The Pharmaceutical Journal
Vol 280 No 7484 p15-16
5/12 January 2008

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• The profession (4)
• Controlled drugs
• Supervision
• Influenza
• Prescribing (2)
• Glaucoma care
• Drug development
• Christmas

Letters to the Editor

The profession

Christmas name game

From Mr M. W. Beaman, FRPharmS

I was intrigued to read the Leading article, “Christmas name game” (PJ, 22/29 December 2007, p700). I wonder how many of those pharmacists (and registered technicians) not included in the list were saying to themselves over Christmas that “it should have been me”?

Those on the list certainly have a record of achievement and delivery and it is to be hoped that this has already been recognised by the awards and honours available both in pharmacy and healthcare as well as further afield.

This list follows hot on the heels of another list in a supplement of the Health Service Journal (November 2007) of the 50 people with the greatest influence on NHS policy and practice in 2007; pharmacy was noticeably absent. Does this reflect a dearth of leaders and champions in pharmacy?

If at the beginning of 2008 all the practice-based commissioning groups in England (and there are probably several hundred) requested that a local pharmacy leader joined their group, would we be found wanting?
Now there is a challenge for 2008.

Mike Beaman
Littlehampton, West Sussex

Let us stick to analogous professions

From Mr F. H. Lawton, MRPharmS

Ah yes. The dear old plumber rears his head again according to the amusing letter by Anthony Cox and Christopher Anton (PJ, 24 November 2007, p590). Unfortunately, but not unreasonably, the plumber is among the most despised of all artisans.

Requesting an emergency call-out in the middle of the night, with water flooding round one’s ankles or a boiler that always seems to break down in the depths of winter, one is hardly in a position to negotiate a “good price”. You just give them a handful of cash and go back to bed feeling relieved but aggrieved.

Job evaluation is one of the most divisive issues that bedevil the free market economy but I believe one has to show greater equanimity when using plumbing as a comparator for pharmacy.

From the relatively pleasant working conditions of a nice, clean, warm, well lit dispensary, with its genteel atmosphere and one’s own professional kudos, I would not fancy spending my working life scrambling up in lofts, pulling up floor boards or clearing human excrement from a six-week old blocked drain — at any price.

It is a question of what we all want out of life. By making such comparisons one is only proving, sadly, that the class war is still alive and well.

If we think there is need for comparators let us stick to analogous professions. We all know that some professions are better remunerated than others but nobody is going to indulge any graduate with a university qualification for just looking cute.

Individually we all have to prove our worth by being better negotiators, cleverer in our application, shrewder in our entrepreneurial activities or just getting our reward with the sheer satisfaction of being useful and of service to our community. That being said, at the risk making myself the pariah of pharmacy in Britain, let us not complain too much about the increase in retention fees.

The percentage increment is naturally hard to come to terms with but the Royal Pharmaceutical Society serves us all well in maintaining the integrity of our profession in difficult times. Nobody in the Society is going to salt away our money in numbered Swiss bank accounts.

And we must always bear in mind that our retention fee and costs of professional indemnity are insignificant compared with those for other professionals — and that includes for artisans.

Frank Lawton
Uxbridge, Middlesex

Brave new world

From Dr B. P. Curwain, MRPharmS

There have been a number of items in the PJ recently that have caught my attention and about which I have some positive thoughts. Terry Maguire asked (PJ, 15 December 2007, p678) whether pharmacy can have a public health role.

I would agree with him that we certainly do, whether it is at the level of giving individual advice to patients in hospital or via community pharmacy, or at the level of giving advice about prescribing and therapeutics provided to primary- and secondary-care prescribers by the thousands of pharmacists working in primary care trusts, hospitals and mental health trusts.

R. G. Powdrill (PJ, 15 December 2007, p682) talks about us striving for a unique role. He writes, correctly, about the growth of prescribing pharmacists.

Once again, the army of pharmacists advising existing prescribers and also those seeing patients in clinics in an increasing variety of settings, continue to act as a vanguard, getting colleagues and patients accustomed to our expanding role.

Also, let us be clear that the role of an expert adviser to other health professionals is actually a higher order skill than simply being a prescriber. In this role, we are expected to have broad expertise, excellent critical evaluation skills, and to offer advice on a huge range of topics.

In the same issue David McNaughton asks why another profession supervises pharmacist prescribing training (PJ, 15 December 2007, p681).

Nurses, with their greater numbers of prescribers, are also asking this question and the view is that doctor supervision of early practice is simply a transient phase, a way of getting supervision when there are few of the relevant peer group available and qualified for the task. Hopefully, Mr McNaughton will not have long to wait.

The growth of funded minor ailment schemes also has the effect of raising our profile among those patients who traditionally consult the GP on such matters. Personally, I do not like the term “minor ailments”. I would prefer either “self-limiting ailments” or perhaps “short-term conditions”.

It is worth remembering that simply saving GP time may be of no interest to some PCTs who are paying their GPs the same whether they are overworked or not.

However, in PCTs which are described as short of GPs then pharmacy-based schemes will be more attractive since they enable the existing GPs to offer a better service and do it more cost effectively than the PCT simply increasing the number of GP practices. It might also in time improve GP recruitment in difficult areas.

A select band of enterprising GPs are already seeing the benefits of employing pharmacists in their practices. The new general medical services contract facilitates skill mix far more than the old one, which was based on a fixed number of GPs. This is an opportunity for some pharmacists and a threat to others.

Finally, returning to the public health theme, to have a role providing funded services means that we need to do things that have measurably good outcomes for patients. This is already being done in Wigan where I understand that a weight management service is funded according to the number of patients successfully losing weight. Sounds a bit like the GP contract does it not?

For community pharmacy, which I have recently rejoined, this brave new world does rely on our delegating some of our traditional tasks around dispensing.

Brian Curwain
Member of Council
Royal Pharmaceutical Society

Industrial pharmacists are heading for extinction

From Mr J. L. Turner, FRPharmS

The industrial pharmacist is soon to be extinct. It is time to recognise this and cease the ineffective and frustrated efforts that I and, to a much greater extent, others have made for two decades to hold on to this obsolete function.

I reach this conclusion after a career of 40 years first in the industry and latterly regulating it. The pharmacy degree I completed in 1963 with a final year of pharmaceutics and engineering at “The Square” fitted me admirably for this.

At that time The Pharmaceutical Journal carried many advertisements for pharmacists in research and development, production, marketing and the like. In my first company all the production department managers and many others were pharmacists.

Contrast that with the situation now: the degree course has little pharmaceutics and no engineering; The Journal has few advertisements from industry and these rarely require an applicant to be a pharmacist. True, the statutory specification for the Qualified Person, who by law must certify every batch of medicine before release, describes well the “old” pharmacy degree course. However, there are now postgraduate courses in the UK that prepare graduates from many disciplines to meet this requirement.

The consultations on the future of our regulatory and professional bodies offer another opportunity to promote the cause of the industrial pharmacist. I thought of joining in, but to what point? None of the specific questions in the Society’s 2020 consultation seemed relevant to a pharmacist working in industry.

None of the evidence yet submitted to the Clarke inquiry addresses even the possibility of pharmacists working in industry, in fact to the contrary: The Square’s evidence, without any qualification, says of pharmacists “their role is clinical, and will become increasingly so as they become prescribers”.

No room here in The Square’s future pharmacy degree for pharmaceutical skills of much use to the manufacture of medicines. It seems that in future a person with a degree in pharmacy that is relevant to industry may not be called a pharmacist, industrial or otherwise, unless registered by the proposed General Pharmaceutical Council.

Some of the evidence submitted to Carter does suggest a way forward. The membership of the new professional body should be wider than those registered as pharmacists and include a significant number of graduate scientists, engineers and others whose expertise and work is relevant to the development, manufacture, distribution, marketing and regulation of medicines.

Membership of this body would demonstrate an expertise, and a concern shared with the pharmacist members, in the production and availability of medicines of high quality, it should promote the interests of these non-pharmacist members and carry with it professional responsibility and status.

Let us go for that.

John Turner
Lymington, Hampshire

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