The Pharmaceutical Journal
Vol 268 No 7194 p543
20 April 2002

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  Supervision
  Checking technicians
  Drug-herb interactions
  NHS
  Community pharmacy
  Hospital pharmacy
  Prison pharmacy
  The Profession
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  CPD
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Letters to the Editor

NHS

Without pharmacists, primary care would collapse

From Mrs A. Morant, MRPharmS

As a pharmacist, with a certificate of competence to practise from the Royal Pharmaceutical Society, I fail to understand why I am required to register with a primary care trust if I wish to continue to work for a contractor to the National Health Service — or indeed to work at all.

Having looked at the Department of Health website, I see reference to clinical governance which is defined as "a framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care can flourish". I also note a whole list of pharmacy-related PCT actions are required by April 2002 although I understand that this date has slipped.

One of the items listed is to "develop a strategy for the local implementation of community pharmacy clinical governance, within a multidisciplinary framework, ensuring that people are identified to carry the work forward into 2002–03". Unfortunately, I could not see any details of what were the specific goals or what were the benchmarks along the way.

Furthermore, the document also stated that a national training programme for community pharmacy clinical governance facilitators will be developed in 2002 drawing on the experience of the national clinical governance support team to ensure a multidisciplinary approach that fits with the general clinical governance picture.

Assuming that the training will be assessed, does this mean that the Government is surreptitiously aiming to withdraw the Society's function as a qualifying body and thus debase it? Another possibility is that it is going to allow PCTs to impose closed-shops which will only allow its approved pharmacists to work. This would contravene our rights — both human and business.

Finally, as a locum pharmacist who could, theoretically, be free to work in any part of the country, will I be required to be "approved" by each of the 300 or more PCTs around the country? If so, will locums have any time for health care after doing all the paperwork? In fact, will it become more important to have the right piece of paper than to care for patients?

The underlying reality is that pharmacy and pharmacists have already been debased and have become factory workers tied to the bench churning out prescriptions at an ever-reducing piece-rate per item. If this is to remain the sole role of the community pharmacist, there is no point in continuing professional development. After all, drug interactions will be indicated automatically by the dispensary's computer system if not previously flagged by the GP's computer when the prescription was generated.

We all know that much of the advice we give is no more than reassurance or the recommendation of simple remedies. However, what must not be overlooked is that, in some instances, the situation will be different and the recommendation will be to go to the GP or hospital without delay. This is not a road down which we can travel if pharmacists are to continue to have a vital role in health care and to be able to provide that first-line advice.

The profession and the patients (not to mention the health service budget) will only really benefit when we receive appropriate remuneration for our professional services. After all, if you see your lawyer, you expect to pay for the advice received. If we ceased to provide advice, with the result that patients would have to go their nearest accident and emergency department (if they can find one), telephone NHS Direct (which would then no longer have the option of directing the caller to a pharmacy) or make an appointment to see their GP, the entire primary care sector would collapse under the additional burden.

Annette Morant
Edgware, Middlesex

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