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Peter Jenkins is a former proprietor pharmacist
from Cardiff
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The roll out of electronic transmission of prescriptions appears to have
been put on hold. What a surprise! The evaluation of the project has
confirmed that it is technically viable so why the delay? Could it be
that no one is prepared to pay either the installation or the running
costs? I hope that our representative bodies made it quite clear from
the start that the cost should not be carried by pharmacy contractors
from existing money. And, naturally, GPs could not be expected to stump
up, so the bill falls back on the Department of Health, which makes sense.
But, whatever the benefits of the system, the Department evidently did
not think it was cost-effective if its money was going to be used. It
may be a good idea for patients in that it would cut out the chance of
some types of fraud and speed up the process, but it seems that in the
end it was not thought that the benefits would justify the resources
needed.
This result was predicted in some quarters and one wonders why so much
effort is put into these projects when they stand so little chance of
being funded. You do not need technical computing knowledge or experience
to work out that whatever system was chosen someone would have to find
the cash eventually. If no cash was to be made available, why run the
exercise unless some level of encouragement had been at least hinted
at? The commercial companies involved must have thought they stood a
chance of getting their money back, and of making a profit. However,
along the way some, perhaps more realistic than others, saw things in
a different light and backed out.
The whole exercise raises a lot of questions as to the real intentions
of the Department with regard to pharmacy. The slow rate at which pharmacies
are being connected to the NHSnet is not a good omen. The big test will
be the new contract, because although we are making good, if slow, progress
the crunch will be when the pricing starts. Even the Department must
accept that contractors’ expenses plus a fair profit will not be
covered by a dispensing or equivalent fee at the present rate. That is
if they want to keep a dispensing service available across the country — but
one wonders what they do want considering the outcome of the Office of
Fair Trading review is still in the background.
There is little real political interest in pharmacy because it has little
clout compared with the medical and nursing lobbies. Consider our political
set up. We have a stream of relatively junior politicians who each want
to make a name for themselves. They all know that whatever job they do
they will not be in the slot for long. Make a real mess and they will
get dumped; make a real success and they are moved up, never to have
pharmacy contact again. They have no power to move mountains, though
they may push molehills about for a short time while we make a great
fuss of them. I, like many others, have resented having to be dependent
on this succession of small figureheads — but that is the way the
system operates.
We must respond as best we can to government plans and now, since ETP
appears to be over the horizon, we can concentrate on those other saviours
of pharmacy on offer, especially prescribing.
Supplementary prescribing
However, before there is prescribing there must be diagnosis. There
is no point to the second without the first but pharmacists are not trained
in any depth on diagnosis.
Counter prescribing has always been practised, giving satisfaction
to the pharmacist, relief to many patients and taking pressure off
other
services. For this the pharmacist is qualified by training and experience.
There are basic questions to ask, interpretations of the answers, the
viewing of spots and listening to sounds and descriptions. The pharmacist
then judges whether to send the patient for a second opinion or to suggest
something to ease the symptoms always with the proviso that if there
is no benefit in a short time or different symptoms appear then deeper
analysis should be sought. Diagnosis is, of course, involved but at a
relatively superficial level since it is often the patient who is the
diagnostician. Working in a shop and looking after staff gives a good
background. The amount of formal training needed is not great, so the
education industry must not be allowed to go into overdrive but rather
just lay out guidelines and let practitioners practise.
We also have patient group directions and various local schemes to treat
such common complaints as head lice. All have produced good economic
results where the pharmacist has been able to write “NHS prescriptions” to
cover the supply. Other schemes whereby patients presenting at the surgery
with, for example, cold symptoms, have been given the option of visiting
their community pharmacist who has supplied medicines and claimed back
his or her costs and a fee. These schemes have many virtues and safeguards
are built in. They are really worthwhile ideas, the development of which
could be a real boon to all concerned — and they are well within
the capabilities of all pharmacists with some practice experience. The
minor ailments scheme is a prime example of this concept.
This is more than can be said for the other prescribing ideas. Given
the costs and time required to train supplementary prescribers, I believe
it is primary care pharmacists who are more likely to go through this
than community pharmacists. Many of them, so far, have worked on drug
budgets, formularies and medicines management, with great expertise and
benefit to the GPs involved. I only wish I had the services of experts
to get my costs down without having to pay their salaries. Before the
training they must link up with a GP mentor and set up individual care
programmes, but we must keep this type of prescribing in perspective.
The nurse prescribers, working from their own formulary, are mainly concentrating
on prescribing dressings rather than the other items with which they
were not so familiar. As ever, nurses are being practical and leading
with their strengths while pharmacy seems to be dazzled by new ideas.
We should concentrate on what we do best and that is to dispense or sell
medicines and to counsel patients. To do what is best is summed up by
the proposed framework for the new contract — all this and being
the available health professional in our pharmacies. What is wrong with
that? If we had concentrated more on these roles we might have been able
to stop the trickle of products from pharmacy to general sale list becoming
such a flood.
If someone does not agree with so-called new ideas as they arise there
are always others ready to call them Luddites, or even unicorns, but
these are easy shots. The truth is not so simple. Rather it is between
those who think they see into the future and those who do not agree with
their vision. The alchemists seeking the philosopher’s stone probably
called disbelievers the same names — but who was right?
Many are trying to move the profession forward; the only argument is
really about the route. It is easy to paint the future with dramatic
flourishes but what do we have to give up and what will we achieve? The
story of ETP and this year’s contract settlement should teach us
how others view us. We must not give up striving but we must be realistic
as to what is best for pharmacists, because members of other professions,
especially doctors, will not part with anything of real value. We could
end up on a middle ground working as what used to be called barefoot
GPs while technicians and automation take over our traditional duties
and strengths, and the multiples become bigger and more powerful. |
The
Pharmaceutical Journal