The Pharmaceutical Journal
Vol 268 No 7197 p645
11 May 2002

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Farmers have a lot to teach us, not least the benefits of forming a trade union

By Roger Waigh

I occasionally wake up early on a Saturday morning and listen to BBC Radio 4. At 6.35am there is a discussion, usually recorded on a working farm, called "Farming Today". Last year, much of it was about foot-and-mouth disease and was pretty gloomy, but this year the hot topic has been the Curry report. Listening to the proposals in the report and the reactions to them, the parallels with pharmacy were intriguing.

The main emphasis in the Curry report, which has been given a "cautious welcome" by farmers, is on the need to get away from subsidies directed at nothing other than maximum food production; the report looks at issues affecting the entire food chain, including environmental issues and rural development. The intention would not be to remove the subsidy money altogether but to redirect it, to channel activities into more beneficial and sustainable areas. Typically, the president of the National Farmers Union said he was not against development but did not want to divert subsidies.

The NFU has many critics, but at least the farmers do have a body with no function other than to represent their interests. While the Royal Pharmaceutical Society may be a "membership organisation", whatever that means, it has never been, was never intended to be, and can never become, a trade union.

I have been increasingly amazed in recent years at tales of pharmacists in the community, working 12 hours without a break. Why on earth do employee pharmacists not get together and form their equivalent of the British Medical Association? Such a body would have an essential role, not only in protecting the interests of employee pharmacists, but acting as the negotiating body when changes are proposed in professional practice. At the present time, the Society or others may float the possibility of change (which is essential if the profession is to survive) but the response is 40,000 whispers — a nebulous cloud of enthusiasm, fear, hope and anxiety.

In past times — those times which some look back on as halcyon days — when many pharmacists in the community owned their own business, there was not perceived to be a need for a union. Indeed the concept would have been alien to most small shopkeepers. Protection came in the form of elected members of Council, whose duty was to serve the interests of other proprietors. The result was a long period, following the formation of the National Health Service, when no change was permitted. The owners were doing very nicely, thank you, so nobody would rock the boat. The problem was that the external circumstances were changing rapidly, old responsibilities were being lost and no new ones were sought. The profession lost status in the eyes of the public and other health professions; the Government started to wonder why it was paying so much for so little, but for decades the Society's Council was a force for complacent self-interest. Recently, it has woken up, very late in the game, and has begun to realise that the community as a whole expects value for money. The problem now lies in engineering change, when pharmacy as a profession has never developed the structures, similar to those of the BMA, which can act as a vehicle for change.

Farmers, too, are extremely conservative. In many cases, they are isolated and have very little idea of the possibilities that are open to them. Much of what they know is handed down from other members of the family; if you are working long hours, seven days a week, you are not likely to find time for agricultural college.

Initially, I thought this represented a major difference between pharmacy and farming, since all pharmacists have had to attend college and new entrants are now all university graduates. On reflection, though, those members of the profession who are 40 years old or more (I hope this doesn't apply to younger people), will have received precious little in the way of preparation for their role in society from the undergraduate course they followed, and the older they are, the worse this will be.

Looking back at the "External London" curriculum which I suffered, there was lots of chemistry but very little pharmacy. Dispensing classes were intended to instill terror and were full of traps for the unwary, intended to make monkeys out of the students. There was no "responding to symptoms"; instead, marks were given mainly for presentation. I was genuinely surprised when I worked in my first community pharmacy that products were not handed out in white demy, sealed with wax. I learned to do the bare essential professional job in community pharmacy from other practitioners: it is no surprise that the descriptor "academic" is a term of abuse when used by some of the older "retail" pharmacists.

Paradoxically, it is currently fashionable to snipe at the schools of pharmacy for the completely opposite reason, since they are now taking their preparatory role extremely seriously, with much teaching carried out by practising pharmacists. One recent sneer described the pharmacy practice education of today's undergraduates as "the imaginative ramblings of their academic tutors". As a profession, we have much to gain from working together. The schools of pharmacy now have many concerned and forward-looking practitioners, people who have worked for years in the community or in hospitals. These pharmacists know the problems faced by the grassroots members of the profession and can see a better future. We should be planning for that future, all of us, not trying to score facile and cynical points off each other.

The current basis for paying community pharmacists is comparable to the basis for paying farmers in the European Union. The major factor is quantity, irrespective of the real needs of the community. There is no doubt that our community needs pharmacists, but the people of Britain have hardly tasted the benefits to be gained from a community pharmacy service that is not simply mechanical. We need a system which responds flexibly to demands for health care, with the practitioners taking responsibility, as and when required, for those elements of health care in which they are experts. Such a service is desired by the younger practitioners, appears to be acceptable to Government, has been laid out by forward thinking members of the profession and, above all, will bring major benefits to the wider community. In the same way, we will all be better off if farmers become the "guardians of the countryside".

Professor Waigh is from the department of pharmaceutical sciences at the University of Strathclyde, Glasgow