The Pharmaceutical Journal
Vol 270 No 7238 p300
1 March 2003
PDF* 90K
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The Pharmaceutical Journal |
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PDF* 90K |
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OFT report
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Corporate pharmacyNo threat to evidence-based practiceFrom Mr I. B. Waite, MRPharmS The article by Kevin Taylor and Geoffrey Harding, "Does corporate pharmacy threaten evidence-based practice and policy?" (PJ, 15 February, p222), is interesting in so far as it demonstrates the gulf in thinking between theorists and practitioners. Much of the work of the community pharmacist is informed by the refinement of working practices using such elementary processes as common sense and does not need theoretical analysis for improvement. The fact that an increasing number of pharmacies are now part of chains is not an indication that there is "cause for concern" at all. The largest turnover pharmacy chain in the United Kingdom has been established for over 130 years and still regards excellence in professional practice as something to which everyone should aspire. The idea that pursuit of profit is something to denigrate can only come from academia since all people-focused activities, such as community pharmacy, survive and grow through giving customers what they want, continuously evaluating and improving the service they give, aiming at total customer satisfaction. That can only be something to be applauded even though it results in greater profits. The notion that "imposing routines on processes such as dispensing" is a result of ruthless rationalisation in pursuit of profit is laughable when one considers that the use of standard operating procedures is a basic tenet of clinical governance, which itself is a process designed to encourage continuous improvements in practice. SOPs are a major means of reducing errors due to human fallibility. Nowhere would company policy or protocols interfere with a pharmacist's clinical judgement since they are completely different aspects of practice. One uses policies and protocols to ensure high standards of practice, but professional judgement is not influenced by them. There is also no evidence that large corporations have in any way been slow in embracing "Pharmacy in the future" or "Pharmacy in a new age". All major pharmacy chains have pharmacy service development departments seeking to create new sources of remuneration outside the global sum, involving the introduction of new services such as medicines management, healthy lifestyle checks, smoking cessation services and so on. The authors appear to suggest that the Royal Pharmaceutical Society's response to the Office of Fair Trading report did not condemn it "out of hand" due to corporate pressure. However, the Society has said it was not in the public interest to remove controls. Do the authors not realise that any response aimed at politicians has to be related to the effect on the public? The Society's response was correctly tailored for the appropriate recipients. There have been many changes to community pharmacy in the past few years and there will be many more thanks to the advent of electronic transfer of prescriptions, pharmacist prescribing and services to primary care trusts. These will happen whether or not there has been input from the "pharmacy practice research community". We have come a long way in the past 150 years and will continue to develop and improve irrespective of theoretical research. The answer to the authors' question is "no". Ian Waite Multiples singled out unfairlyFrom Ms N. Kerr, MRPharmS Having read the Broad Spectrum article by Kevin Taylor and Geoffrey Harding (PJ, 15 February, p222) I would like to refute some of their claims concerning "corporate pharmacy". Moss Pharmacy historically has recognised the importance of being involved in practice research and has embraced the need for evidenced-based practice. It has been the community pharmacy partner in several major published research projects, which include medicines management, smoking cessation research in prisons, the Sheffield Heart Programme and compliance research in association with several schools of pharmacy, funded through the Government's research and development strategy. It was also one of the first companies to be involved in emergency hormonal contraception research. The authors appear to be denigrating the introduction of procedures and "imposing routines". It is important to point out that the driver for this has come from the Government via the National Patient Safety Agency, the Commission for Health Improvement and the Royal Pharmaceutical Society as part of the clinical governance agenda. It should also be noted that company policy, in line with 'Medicines, ethics and practice', supports our pharmacists' ability to exercise their independent professional judgement, and promotes an environment where our pharmacists are encouraged to make their own professional decisions. Dispensing is a codifiable task that does not require a pharmacy degree to undertake. The introduction of clinical governance and standard operating procedures will allow pharmacists more freedom to pursue extended roles and, if they so wish, practice research. We seek to celebrate pharmacists as professionals, not to "de-skill" them. The authors seem to suggest that pharmacists should stick to the supervision of dispensing, an idea I thought we had left in the 20th century. I find it, at best, misinformed that our efforts to drive forward the profession should be put down to the needs of "commercial expediency" and the "maximisation of profit". I am sure that anyone who has tried to develop new professional services will agree that if these were the only drivers then the service would not have gone far. Proposals for services will only be successful if backed up by solid evidence for their need, likely success and cost-effectiveness. The authors rightly celebrate evidence-based methodology but it would appear that they do not extend this ethos to their Broad Spectrum article, where they prefer to just single out "the multiples" for the problems faced by the pharmacy profession. Nanette Kerr |
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