The Pharmaceutical Journal
Vol 279 No 7482 p682-683
15 December 2007

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Letters to the Editor

The profession

One small step to make one giant leap

From Mr Y. K. J. Tang, MRPharmS

As I read in the news that yet another GP surgery contract had been awarded to a partnership founded by two Essex GPs, this time in my own local area of Southend-on-Sea, I began to wonder.

Every pharmacist I have spoken to so far thinks such contracts are beyond the reach of pharmacists because “we are not doctors”.

This is a sad mentality, not just because of the obvious subservience this pessimistic view represents, but the inability of our profession to break out of our self-imposed straitjacket to realise the opportunities that the new NHS presents and most alarming of all, the timidity in which pharmacists are ignoring one of our greatest assets, business skills.

Yes, primary care trusts and thus the new NHS are now dominated by one profession — GPs. Yes, an increasing emphasis on local commissioning means, despite quarrels among themselves, GPs are always more likely to look after their own than a competing profession like ours (just ask the nurses).

But what makes GPs more qualified to run GP contracts than pharmacists? Which part of their medical training prepares them for this new commercial role? Other than their local power base, what qualities do GPs possess that pharmacists do not? After all, these contracts are open to competitive tender.

To me, the answer lies in the lack of confidence and most important of all, the lack of ambition — an inability to think outside the restricted box that is also called the dispensary, and the unwillingness to leave the comfort zone that our profession has dwelt albeit so tantalisingly since the advent of the NHS.

Most of those who work in community pharmacy are also businessmen (or business women) and possess vital business management skills. As GP contracts resemble businesses more and more, as I am sure many GPs now realise and have already begun to practise, pharmacists have the skills required to run these commercial concerns more efficiently and more economically.

Ever since the “cost-plus” pharmacy contract was so timidly abandoned, community pharmacists have had to cope with a relentless series of attacks on their margins, even before the latest category M fiasco. Yet they still survive, albeit only just. This is testament to our tenacity under pressure.

If only we can look beyond our dispensary bench and pharmacy counter and realise that, if GPs are prepared to leave their own comfort zone of the consultation room and embrace the new opportunities that the NHS presents, so can we. And so we must.

Are we so benevolent and immersed in the NHS equity ethos to see the benefits that our business skills can bring to primary health care? Are we so myopic in our outlook to ignore a win-win opportunity for both our profession and our patients?

When John F. Kennedy made that famous speech about the American dream of getting man to the moon and bring them safely back before the end of the decade, many of the technologies required did not even exist, but they made it happen. They succeeded because they had the vision and were prepared to look beyond the horizon.

I see no reason why pharmacists cannot do just as good a job in running a GP surgery as the GP partnership. All it takes is for a few individuals to start that “one small step” for our profession to make that “one giant leap”.

Y. K. Jonathan Tang
Westcliff-on-Sea, Essex

Striving for that unique role

From Mr R. G. Powdrill, MRPharmS

I registered in 1967. It was a wonderful time to be young. Everyone seemed to be upbeat most of the time — even older pharmacists. There was creativity and imaginative enterprise among young people in so many areas of life.

What a pity more of us did not put more into the future of our profession. Maybe we were just waiting for closing time so that we could get back to the party known as the 60s. Young pharmacists felt quite well paid with their recently acquired motor cars and most established proprietors were making a mint. Were we complacent? Without doubt.

I remember that back then, in The Journal, almost every other letter was headed “The pharmacist’s role”. It continued month after month, year after year. But who would have imagined that we would still be addressing such an important issue 40 years later?

In 1967 we were still actually preparing many medicines to be dispensed, but slowly this was giving way to already prepared unit-dose medicines. What had been an admirable role, unique to pharmacists, was beginning to disappear after many decades. Aware of this we were looking for a new role.

So, over the years we have found new roles. According to the “Pharmacy 2020” questionnaire we now have at least 35 roles. The huge problem is, however, that the vital description “unique to pharmacists” does not apply to any of them.

I think that this is of paramount importance. Yet I have never seen the issue addressed. If you look at any other profession which is esteemed by the general public and politicians, and you will notice that they all have an easily identified and easily understood role which is unique to them (disregarding any inconsequential trespassing which occurs in a practical world). Such a role attracts respect, giving a solid foundation to a profession and making it indispensable.

We used to have the unique role of preparing medicines but that has gone. “Dishing out the pills” simply does not “hack it” with the public or politicians. In any case it is no longer a unique role.

So now we are asked to guess what we will spending most time on in 2020, and how we are likely to get there. I suggest we can easily get there by drifting.

Unless the Royal Pharmaceutical Society is deliberately trying to be provocative, this has to be the most lamentable thing I have ever seen.

The amount of writing on “The pharmacist’s role” would probably stretch from here to the stratosphere. Why do we not start by suggesting that our main role should be one that best suits our training? That might sound logical and quite obvious. Obvious but extremely difficult to face.

This is because role number 22 (prescribing) has always been the domain of a powerful group of professionals, known as physicians. As a matter of fact they enjoy two roles that are more or less unique to them.

Common sense dictates that a pharmacist’s training gives him or her the perfect platform to learn to become a competent prescriber and that a physician’s training is oriented towards diagnosis of illness and disease. Of course, politics, not common sense, has dictated lawful practice over the years and will continue to do so unless pharmacists make a serious beginning on “moving this mountain”.

Past president of the Society Nicholas Wood believes that by 2020 we will, on our present course, see clinical-modernist pharmacists sleep-walking into this role and that they will “closely resemble GPs of today” (PJ, 13 October 2007, p402–3). I believe he is super-optimistic.

In the eyes of society, drugs are glamourous and to hold the right over prescribing is a nearly unique power that physicians will be loathe to relinquish.

Yes, we have made tentative beginnings in the role of prescribing. I fiercely believe it is the only role really worth striving for and ultimately needs to be, if not totally unique to pharmacists, then “the hook on which we hang our hats”.

To achieve such a turn around would require decades of ongoing work and negotiation, but the alternative may well be a gentle slide into oblivion, fulfilling those 35 or more functions shared with all kinds of groups of people.

So instead of this weak plan to reach such a dismal future, I think we need to proclaim: “By the year 2037 we will have achieved our collective goal of becoming the profession which essentially prescribes drugs. We will move profitably and unstoppably in our determination to reach that ultimate goal.”

How I wish we had made a start in 1967.

R. G. Powdrill
Market Harborough, Leicestershire

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