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Letters to the Editor
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The profession
We can learn to be magicians
From Dr. B. Curwain, MRPharmS
Darrin Baines writes about the need for magicians (PJ, 3 September
p285 PDF (60K)). He is right, although the term is simply shorthand for
those who think
radically, understand others’ points of view, and are comfortable
with change and uncertainty. Probably the training that pharmacists go
through predisposes us to think in terms of predictable, safe systems and
situations. Caution and getting it right remain important in pharmacy practice.
A discomfort with uncertainty, and a fervent desire to hang on to what
we already have, has been evident in our history over the past few decades.
As a profession our behaviour has reflected insecurity about the status
of our function in the delivery of health care. This insecurity may have
its roots in the decline of traditional compounding and small-scale manufacturing
of medicines. Our role as community pharmacists, and increasingly our income,
appeared for a while mainly to involve dispensing what others made and
doctors prescribed. As a result, we tied ourselves up in exquisite knots
so that we could hang on to this. The final check and the need to be present
constantly both disempowered our staff and made the job of a community
pharmacist deeply unattractive to many. We hung on to the technical stuff
and neglected to develop our clinical skills. It has isolated us from the
rest of primary care and some pharmacy bodies colluded with this. Only
recently have we begun to have better contact with the other health care
professions.
What needs to happen next? We must move firmly forward on improving the
skill-mix in pharmacies, and then on delegating more of the routine tasks
to non-pharmacist staff. Of course we need pharmaceutical input to prescriptions
but, increasingly, this is happening through pharmaceutical support to
GPs. Practice-based commissioning represents a huge opportunity for pharmacists
but it will be a threat if we do not grasp it. As primary care trusts get
larger and become mainly commissioning organisations, are they going to
continue to pay for pharmacists working in practices? Certainly if the
financial risks around practice-based commissioning move to the service
providers, PCTs will pull out and pharmacist and technician employment
will be transferred. It may happen anyway.
If community pharmacy wants fully to join in with the NHS arrangements,
the model of one pharmacist at a time in each pharmacy practice is unhelpful,
especially if the pharmacy is expected to be open all hours. It has allowed
the development of a specialist group of pharmacists working in PCTs. In
towns and cities, we need to see mergers so that busy pharmacies can be
properly staffed and still be able to send members to meetings with other
parts of the health system during the working day. This will also decrease
the professional isolation in which many community pharmacists work. In
more rural areas, there may be no requirement to be forever open if the
local community is clear about the arrangements. The Government’s
desire for ever-better access to medicines has to be balanced against other
issues in developing the service. We do need pharmacists available to the
public to provide both treatment and health and lifestyle advice, and the
Government wants this.
There are ways in which we can be both integrated in the NHS and freely
available to the public but we have to be comfortable with the changes
it will bring. The more of us who can learn to be magicians, or at least
trainee magicians, the brighter our future will be.
Brian Curwain
Chief Pharmacist
New Forest Primary Care Trust |
The
Pharmaceutical Journal