The Pharmaceutical Journal
Vol 270 No 7233 p114
25 January 2003

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Letters to the Editor

The Profession

Poor public image down to individuals

From Dr L. Matowe

I would like to comment on Dr Pauline Norris's article on how the profession should respond to its declining public image (PJ, 11 January, p48). In the article Dr Norris argues that any decline in the public status of pharmacy may be the result of general changes in the status of professions in the late 20th century and early 21st century. Whereas this is a credible argument the worry for pharmacists is that fellow health care professionals, eg, doctors, still maintain a good public image as demonstrated by the MORI report that I cited in my comment (PJ, 9 November 2002, p674).

Dr Norris suggests that the best strategy to improve the image of pharmacists would be to concentrate on improving and extending pharmacy's contribution to patient well-being. This pharmacists have been doing for a long time and is exemplified by the advent of pharmaceutical care, clinical pharmacy and primary care pharmacy among other roles. Patients are aware of pharmacists' contribution to their well-being hence their frequent visits to pharmacies for an initial consultation. The issue, however, is how much importance patients attribute to this pharmacist-initiated care.

Variation in performance occurs in every profession and clients are aware of this and hence choose their service providers. In health care, practice guidelines have even been widely implemented to standardise care. The question, however, is whether variation in care affects public perception of a profession.

Over the years pharmacists have been striving to improve their performance. In Britain, for example, the Royal Pharmaceutical Society has run successful continuing education programmes, culminating in the current plans to make continuing professional development compulsory. Competence examinations are also taken before new graduates can register. These are all efforts to maintain professional competence and thus there is no justification for portraying the profession as complacent.

In conclusion, I concur with Dr Norris that a strong and courageous professional organisation is required to address issues pertaining to image. Such strength and courage has often been demonstrated by the Society. It is mainly the effort at individual pharmacist level that has been invisible.

Lloyd Matowe
Department of Pharmacy Practice,
Kuwait University

Levy a fee for promoting pharmacy’s public image

From Mr S. Vohra, MRPharmS

Reading the Broad Spectrum article written by Dr Pauline Norris on "... pharmacy's declining public image", may I dare to propose a £10 or £20 sum be paid by all pharmacists to be used on beneficial advertising that promotes the expertise, professionalism and the important service provided by pharmacists to their local community? This sum can be levied at the same time as the annual retention fee and is, in my opinion, a small price to pay if it helps improve our public image. Most pharmacists will probably object to this charge but community pharmacists at least should see the sense in it. This type of responsible promotion will do much to enhance our image.

Samir Vohra
Hounslow, Middlesex

Two-pharmacist model favours delivery of care

From Ms P. Grant, MRPharmS

I would like to echo Oliver Carter's "wake up" call to community pharmacists (PJ, 21/28 December 2002, p886). As a fourth year pharmacy student, he has already identified the need for a change in working practices in community pharmacies if they are to deliver patient-centred care. Unless a pharmacist is actively adding value to the dispensing process, then he or she has no need to be part of that process. As Mr Carter points out, if all a pharmacist does is supply medicines to a patient according to a prescriber's specification, then he or she mimics the role of a dispensing technician. As long as staffing levels in community pharmacies dictate the use of pharmacists as dispensers, this practice will continue.

Newly qualified pharmacy graduates, having studied clinical pharmacology, therapeutics and pharmaceutics for four years are already emerging into the commercial world of retail pharmacy full of enthusiasm and expectations. They soon discover that actually the working environment of the high volume dispensing pharmacy precludes them from using much of their newly acquired knowledge in any practical way, and disillusionment sets in.

So what are possible solutions to this seemingly intractable problem? Dr Brian Curwain (PJ, 4 January, p13), with his wide experience of both community pharmacy and the primary care environment, touches on a couple of practical solutions. One is to operate a community pharmacy with two pharmacists on the premises for at least part of the working week. "But there are not enough pharmacists to go round", I hear you cry, and "How will we pay them?" I believe there would soon be enough pharmacists to support a two-pharmacist model, if working practices were changed. This model would allow pharmacists to spend time with patients, advising them about their treatments, assessing their ability to comply with prescribed therapy and offering innovative, practical pharmaceutical solutions for older patients with multiple conditions. These patients are currently struggling to comply with their complex medical therapies against a background of declining cognitive function, visual impairment and loss of manual dexterity. They are currently denied the practical help that they need.

The combination of a newly qualified graduate working alongside an experienced established pharmacist could provide a symbiotic partnership that would allow the delivery of pharmaceutical care to patients. The current single pharmacist model favours the delivery of pharmaceutical products without that important added value component of care, which many patients need. This improved working environment would not only increase job satisfaction for both pharmacists, but also help to retain our new graduates within the profession and ensure a viable future for community pharmacy.

The funding problem is one that needs to be urgently addressed at a national level by both our professional and negotiating bodies working in unison. Each community pharmacy dispensing more than 1,600 prescription items a month currently receives, every month, the sum of £1,460 from central funds to provide additional professional services for patients. If our negotiating bodies could persuade the Government to increase this payment, and ringfence the monies to pay for additional pharmacist time in community pharmacies, then we could really begin to deliver the Government's vision for patient-centred care.

Newly trained graduates are the life-blood of any profession; they represent its future. We, as practising professionals, need to harness both their knowledge and initial enthusiasm and provide them with a working environment where they can use their knowledge and skills to deliver pharmaceutical care for patients. If we fail to do this, then we will lose both a precious asset and any credibility we may currently have as a health care profession.

P. Grant
Poole

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