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Steven Axon, of Amersham, Buckinghamshire,
is a former secretary of the
Pharmaceutical Services Negotiating Committee
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A pharmaceutical politician once said to me that he measured success by the length of a person’s car. It is sad but true that status is often judged by money earned. Many pharmacists do not take this view, however. They believe that enhancement of professional input into health care through new and extended roles is the key to improved status. Yet
a day’s pharmacy locum work cannot cover the daily rate of other
professions or trades as it could 30 years ago — a time when a
pharmacist’s notional salary was just over two-thirds of a GP’s
target income.
Reason for decline
One possible reason for pharmacists’ financial decline may be that
we have become a predominantly employee profession, which inevitably
depresses both pharmacist salaries and locum pay rates. When corporations
own most of the pharmacies, the community pharmacist’s salary and
status are likely to remain depressed and the pharmacist seen as just
another departmental head within a “store”.
Far from adopting the approach commended to the branch representatives’ meeting
this year (PJ, 10 June, p699) — whereby pharmacists should be encouraged
to refer to their premises as pharmacies, rather than stores or shops — the
profession continues to present itself in terms of a “brand”.
One widely broadcast advertisement describes a company as “your
local health authority” (which clearly it is not). Another emphasises
the value of a specialist “sun care adviser”, whose role
might appear as having equivalent status to a specialist “medicines
adviser”.
Dominance of the commercial over the professional role of the pharmacist
at practice level will also hasten the decline of pharmacists’ status
and salary. Imran
Khan (PJ, 3 June, p654) related an example concerning
medicines use review targets. With such an aggressively commercial approach,
coupled with brand exposure, it is not surprising that the National Pharmacy
Association worries over the loss
of care homes business from the independent sector (PJ, 3 June, p646). Will the current 250 per annum maximum for
MURs fare any better than the “five homes” rule for residential
homes services? Given the lack of logic in these rules and commercial
motivation, the MUR limit or any other arbitrary limit placed on pharmacy
services is likely to be circumvented by a “loophole” or
challenged as a restrictive practice.
Progress of a sister profession supports the cognitive path to status
and better rewards. The status of nurses has been greatly enhanced in
a number of areas, some of which have alarming parallels in pharmacy.
For new entrants into nursing, the option of a degree course has given
an enhanced academic perspective that might have seemed to some to be
missing from traditional,
practice-oriented training. By comparison, pharmacy is no longer the
only easily accessible “scientist in the high street”. Increasing
the length of study for pharmacists by a year and upgrading the bachelor’s
degree to the master’s has gone unnoticed. This is not surprising
when we find that, despite the long and complex training and the preregistration
period, every new role, however simple, that pharmacists take on needs
additional training, accreditation and external monitoring. Why cannot
the Royal Pharmaceutical Society accredit degrees that teach a student
to be a pharmacist in the first place?
For practising nurses, extending their role to justify titles of “practice
nurse”, “nurse practitioner” and “consultant
nurse” has increased status considerably, particularly when aided
by sympathetic treatment in television soap operas. In my own surgery
it is more difficult to get an appointment with the nurse than with the
GP. Pharmacy on the other hand seems content to promote the concept of
the “storekeeper”, stressing its availability without appointment
and free advice. Not surprisingly it is often inaccurately portrayed
in a subservient role in those same soap operas. The comparison between
the achievements of the Society and those of the nurses in the field
of prescribing was dealt with in a letter from Garry
Barrett (PJ, 3 June,
p653). in which he likens the pharmacy approach as “grasping at
crumbs”.
Ironically nurses’ enhanced status stems from their original position
as employees in a supportive role, with limited responsibilities and
requiring supervision changing to a profession with an independent role,
albeit still predominantly employed. Increased remuneration has followed
to reflect increased status. Pay attention to salaries
If it is not already too late to turn back the tide, more attention
needs to be given both to promoting the professional role rather than
the
pharmacy “brand”, and to salaries of employed pharmacists
both now and in the future. There is no organisation to represent employee
pharmacists. All attempts to set one up in the past have failed. The
Jenkin judgment of 1921 made it clear that the Society is prohibited
by its Charter from representing employee pharmacists in their dealings
with employer pharmacists or acting as a trade union (like the British
Medical Association and Royal College of Nursing). The NPA and the
Pharmaceutical Services Negotiating Committee were set up, as a result
of “Jenkin”, to represent pharmacy owners, and recent changes
to local pharmaceutical committee constitutions from the PSNC have
even removed the small voice that employees once had locally. Without
a representative organisation, heavy reliance is placed on benevolent
employers. Whether pharmacy owners merit that description is for individual
judgement. They certainly have commercial motives to keep salaries
depressed. The Society’s pharmacist employees
So what is a pharmacist worth? Where better to look for a guide than
to our own Society?
The Pharmaceutical Journal of 3 June carried a letter (p654) about
the cost of our
41 Council members and an advertisement (pA24) for
a “professional
ethics pharmacist” at Lambeth. The requirements for this post stated: “ You
should be a pharmacist with experience in one or more fields of practice
and be enthusiastic, proactive and capable of dealing tactfully and diplomatically
with a wide range of people. A thorough understanding of the Code of
Ethics and pharmacy legislation is essential, as is the ability to communicate
effectively, both orally and in writing. You should have good organisational
and administrative skills and be able to manage your time to meet competing
priorities.”
The salary offered by those same Council members (whose total cost to
the profession in 2005 was £480,744) for this paragon of pharmaceutical
perfection to work in central London started at £31,064 per annum.
Council members giving up time for the good of their organisation should
not be out of pocket.However, the £17 per hour offered for the
employment of this professional pharmacist with a wide range of additional
expertise and skills might be compared with the additional salary of £200
per day agreed by the Council (and the Privy Council) to be paid to themselves
by way of attendance allowance for their time and expertise.
From an IDS report, it appears that £31,064 per annum is below
the national average (male) earnings for April 2005 of £31,515.
Of course, there are pharmacists earning less than this but our Society
has no control over what others consider a pharmacist is worth. It does,
however, have control of what it pays its own employee pharmacists.
Salaries at the “top of the office” at Lambeth are probably
in keeping with the responsibilities of the posts and may be justified
compared with salaries of senior executives in other organisations. However,
the salaries advertised in the PJ for lesser pharmacist posts at headquarters
does not say much for what the Society thinks of the status of its own
profession. Other examples (PJ, 27 May, pA19) include a regional
lead inspector at £35,959 and a practice pharmacist at £31,434.
If £17 per hour really is what the Council considers a pharmacist
with the listed additional skills is worth, it is not altogether surprising
that LPCs have such difficulty in negotiating at PCT level. |
The
Pharmaceutical Journal