| • The profession (3)
• NPC (3)
• Community pharmacy
• Prescription pricing
• Wholesaling
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• Dispensing
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• Regulation
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• Retention fees (2)
• Listening friends
• The Journal
Letters to the Editor
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The profession
Change must be driven by the needs of patients
From Mr S. R. Axon, FRPharmS
Perhaps one should not read too much into editorial headlines but it
was disappointing to read on the cover of the 8 September issue of The
Pharmaceutical Journal that “wholesaling
drives change for pharmacy”,
from which a casual observer might infer that the commercial motivation
rather than the professional one remains the change driver within pharmacy.
On p249 of the same issue some may find comfort in reading that pharmacy
is being “protected” by UniChem signing its agreement
with Pfizer and believe that altruism is alive and well within corporate
pharmacy.
Some may even agree with the Pharmaceutical Services Negotiating
Committee’s
view, confirmed at the UniChem convention, that the transition has been “remarkably
smooth because and only because we’ve kept the specialist wholesaler
in the game”.
Others might feel that this was a clear case of preaching
to the converted. It was therefore good to see the balanced
article on p259, which both put matters into perspective and raised
some interesting points.
If the new arrangements are as protective as UniChem would have us
believe, and as smooth as the PSNC claims, we may wonder why both the
National
Pharmacy Association and the PSNC plan to continue feeding information
back to the Office of Fair Trading, which was, in turn, prompted into
launching its market study by 500 letters of complaint and 40 letters
from members of Parliament.
We must all be aware that, for some years,
the OFT has involved itself with competition issues relating to the
distribution of pharmaceuticals at community pharmacy level and only
failed in its
attempt to remove control of entry by the intervention of the Department
of Health. The further involvement with the OFT, this time at wholesaler
level, can only assist the OFT in its primary objective of removing
control of entry.
It is now 20 years or so since the introduction of control of entry.
With the increase in pharmacy values leading, among other things, to
an expansion of multiple pharmacy at the expense of independent pharmacists
and where new pharmacies have no option but to use the 100-hour exemption
in order to open in competition with the multiples, some might wonder
whether the OFT might now have a stronger case.
If we are to preserve any credibility as a profession any changes in
pharmacy should be driven by the needs of patients. These are, primarily,
to receive their medicines safely, efficiently and promptly and, secondly,
to receive only such enhanced and additional services as they require. The
self protective motives of any sector should never be a driver for
change and neither should we contend (as UniChem appears to) that pharmaceutical
manufacturers cannot have their distribution arrangements challenged
and modified by agreement or even regulation.
If we are to move forward
as a profession then the interests of pharmacy should be protected,
insofar
as they can be, by the Royal Pharmaceutical Society and the many
other bodies representing the various sectors, and not by the unilateral
actions of individual players within the supply chain. Stephen Axon
Amersham,
Buckinghamshire
Control of entry denies the profession the chance to evolve
From Mr P. L. H. Marks, MRPharmS
Tom Moberly’s article “Experiences
of 100-hour pharmacies” (PJ,
25 August, p201) provides a platform for further thoughts within the
profession regarding control of entry.
Since the regulations were instituted over 20 years ago, community pharmacy
has undergone unprecedented increases in volumes of prescriptions dispensed
and new roles introduced. Yet the number of pharmacy premises have hardly
increased and most pharmacies occupy the same premises they did 20 years
ago.
Often these premises are unsuitable for the volume of prescriptions
now dispensed. Does this link to the significant increase in dispensing
errors? How can this nationally be considered adequate service provision?
The article provided further insight by detailing the fact that uptake
of enhanced and other new roles are significantly greater in new contract
pharmacies, demonstrating that competition generates choice for patients
and enhances the pharmacy profession.
It is somewhat extraordinary that existing contractors maintain the
mantra that a new pharmacy would have a devastating effect on their
business.
The obvious conclusion is that these pharmacies believe they are providing
a poor level of service such that patients who have been using their
services would leave immediately a new, untried provider opens.
I understand
that contractors risk their own money in their practices but so would
any new entrant and all other businesses. Furthermore, why should pharmacy
be different from any other business, particularly when its principal
creditor (the Department of Health) is unlikely to fold and not pay its
accounts.
Pharmacy contractors are paid through an annual global sum. How would
an increase in pharmacy numbers cause increased costs to primary care
trust budgets? The same overall sum will be distributed. There would
be no extra cost to the DoH or PCTs but there would be extra access and
competition for patients.
It is easy to understand why the Pharmaceutical Services Negotiating
Committee, the National Pharmacy Association and other contractor organisations
give such robust support to contract limitation: they are
funded by the principal beneficiaries, ie, contractors, to whom the restrictive
regulations gifts inflated goodwill values for their practices.
It is surprising that the profession as a whole has such an unquestioning
attitude to these 20-year-old regulations that benefit a few contractors
while effectively denying the profession the chance to evolve and, more
importantly, remove the principal driver to all service improvement —
competition. Philip Marks
Leeds
Pharmacists are valuable enough
From Mr A. J. T. Low, MRPharmS
I would like to add my support to the letter from Mark
Griffiths (PJ,
11 August, p156) about the key role played by pharmacies in the provision
of a modern health service. The debate concerning the responsible pharmacist
is not a by-the-way issue — it is of paramount importance. I took
part in the survey conducted by the Royal Pharmaceutical Society and
I am glad that I could do so.
One of the points in question is whether a pharmacist needs to be present
at all, or whether there can be a technological link from the pharmacist
to the customer in the community pharmacy — so-called “remote
supervision”.
I believe that if pharmacists persist in saying they can do so much more
than they can do at present, they will do themselves out of a job. There
is a danger of mass unemployment, as Mr Griffiths says.
Is it a quest
for gratification of our vanity that has led pharmacists to think the
way to rise above the battle (doing prescriptions and providing over-the-counter
remedies and solutions) is either to become tangled up in elaborately
structured services or to move out of the pharmacy altogether, doing
things that our elders and betters will command us tomorrow?
The proposition that we should not actually be present in the pharmacy
is remote from reality, considerably undermines our present important
role in the traditional pharmacy model and could lead us sleepwalking
into danger. The red flag of this proposition is that government officials
will say that our current jobs could be done by accuracy-checking technicians
and health care counter assistants.
There is no doubt that pharmacists are extremely capable. The training
I found arduous and I see some extremely competent colleagues. But
that our voices should be raised to say we are above being physically
present
on the premises seems, to me, to be deluded.
What we have done, by claiming that we are worth much more, is actually
to undermine our present status. Will it be much longer before our
remuneration for our core role dwindles even further and we are blown
onto the dole
queues, downgraded in the eyes of other health professionals, while
we claim that dispensing and work on the medicines counter was beneath
us
anyway?
As Mr Griffiths asks, could one see doctors adopting this approach
in future? No, they have too much sense and are much more secure in
their
sense of self and self-worth.
Our forte is that we can be seen easily by members of the public on
minor matters. I believe that is what people like. I do not think we
should
undermine it by giving ourselves ideas above our station. We are valuable
enough already. Andrew Low
Harrow, Middlesex
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The
Pharmaceutical Journal