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Lessons from pharmacy’s history

Whether or not the pharmacy profession has learnt from the past was the subject of a recent debate. Francesca Rivers reports

by Francesca Rivers

Whether or not the pharmacy profession has learnt from the past was the subject of a recent debate. Francesca Rivers reports

 

Following a lively debate in London last month, headed by four key figures in pharmacy, the motion that “this house believes that pharmacy has not learnt from the past” fell at the vote, with 70 per cent of the floor in opposition and only 10 per cent in support (20 per cent abstained).

In favour

Opening the debate was Graham Phillips, independent community pharmacist and former member of the Royal Pharmaceutical Society’ Council.

Mr Phillips argued that an examination of the history of the pharmacy profession reveals a trend of repeated mistakes. He cited a report on the practice of pharmacy, published in 1963, recommending that an emphasis be placed on improving the image of pharmacy, and raising its profile with the public.

He said: “Pharmacy took a punitive rather than proactive approach to this. Restricted titles were only to be used in connection with supply of medicines and medicinal products. Misdemeanours by the profession were to be treated as matters of professional misconduct.”

There was a failing on the part of the profession, he suggested, to act on the advice and take opportunities to promote pharmacy and improve its reputation and status. Nearly 20 years later, at the 1981 British Pharmaceutical Conference, the then health minister Gerard Vaughan declared that, although there was a future for hospital and industrial pharmacists, the future of community pharmacists was less certain.

Mr Phillips argued: “The Vaughan intervention, as it came to be known, was the outcome of this failure by pharmacy to take action to improve the public perception of pharmacists, and to improve politicians’ perception. … The crucial lessons of that event were clear: if you take your eye off the ball of the perception of pharmacists, the profession becomes extremely vulnerable to outside attack.”

Leadership is another crucial factor in pharmacy’s success, he said, and a report published by the Nuffield Foundation in 1986 offered a way of changing the image of the community pharmacist from that of “shopkeeper” to a professional with a more clinical role.

The Society, he argued, was inadequate in its leadership following the report, and failed to communicate a clear vision and way forward, and thus little actually changed.

Pharmacy politics is fundamental to the future of the profession, Mr Phillips said — a lesson consistently disregarded, since the political agenda remains ignored. Government perception of pharmacy is poor, and the profession is not considered important enough to merit the ministerial attention that it does, in fact, deserve, he argued.

Also supporting the motion was Diane Leakey, head of information at the Medicines and Healthcare products Regulatory Agency. She maintained that pharmacists continue to be viewed by the public as shopkeepers rather than as health professionals — and that petty internal warfare has led to wasted opportunities for the profession.

The Which? report of 1975, she recalled, detailed the results of a covert pharmacy survey, and was critical of the profession. It indicated the need for a large scale, intensive campaign to change the profession, she said — a campaign which did not materialise, as evidenced by the more recent Which? reports of 2005 and 2008 (PJ, 27 September 2008, p349), both of which present pharmacy in an unfavourable light.

There is increasing demand from patients to obtain medicine via the internet, and thus the need for accessible healthcare professionals has never been greater, said Mrs Leakey.

“The pharmacy profession shows absolutely no commitment to adapt to the information technology environment,” she declared, pointing out that less than half of pharmacies have internet access.

Mrs Leakey also pointed to a failure by pharmacists to be more active in taking on a clinical role. More nurses than pharmacists are currently qualified as prescribers, she said, and only 10 per cent of pharmacoviligance reports to the MHRA are made by pharmacists.

“Pharmacists should be the experts in reporting these, not — as they tell me — reporting them back to doctors because it’s ‘their job’,” she said.

Against

First to oppose of the motion was Tony Moffat, emeritus professor of pharmaceutical analysis at the University of London School of Pharmacy and former chief scientist at the Society. Pharmacists do learn, and have learnt, throughout the course of history, argued Professor Moffat.

Pharmaceutical science provides numerous examples of this learning, he said, describing the scientific progression from discovery of the effects of opium to extraction of the active compound to produce the safer and more effective drug morphine, and then to production of the less addictive compound codeine.

Alexander Florence, former dean of the School of Pharmacy, University of London, also spoke against the motion, pointing out that learning from the past does not have to equate to reaching perfection. Progress is not about always succeeding, Professor Florence said.

“Success is the ability to go from one failing to another with no loss of enthusiasm”, he said, quoting Sir Winston Churchill.

Degrees in pharmacy have progressed, he observed, from the one-and-a-half year courses that sufficed in the 1920s to the four-year courses that exist now, with specialist postgraduate courses also available, demonstrating a progression in pharmacy education that reflects the development of the profession.

He rebuffed suggestions that pharmacy fails to give the public what they need, citing medicines use reviews, sexual health services, emergency hormonal contraception and management of patients with long-term conditions as examples of pharmacy learning to provide services where there is a requirement.

UK hospital pharmacy, argued Professor Florence, is taking a lead role in Europe, and the existence of the wide range of jobs today that were not in existence in previous years demonstrates the progress of the profession.

“You just have to look at the advertisement pages of the PJ to realise this desire for clinical ward services, specialisms in oncology, paediatrics, pain relief and so on,” he said.

In the area of adverse drug reaction reporting, he continued, hospital pharmacists have even been proven superior to doctors in their approach.

Pharmacy has potential, affirmed Professor Florence, and has been held back by medical hegemony, not by pharmacists. “I see no evidence that the profession in toto has not learnt from the past”, he said: “It has made enormous strides … we are entering a new learning phase.”

 

The pharmacy debate organised by the English Speaking Union in collaboration with the Museum of the Royal Pharmaceutical Society took place in London on 26 November 2008

Citation: The Pharmaceutical Journal URI: 10043903

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