The Pharmaceutical Journal
Vol 280 No 7498 p470
19 April 2008

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“Would you trust your ‘chemist’ to check your health?” We must deliver

By Alan Rogers

What a start to the month. The Clarke inquiry report was published on 1 April 2008, followed by the White Paper for pharmacy in England, the Galbraith report on control of entry and an assortment of supporting documents — a total of 523 pages on which you will be consulted.

But that is not the really good news. The really good news is that pharmacy was on the front page of The Daily Telegraph (“High Street chemists to take over range of GP services”), with follow-ups in the Telegraph (“‘Super chemists’ to treat half of all minor ailments”) and The Guardian (“Wider role planned for high-street chemists”). At last we have got the press coverage we have been demanding.

Did I mention the bad news? Well, the Telegraph then asked for readers’ views in an online forum, entitled “Would you trust your chemist to check your health?” Of 164 respondents, 61 were broadly in favour, 65 were against, and 38 were either non-committal or crackpot.

People who contribute to online forums may not be representative of the general population, and although we can produce market research showing public satisfaction with pharmacy services, complaints are always more sensational. This emphasises that however good our press coverage, our public image is largely determined by the everyday experiences of our patients.

Before we trumpet the 61 votes in our favour, I note that at least 13 of those were by pharmacists, prompted by the Royal Pharmaceutical Society’s public relations department to join the debate. Many of the critical comments showed a total lack of understanding of the training, expertise and current role of pharmacists, let alone of their potential for an extended role.

The continued use of the word “chemist” by quality broadsheets suggests that they still have this quaint view of us sweating over our mortars and pestles, or counting out tablets on triangles. It is depressing how much we still have to do to educate the public and the media.

Ignorance on the part of the public is unfortunate but ignorance on the part of our so-called PR experts is unforgivable. On the front page of the Telegraph, Neal Patel of the National Pharmacy Association is quoted as saying: “Pharmacists train for five years and are able to do far more than dole out prescriptions.” This contemptuous dismissal of our current role only serves to reinforce the idea that dispensing is a mechanical process, with no clinical input.

I spent 33 years of my life “doling out prescriptions”. I found it professionally satisfying because I also managed to dole out a great deal of good advice. I believe that my patients benefited greatly from my proactive professional approach, and my local GPs welcomed my interventions and respected my views, without worrying that I was trying to poach their business.

Patient health and professional public relations were both well served. I am sure that many community colleagues were equally offended by Mr Patel’s inept comments.

At the same time, I am sick of high minded officials announcing that pharmacy is now a “clinical” profession. Pharmacy has been advancing as a clinical profession for many years, but it is an evolutionary process. We cannot “modernise” it overnight. As we earn the respect of our patients and colleagues, we can push the boundaries. We also need to be sure that most of the profession is capable and comfortable with the pace and direction of travel.

Innovators are needed at the cutting edge of professional practice but many pharmacists do an excellent job, yet feel uncertain about the future. Neither D. R. K. Brown — “There are too many fanciful visionaries in high places, whose radical and often ridiculous ideas for the future of pharmacy could be the ruin of our profession” (PJ, 19 January 2008, p51) — nor David Morgan — “As a pharmacist already swamped and exhausted dispensing torrents of prescriptions to the worried well, I feel this will only work if the big chains and supermarkets employ a second pharmacist. … The whole sector is in crisis and the last thing we need are more under-funded initiatives” (Telegraph Online, 2 April 2008) — should be dismissed as flat-earthers.

It is equally tempting to dismiss the dissenters on the Telegraph internet forum as difficult or even barmy. However, some of the concerns are real, and we may learn from analysing the comments. A few opponents were obviously GPs: “This is dangerous. Whenever I find myself at a pharmacy counter, I have to bite my tongue at the poor quality advice that is given out.”

Another referred to cherry-picking the easiest services. Sour grapes, perhaps, but proof that these pharmacists have poor relationships with their GPs.

References to lack of privacy and facilities suggest that consultation rooms have gone unnoticed by non-medicines use review patients. Another missed PR opportunity?

Some asked how pharmacists will have the time and who will do the dispensing. Others inevitably complained about it taking “10 minutes to get a box off the shelf, put a label on it, look what the computer says, then put it in a paper bag”. Although some pharmacists feel uncomfortable with open plan dispensaries, these do banish the mystery of what goes on behind the dispensing screen, and help patients understand that other people are involved in the dispensing process.

There were references to errors, both in dispensing and in diagnostic testing, and concerns about access to patient records, liaison with GPs, and the split in responsibility for patient care. Some questioned not only pharmacists’ training, but the role of support staff — “the testing will be done by ‘trained’ pharmacy assistants”, “… women in white coats … (with almost no training)” and “some kind of courses or equivalents of National Vocational Qualification”.

The perceived lack of professionalism is worrying. Respondents’ comments included “the rate of turnover of pharmacists”, pharmacists having “a vested interest in gathering as much information as they can about their customers”, pharmacists’ professional judgement being replaced with company policy, pharmacists being “out to make a profit by recommending unnecessary products”, “products of very doubtful efficacy”, “a pill salesman”, “a shop assistant with an attitude problem” and “will we be offered three for two on antibiotics or buy one get one free on prescriptions?”.

Our case was not helped by the Telegraph’s photograph of a multiple pharmacy with its huge window posters offering free services and free goods with purchases. Does this image really fit in with our new profile? We are proud to be the health professional in the high street, but if we are to be taken seriously, we cannot continue to provide clinical services just to the left of the sandwich counter or behind the Rimmel stand.

It makes uncomfortable reading. Resolving the issues may be equally uncomfortable, but it is a task we must not shirk.