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Stephen Goundrey-Smith is healthcare development
manager, SGS PharmaSolutions
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The Broad spectrum feature is
open to any reader. Contributions of around 1,100 words commenting
on topical issues
may be posted to Graeme Smith, managing editor, or
e-mailed to graeme.smith@pharmj.org.uk for consideration
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During the past few months, there have been many, many letters in The
Pharmaceutical Journal from disgruntled pharmacists on the various
controversial issues that trouble the profession.
Such issues range
from the substantial increase in the retention fee to the responsible
pharmacist consultation, and from the loss of the category M margin
to the rates charged by locum pharmacists. Many of these issues reflect the ongoing debates that other
professions, as well as pharmacy, have on matters related to the professional
role, autonomy and value, and other political matters. Some of the underlying
issues are by no means exclusive to pharmacy and, as a consequence, it
is possible to view many of these letters with equanimity.
However, a recent letter described how a pharmacist wrote to his MP over
the retention fee issue and how the MP’s response showed “how
irrelevant we are to the powers that be in Westminster” (PJ,
24 November 2007, p587). Comments like this are rather more
disturbing.
During the course of this year, several commentators have stressed the
importance of political lobbying and have suggested that pharmacists
are too self-effacing when it comes to selling themselves as providers
of new services and health care initiatives. There are many who would
suggest that pharmacists have only themselves to blame for their lack
of relevance to the political powers and
authorities.
However, there are many pharmacists who are active in public life and
who are vociferous in their advocacy of the role of pharmacists in health
care. There are equally many pharmacists who are innovators, adept at
building relationships with local commissioners and developing new health
care services and initiatives to meet local needs.
It cannot, therefore,
be accurate to say that pharmacy’s marginalisation is entirely
due to a lack of political astuteness on the part of practising pharmacists.
The real issue is the disempowerment that many pharmacists experience
and the pharmacy profession’s quest for relevance must begin with
a move to build up the profession’s power base.
Recently, taxi drivers in Banbury, Oxfordshire, went on strike on a Friday
and Saturday night, as a result of Cherwell District Council’s
decision to delimit the number of taxi licenses granted each year and
the potential threat to the cabbies’ monopoly.
This action led
to angry confrontations in the town centre between cabbies and would-be
customers, extra buses being drafted in and a heightened police presence
in the town. As a consequence, many people in Banbury are now aware
of the relevance of taxi services in Banbury. And the Banbury taxi drivers
gained the attention they sought, not by writing letters to their MP,
or through tedious negotiation with the council, but by taking action
as a united body, to protect their interests.
Although there is not an exact parallel with the pharmacy profession
(and I am not suggesting that pharmacists go on strike to bring their
plight to the attention of the powers-that-be), pharmacists need to
build up their power base and learn to develop and protect their professional
interests. At first sight, this might fly in the face of the multidisciplinary
team approach that health professions are increasingly encouraged to
take.
However, sadly, for the majority of community pharmacists, collaboration
with other primary care health professionals is an illusion. The medical
profession is adept at protecting its own interests and the nursing
profession has become adept at advancing its standing. The pharmacy profession must
do the same if it is to survive as a recognisable profession. Pharmacists
will need to address a number of issues if they are to regain the status
and role that, as members of a profession, they should have.
First, the pharmacy profession is fragmented, not united. The Royal Pharmaceutical
Society has been heavily criticised for failing to advance the standing
of pharmacists, instead finding new ways to take their money and discipline
them. Consequently, many pharmacists feel a greater affiliation to their
employer, rather than to their professional body.
In addition, there
is a heterogeneous body of locum pharmacists who have no allegiance to
anyone, except perhaps themselves and maybe the Pharmacists
Defence Association.
Secondly, it is a fact that many pharmacists — especially employee
and locum pharmacists — do not have ultimate control over their
practice. The practice of community pharmacy is largely under the auspices
of large retail organisations, whose business objectives may not be aligned
with those of the pharmacy profession and where pharmacists are often
valued as managers rather than as pharmacists.
The role of the pharmacist
is likely to become more irrelevant in this organisational situation
with the proposed changes in the supervision regulations.
Third, for many pharmacists, particularly in the community, the reality
of pharmacy practice does not reflect their unique expertise and knowledge
base. The medicines management process is about the development, formulation,
supply and use of medicines, together with counselling and provision
of information about medicines-related issues. Pharmacists have the knowledge
and training to be involved in the development and formulation of medicines
and, although many pharmacists are indeed working in these areas, the
influence of the pharmacy profession in the pharmaceutical industry has
declined, for reasons that are beyond the scope of this article.
Pharmacists
should be concerned with the counselling of patients and the provision
of advice on medicines but often, in community pharmacy, these important
areas of activity are squeezed out by the sheer volume of prescriptions
that many pharmacies are processing. This is undoubtedly one of the reasons
why growth of medicines-use-review and enhanced-services activity has
been slow.
Consequently, all too often, the practice of pharmacy focuses only on
the supply element of the medicines management process. And yet, with
the growth of e-commerce technology, this aspect of pharmacy practice
is one that could so easily be taken on by any number of non-specialist
logistics companies. What is more, when the supervision regulations have
been changed, many pharmacy multiples may look at doing exactly that.
Pharmacists need to consider how they can re-engineer their practice
in order to make the most of the knowledge and skills that only they
have. Only by doing this will they begin to build up their professional
interests.
This will involve thinking outside the box and considering business models
that are radically different to the retail model that community pharmacy
currently conforms to. It is an urgent priority — especially for
locum pharmacists who, in contrast with contractors and employed pharmacists,
may find themselves in the wilderness when the supervision regulations
change.
However, if the pharmacy profession can build initiatives and services
based on the unique skill set and expertise of pharmacists, then its
professional interests will be strengthened and the quest for relevance
will bear fruit. |
The
Pharmaceutical Journal