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A pressure cooker waiting to blow

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Someone on the phone, MUR targetsto meet, out of stock drugs to source and five people waiting for their scriptsto be dispensed - this is the reality of community pharmacy.  It is no wonder then that 85% of employedpharmacists say they have experienced stress in the last year.

Pharmacists are the funnelthrough which all of a pharmacy's activities must travel.  This may have been acceptable at a time whendispensing scripts was the sole role of a pharmacist but pharmacy is a changingprofession. More clinical services are being sought by all pharmacists - apartfrom those actually working on the ground it seems.

When I first encountered thisresistance towards clinical services I was a little surprised.  The opportunity it provides to apply moreknowledge seems one to grasp.  But thisdesire is hard to reconcile with the realities of community pharmacy.  It simply is not possible to continue addingresponsibilities without removal of others. The stack of cards will eventually fall, and when it does it will bepatients and the profession that suffers.

We're doing thingsbackwards.  The machinery of theprofession is pushing for services before pushing for the support.  What's more the people to support pharmacistsare already present:  ACTs, dispensers,healthcare assistants - trained people waiting to be liberated from draconianrestrictions.  The hospital sectorappears to have got the balance between safety and skills right, communityshould be able to do the same.

If we continue in this way thereis a risk that pharmacists will become alienated by clinical services.  Already MURs are seen as a burden when theyshould be seen as an opportunity for the profession to showcase its skills and,most importantly, improve patient care. It's inevitable that when pharmacists are deciding who should be givenan MUR the primary criterion is not who will benefit most but who will be donethe quickest.

The PCT in my area has expressedconcern that the wrong patients were being selected for MURs.  This is the other potential risk: theprofession may no longer be trusted with providing services if they are perceivedto be incapable of delivering them. Those commissioning services will see the profession as lacking thenecessary skills, they won't see it as a result of an excessive workload.

To make the vision for communitypharmacy less romanticism and more reality this fundamental issue will have tobe tackled.  It will require a paradigmshift which will not be easy but would certainly reap rewards.

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From: Tomorrow's pharmacist blog

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