The Pharmaceutical Journal
Vol 270 No 7230 p13
4 January 2003

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  Locum pharmacy
  Period-of-treatment fee
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Letters to the Editor

Community pharmacy

An urgent need to act creatively

From Dr B. P. Curwain, MRPharmS

Both Peter Cattee and Mike Bland have made many good points (PJ, 14 December 2002, pp844–5) in their replies to my letter (PJ, 30 November 2002, p779). I am not calling for large amounts of pharmacist time to be based in medical practice but until community pharmacists can access the whole patient record, and until pharmacies are generally suitable for private consultations, the surgery is more appropriate for some functions. It is precisely because I am worried about the continued provision of services from community pharmacies that I wrote in the first place.

All of us in the New Forest medicines management team regularly visit our community pharmacies. Some of us do locum work, and we are well aware how painfully stretched the service is in terms of pharmacists and support staff. Robust technician-led dispensing and checking systems can be developed, although not overnight. Evidence from hospital pharmacy (eg, Winchester) suggests that technicians are more accurate dispensers than pharmacists. As more pharmaceutical and medicines management input occurs in NHS surgeries, perhaps there will be some who argue that the need for pharmacist input in the pharmacy is reduced. This is why we must find ways to facilitate our community colleagues' participation in activities such as review, repeat dispensing and domiciliary visits.

As Mike Bland points out, there are disadvantages in having a pharmacy open without a pharmacist present. It is also debatable how "present" a pharmacist would be if he or she had just begun a 20-minute medication review in a private area. Thus, if we seek to provide a truly modern community pharmacy service, we do need to think a bit laterally. In some urban areas, fewer, larger pharmacies with two pharmacists on the staff would ease many of the problems; and in rural areas, like the New Forest, there are probably some pharmacies that could open shorter hours, allowing the pharmacist to do some work elsewhere.

I agree wholeheartedly about the urgent need for a new contract although I doubt that significant new money will be on the table. The Government wants to re-engineer the service and will probably only offer limited extra funding. I do not support this but am trying to understand the world as it is. It is because of the value I place on community pharmacy services that I see an urgent need to act creatively, before things go wrong.

Brian Curwain
Christchurch, Dorset

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