health Service believed they had never been less appreciated by the Government. But there have been harder times in the past for pharmacists and, at the moment, there are grounds for hope that our unique contribution to medicines management is about to be recognised.

To be optimistic in pharmacy just now it helps to have a long memory. Half a century ago, in the newly founded National Health Service, the job of the pharmacist was personally to prepare prescription medicines, a high proportion of which needed to be compounded extemporaneously. In this artisan role, the standing of the pharmacist was perhaps slightly above that of the carpenter. He — for there were few women pharmacists then — was respected for his expertise but was hardly considered a professional. Salaries for pharmacists during the Depression of the 1930s had been so paltry that The Journal felt obliged to carry a notice advising employers that no advertisements would be accepted where the salary offered to employee pharmacists was less than £2 per week.

The launch of the NHS coincided with the beginning of a transformation of the profession. With the advent of penicillin during the 1939–45 war, medicine started its graduation from well-meaning quackery to the application of science to healing. In no instance was the change more conspicuous than in the treatment of pneumonia. When my father contracted the disease in 1933 he was treated with a black cough mixture, the uselessness of which was camouflaged by its dog-Latin title of Mist Tussis Nig. He was dead within 10 days. With the availability of the sulfonamides and then penicillin, pneumonia was relegated from a lethal disease to being merely a mild nuisance. The capability of the new antibiotics to rid mankind of the great killer diseases, such as diphtheria, scarlet fever, smallpox and pneumonia marked the transformation of medicine from virtual impotence to a new era of efficacy and scientific application. The standing of pharmacists, as the purveyors of the new wonder drugs, inevitably benefited, too; and within the health service pharmacists were better paid than ever before.

The availability of new, effective drugs led to the demise of the era of the bottle of medicine, when almost every patient came away from the doctor with a prescription for a "magic" mixture: white for indigestion, black for a cough, red for a tonic. Although the change was gradual, the day came when pharmacists were no longer required to mix mixtures and blend ointments. Imperceptibly, the men — and now increasing numbers of women — in white coats became counters of tablets. And, since familiarity breeds — if not contempt — then at least indifference, the pharmacist has come to be seen in recent times not so much the supplier of wonder drugs as the hander-out of packets from the dispensary shelf. In the past few years, to judge by the financial rewards offered to NHS pharmacists by the Government, their masters have come to look at them in that way, too.

In the early days of the NHS, the skills a pharmacist required were a knowledge of weights and measures, an awareness of the physical properties of the prescription ingredients involved and the manual dexterity to combine them. Although the profession may look with some embarrassment at its mortar and pestle days as compounders of largely ineffective medicines, at least in those earlier times pharmacists were recognised as having unique skills. Nowadays the knowledge of pharmacists is much greater, but as many Journal correspondents have repeatedly warned, pharmacists in the NHS have been in danger of being viewed as overqualified and overpaid tablet counters.

How, then, to harness pharmacists' knowledge and experience so that they can be seen as providing essential services in the health chain? The answer is staring the profession in the face. Far too much current medication, for all its effectiveness, is still at the sledgehammer-cracking-the-nut stage. Too often a moderate improvement in symptoms is achieved at the cost of debilitating side effects. Doctors are usually satisfied provided patients show measurable improvements in their vital statistics. The headache experienced by a patient on a beta-blocker is seen by the physician as a minor inconvenience in exchange for a major reduction in the risk of a coronary episode or stroke. Doctors have become increasingly focused on the main chance and less and less concerned with untoward reactions to the drugs. For the hard-pressed general practitioner or hospital doctor it is generally sufficient to have effected a lower blood pressure reading, to have administered a drug that has been shown in clinical trials to have reduced the risk of a thrombosis or to have prescribed an anxiolytic for a worried patient.

Work pressure and lack of awareness account for the alarmingly high level of medication errors which, in hospitals, where work stresses are greatest, have been shown to run at an incredible 5 per cent of treatments. The Audit Commission report on the effective management of medicines in hospitals (PJ, 22/29 December 2001, p873) stresses the role pharmacists must play in future to reduce medication errors and the resulting adverse reactions and deaths, both of which are on the increase. The intervention of pharmacists in hospital prescribing, according to the report, already results in medication alterations in from one-fifth to one-quarter of inpatient treatments. If intervention on such a scale is necessary, when much of the prescribing is being done by specialists, how much more crucial a role have pharmacists to play in general practice prescribing?

It will be no use the profession waiting for the health minister to take the initiative. We shall need to carry out further pilot studies showing the improvements in medicines management when pharmacists are involved in general practice prescribing and the resulting reductions in errors and adverse reactions — and the results should be published. All studies so far have shown improvements but most have not been given the publicity they deserve. We must remember that what will impress the Department of Health most is that pharmacist involvement in prescribing will result in cost savings due to reductions in the amounts prescribed, the elimination of overlapping treatments and better patient compliance.

In the long term, better targeted drugs with fewer side effects will gradually be introduced. In the meantime pharmacists, as the experts in medicines management, have an opportunity to come into their own.

Ray Sturgess is a retired pharmacist from Knaresborough, North Yorkshire, with experience in the pharmaceutical industry and in community pharmacy