The Pharmaceutical Journal
Vol 279 No 7476 p498
3 November 2007

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The profession

Considering a potential divergence within pharmacy practice

From Professor L. I. Goodyer, MRPharmS

I have to agree with Nicholas Wood (PJ, 13 October, p402) that we need to consider a potential divergence within pharmacy practice, particularly in the community sector, between those undertaking the more traditional roles and, in Clive Jackson’s terms, the “clinical modernists”. We probably need to go further than that and reconsider the definition of a practising pharmacist.

First, however, Mr Wood seems to give the impression that pharmacist prescribing is a uniquely UK phenomenon. This is not the case since there are a number of US states where such prescribing is well established, as it is for certain types of nurses. Although, as in the UK, such activities are currently most widely seen in the hospital sector, there are other scenarios in which pharmacists do make prescribing decisions.

For instance, I recently conducted a survey involving 60 travel medicine clinics in the US. In eight of these, pharmacists decided the vaccinations to be administered and were responsible for their administration. Parallels between community pharmacy practice internationally are difficult to identify because they are often based on different legal and ethical frameworks, not the least being the classification of prescription only medicines.

I agree that any system of medicines distribution must be regulated and that in general there should be more than one person involved between prescribing and the patient receiving the dispensed product, although I am not convinced this always needs to be a doctor or pharmacist.

It should also be noted that dispensing doctors practise both in the UK and many other countries. It also does not necessarily follow that because there was a separation between the clinical and dispensing role during the 18th century that a “pharmaclinician” — I would prefer the term “medicines therapist” — would not now have a role.

There is, of course, a vast difference between the materia medica of those times and the medicines of the present day. It can be argued that there should always be a role for a profession with a strong underpinning of science in determining the clinical use of medicines. In today’s multiprofessional environment many professions allied to medicine can prescribe in the UK and this is seen as part of their developing role in an ever changing health care system. In the final analysis it will be experience gained through research into these clinical roles that demonstrate their value.

Coming back to my first point, we must ask the question of a definition of the practice of pharmacy. At the moment it encompasses “anyone holding himself to be a pharmacist and giving advice on medicines”. I doubt whether the new General Pharmaceutical Council will be interested in registering many academics far removed from patient care or indeed those in industry.

Notwithstanding this, many such individuals could gain benefit from joining a new professional body. By considering such a body to be all inclusive the pharmacy profession will be strengthened and provide the public with a modern, science-based pharmaceutical service.

Larry Goodyer
Head, Leicester School of Pharmacy
De Montfort University

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