The Pharmaceutical Journal
Vol 269 No 7219 p541
12 October 2002

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British Pharmaceutical Conference 2002 summary

Pharmacists in practice

Changes in pharmacy discussed

Why are pharmacists so shy asked Dr STEVEN KAYNE, community pharmacist, Glasgow, "I prescribe every day of the week, over the counter, and my armament is growing with POM-to-P switches, but do our colleagues know this and what we do?"

Publicising pharmacists' roles was one of the tips for surviving the changes outlined by Dr Kayne. "We need to learn from the nurses. They tell everyone, and everyone knows what they do. We need to look at things not as obstacles but as challenges; we need to be more active in primary care trusts, and we need to be more client oriented," he said.

OMAR ALI, formulary development pharmacist for Surrey and Sussex NHS Trust, cited clinical governance and revalidation as evolutionary pressures on pharmacy. "The time when a manager can say to the chief executive that a person is competent is gone. Now the chief executive will say: 'Show me'. You need to be able to show evidence for each of your staff," he said, when speaking about his experience of clinical governance. However, in community pharmacy, clinical governance does not really exist he added. Dr KAYNE commented that lack of uptake in community pharmacy is a cultural problem because community pharmacists are used to working alone and can be difficult to reach. However, "clinical governance will happen, especially with the youngsters who know what it is," he predicted.

Following presentations on the procedure for reclassifying medicines and potential products for future switches, participants at the session voiced concerns for safety, particularly with P-to-GSL switches, and treatment inequality. MEL SMITH, professional relations manager at Reckitt Benckiser Healthcare, stated: "What upsets community pharmacists is that patients use GSL products for the same reason they have used pharmacy medicines in the past. Then, having read the information inside, they get worried and ring up the pharmacist. At least with pharmacy products, there is some pharmacist intervention at the time." He asked if the MCA had conducted any post-marketing surveillance. AMANDA WILLIAMS, senior pharmaceutical assessor, MCA, replied that the MCA relies heavily on pharmacists and the yellow card system. "Once out there, it is up to the patient to decide, but the risk of someone taking a product when they should not is always taken into account when we make reclassifications," she said. ANTHONY COX, teaching fellow at Aston University, proposed the case for putting an OTC drug reaction form inside OTC products.

Dr NICOLA GRAY, a member of the Royal Pharmaceutical Society's council, was concerned that reclassification could open up a "chasm of health inequalities", using emergency hormonal contraception to illustrate the point. "It is not equitable to say 'I'm sorry, you have to go and sit in the surgery because you cannot pay the £24.' Convenience should not be defined by a person's ability to pay." Dr Gray went on to call for finding ways of allowing people to get pharmacy medicines on the National Health Service and said she was thankful that patient group directives were available in some areas. Perhaps reclassification was a cost-shifting exercise she suggested. This was denied by SHIRLEY NORTON, group manager, MCA, who insisted that reclassification does provide convenience and choice. Mrs WILLIAMS pointed out that one of the drivers for POM-to-P switches was the Wanless report, which also proposes a voucher system for Pharmacy medicines. The system already existed in some places, but needed time to spread, she said.

Mr COX expressed the need for access to patient records in order for pharmacists to be aware of interactions and contraindications when recommending medicines. Ms NORTON recognised this, but said that the MCA does not want to delay switches waiting for the technology. However, when the technology did arrive, "it may open the door to some of the more potent medicines on the list going through," she said.

It was also commented that labelling a product GSL changed public perception. The products seems safer and less effective and makes a mockery of the pharmacist's role. Ms Norton, however, maintains that the public are sufficiently informed for this not to be the case and furthermore, a product is not reclassified to GSL unless it passes strict requirements.