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Roger Cotton is senior manager for corporate social
responsibility at
Alliance Pharmacy
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Let me say at the outset that I am fully supportive of the move to allow
independent pharmacist prescribing. However, as a corporate social responsibility
practitioner, as well as a pharmacist, I think we need to take a step
back from the euphoria surrounding the announcement by the Secretary
of State for Health, Patricia Hewitt, and reflect on the risks involved.
In an editorial in the BMJ for 19 November 2005 (p1154), Anthony Avery,
professor of primary health care, and Mike Pringle, professor of general
practice, Nottingham University Medical School, appear to be supportive
of the move in principle, but point out that this important departure
from current practice deserves scrutiny.
I would certainly agree with that, although my reasons are not around
exceeding competencies, training and clinical governance that they mention.
These are all important issues, but I suspect everyone has jumped ahead,
to a kind of “
solutions mode” of thinking, before having fully analysed the potential
impacts of this decision. If we do not approach this systematically,
we risk a piecemeal approach to preparing the profession for this change
and a failure to take other interest groups, especially patients and
GPs with us.
We cannot afford to have our professional bodies take us forward by a “decide,
act and defend” leadership route, which will prove unsustainable.
Listen, learn and engage
If we accept that we need to take stakeholders with us as we prepare
for independent prescribing by pharmacists, then we need
to “listen, learn and engage” and do so as a profession.
If we fail to do this as a united profession we put our profession’s
reputation at risk. I believe that a project-based approach to risk management
is needed, going way beyond setting a two-year registration limit for
prescribers, providing appropriate training and introducing a new batch
of standard operating procedures.
We have to explore all the potential risks, in depth, before we can mitigate
against them, to prevent them becoming issues and our profession having
to behave defensively in the future.
So what sort of risks am I referring to?
First, introducing independent prescribing will change the dynamics of
the following
relationships:
- Patients and pharmacists
- Pharmacists and GPs
- Manufacturers and pharmacists
- British Medical Association and Royal Pharmaceutical Society
- Pharmacy profession and patient groups
- Pharmacy profession and media
There are probably others. Suffice to say almost every relationship
that we can think of, in relation to our practice, will be affected in
some way.
Let me illustrate how some of these relationship changes could impact
on pharmacy and pharmacists:
· GPs are subject to patient expectations that a consultation is almost
invariably followed by a prescription. If pharmacists are subject to
such pressures will they react similarly?
· GPs have sometimes been accused of over-prescribing, particularly
for antibiotics and antidepressants, resulting in resistant strains of
bacteria and drug dependency. With little or
no experience of prescribing such an array of medicines, how do we ensure
pharmacists avoid the same accusations?
· Researchers for consumer groups are bound to find examples of poor
practice, leading to allegations of “prescribing for profit” and
not in the best interests of the
patient.
· Errors in diagnosis by pharmacists would be jumped on by some GPs as
evidence of some members of our profession, if not the entire profession,
being unfit to prescribe.
It is only to be expected that, in the early stages of such a radical
change as this, however much we welcome it we will see examples of error,
misjudgement and poor decisions.
Although none of these will invalidate the rationale behind Mrs Hewitt’s
decision to grant our profession prescribing rights, they will put our
profession in a bad light. Make no mistake: the spotlight will be trained
upon us from the outset.
From a corporate responsibility perspective, it is these relationship
changes that have to be taken into account when seeking to safeguard
properly our profession’s reputation. At the corporate level, this
would be about protecting a brand. We need to think of our profession
as a brand, too. This is where we need our various professional organisations
to show leadership.
How shall this leadership manifest itself?
On the basis that our stakeholders, (customers, patient groups, GPs,
pharmaceutical manufacturers, etc), give us the metaphoric “licence
to operate”, in this case to act as reputable independent prescribers,
we have to hold a genuine dialogue with them.
We need to listen, learn and engage with stakeholders, not just talk
among ourselves and decide things in isolation. We need to bring stakeholders
with us. We need their input as we explore the impact of these changes
to our relationships. We need to understand their opinions, concerns,
hopes, and even anger if it exists.
Collaborative approach
It is my contention that our professional organisations must invite
all the various stakeholders, including practising pharmacists, to work
with them as they inquire into how this change in practice will impact
on various relationships. This could involve a series of meetings with
a collaborative approach to identify the risks properly, explore how
they can be mitigated and determine how we prepare for this change
in a way that ensures our stakeholders are engaged with us. The “decide,
act and defend” approach has to be avoided, and this can only
be done if we are listening, learning together and engaging stakeholders
from the outset.
We need our professional leaders to develop a risk management strategy
for this welcome change, to avoid the sort of risks outlined above becoming
issues in which they find themselves pitted against stakeholders, not
working with them. Only in this way can we defend our brand and its reputation
from the risks of independent prescribing. |
The
Pharmaceutical Journal