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Letters to the Editor
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Big Conversation
Pharmacists should manage the primary care drug budget
From Dr N. J. Gray, MRPharmS
I was disappointed that the report of the “Big Conversation” meeting
with Rosie Winterton did not accurately reflect one of the “radical” ideas
that were presented to the Minister during the group discussion at Lambeth
last week (PJ, 26 June, p791).
We asked that pharmacists should manage the primary care drug budget,
not the community pharmacy budget. The background information presented
for our discussion asked how community pharmacists could best re-engineer
their services with an ongoing 8 per cent annual increase in dispensed
items. We made the point that there was no reason to assume that this
should always be so, if community pharmacists could optimise patient
therapy. Quality from optimising patient therapy should result in cost
savings through waste reduction. Our discussion group believed that there
is great expertise among community and primary care pharmacists to undertake
this task. Community pharmacists are well used to managing budgets in
their practices. Some practice and primary care pharmacists are managing
their own drug budget in all but name. Hospital pharmacists have taken
this responsibility for many years now, playing a pivotal role in the
introduction of new drugs into practice, and developing and managing
formularies. We have the skills, and we are training pharmacists who
will also have the skills. Pharmacists, in partnership, can achieve this.
It was this suggestion that prompted Howard Stoate to say that he believed,
as a GP, that other GPs would welcome it if pharmacists took over chronic
disease management: it would let them get on with other things.
Pharmacists have an excellent argument to present in order to make optimal
use of their medicines expertise for patient and NHS benefit. Responsibility
for managing the drug budgets, at an individual patient and local population
level, would be a most logical and professionally satisfying move that
would cement pharmacists’ role within the primary health care team.
Nicola Gray
Member of Council
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The community/primary care drug budget was described in error
as the community pharmacy budget. — EDITOR
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Let's clear the decks of the time wasters
From Mr N. Baumber, FRPharmS
It is both exciting and nerve-wracking to see a health minister discussing
the future with pharmacists who are always eager to please, and the latest “Big
Conversation” exercise held at the Royal Pharmaceutical Society with
Rosie Winterton is no exception. However, apart from any government’s
inability to pay for what it gets, the problem for community pharmacists
remains the lack of time.
As a caring sort of person I do not mind too much spending three evenings
each week checking trays for the elderly. It is an essential part of secondary
dispensing but there is no time to do it in a busy working day. It also
clashes with evening meetings creating problems for continuing professional
development, holidays and family life. There is still no rational method
of payment to cover the costs in our part of the world.
And I do not mind spending an hour on my way home visiting patients because
this seems to take the stress out of their lives and resolves the problems
of the day.
Of the hurdles that we have to cross, to be able to work in a different
way, it is the time wasting things that are most annoying which have been
created by previous legislation. At the top of my list is the handwritten
record of sales and purchases of methadone. Supervision is on the increase
and has become a permanent daily feature. It takes a while to pre-fill
the bottles, especially at weekends and bank holidays, but the laborious
entry of details that is duplicated on the prescription and in the Controlled
Drugs ledger is nonsensical. Storage considerations apart, its classification
should be no more onerous than temazepam or buprenorphine.
However, the main time waster is still created by the prescription charge
and the consequent insistence on policing the exemptions on the back of
the prescription form. I estimate that this consumes about three million
hours of pharmacist time per year in England and Wales, not including the
time spent by staff trying to pin down signatures, payment and evidence
in a busy pharmacy. The gross income to the Exchequer is no more than £16
per taxpayer per year but it costs pharmacy dear in many ways (see PJ,
13 September 2003, p320).
Clear the decks of time wasting activities and we might find the time to
plan, to learn, to teach and to become caring, motivated human beings.
The ball is in the politicians’ court.
Noel Baumber
Grantham, Lincolnshire |
The
Pharmaceutical Journal