The Pharmaceutical Journal
Vol 279 No 7479 p584
24 November 2007

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Time to think long and hard about how pharmacy's future is being moulded

By Graham Morris

Reading George Batey’s letter (PJ, 3 November 2007, p498) I felt moved to add to his observations. I do get irritated by statements that pharmacists will have to “stop counting tablets” and come out from the dispensary.

I have spent many a busy year dealing face-to-face with customers, discussing problems with doctors, district nurses, practice nurses, local hospices, care homes, supervising methadone, etc. That is, of course, between updating my continuing professional development and standard operating procedures, performing medicines use reviews and dealing with the ever increasing paper workload that seems to have mushroomed out of all proportion.

What a fool I have been. I can only assume that all my efforts were in vain as I should have just trained up one of my staff to perform my role. Each morning I could have read the paper in the stockroom, with my feet up for three hours and let the dispensary look after itself. If there are any problems that cannot be solved the staff can tell the patient to come back later.

However, as a pharmacist, how many times have your ears pricked up when a patient says something to one of your trained staff and you have intervened? How many times has an error jumped off the prescription due to a sixth sense that is developed with experience? How many times have you been approached by a patient with a problem that is far beyond the expertise of your staff? Try writing that into an SOP!

Do you honestly believe technicians will fulfil this role to your professional satisfaction? For years we have promoted the knowledge, convenience and accessibility of pharmacists; now it is beginning to appear as if it was all for nothing.

Patients have had a rough deal from governmental contract changes to the health professions. What a great success the new GP contract has proven to be; now the majority of patients are unable to contact their GPs over a weekend. However, patients can at least keep themselves busy by extracting their own teeth with a pair of pliers while sitting in casualty in the hope of seeing a doctor.

The result of these changes is the worse accessibility to GPs and dentists that I have seen in my 30-year career. The most polite way of describing the situation is as a shambles. Now the latest brainwave will reduce patient access to their pharmacists too, while weakening your long-term future and income, if the “responsible pharmacist” idea is accepted.

I have read that under the changes pharmacy owners will be able to delegate the running of their business to a nominated pharmacist. The Department of Health has said that currently pharmacy technicians will be excluded from taking charge although this is likely to be reviewed in the future. This statement should be enough to make all community pharmacists sit bolt upright.

If you believe reduced remuneration, increased retention fees, lack of income from long awaited primary care trust services, increased workloads, direct-to-pharmacy distribution, practice-based commissioning, internet pharmacies, in-store GPs and 100-hour pharmacies are a real worry, these will pale into insignificance if you consider the possible effect of pharmacy technicians taking charge of the pharmacy and the impact of electronic prescription service technology.

Once EPS allows patients to nominate their preferred pharmacy to receive their prescriptions, then the starting flag is raised for altering the existing pattern of where prescriptions are dispensed. EPS will ensure that repeat prescriptions will arrive at their designated pharmacy well in advance of the patient and allow dispensing in readiness for collection.

The next step is when EPS is used to transmit non-urgent repeat prescriptions to the prescription processing centre of a large company, where the company distributes the completed items to their branches overnight. The patient would not notice any difference. This concept of “hub and spoke” dispensing will increase efficiency and so reduce costs. Robotic dispensers linked to existing pharmacy systems software exist now and work with frightening efficiency around the clock.

If dispensing technicians are eventually allowed to take charge of the pharmacy that receives these completed prescriptions, the next dilution of supervision will be video links in the pharmacy to a central pharmacist help desk to allow face-to-face discussions with patients who have specific problems.

The video link pharmacist will have access to the patient’s medication record, the prescription that has been dispensed and any other viewable information held on the NHS spine. One responsible pharmacist for each pharmacy will disappear.

The outcome would be to reduce pharmacy running costs and relieve the problem of obtaining locum cover. Dispensing fees can be further reduced due to the more efficient dispensing techniques, and the larger pharmacy companies, which are in a position to afford such an investment, will gain from the changes due to the economy of scale.

What I have outlined so far seems to favour the larger pharmacy chains and they are probably happy with the impending legislation. However, I do not believe they will be safe in the long term either.

Data captured by EPS already collates what has been prescribed and what is eventually dispensed. With such detailed information, what is to stop the Government eventually putting out to tender for the best price of what is dispensed nationally and using the dictionary of medicines and devices held within EPS to force contractors into using a specific dispensed product?

This is the exact same mechanism that many large companies already enforce on their employee pharmacists using existing dispensing software control. Why would the Government not employ exactly the same control by using EPS to restrict all contractors’ choice of dispensed product down to a single specific generic manufacturer? It could easily be made technically possible.

Pharmacists need to think carefully about the long-term implications involved before being allowed to “temporarily vacate the premises” abandon patient contact and offer services to those who may well have no money, interest or inclination to pay for them.

If the Government wants more involvement of pharmacists away from the dispensary, why not fund additional pharmacists to perform these activities co-ordinated on a local basis within the existing pharmacy model. This would stop short-changing patient access to instant health care advice and retain the essential “on site” expertise and safety that pharmacists have always provided to the dispensing process, as well as just letting us “count tablets”.

Be very careful that your future is not being moulded by what pharmacy owners and the Government want, rather than what you, as the pharmacist in charge, feel is safe and right for the patient.