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The Pharmaceutical Journal
Vol 269 No 7226 p779-780
30 November 2002

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Letters to the Editor

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Community pharmacy

Public health role is the key to the future

We must avoid past mistakes

Supervision and absence cannot coexist

Public health role is the key to the future

From Mr A. D. Castell, MRPharmS

I applaud the article by Dr Jill Jesson (PJ, 16 November, p725) which so clearly expounds the argument that the North East London Local Pharmaceutical Committee has been promulgating for some years.

This is that the core public health concept of sustainable communities is the key unifying factor in the future of the health service and that, in practically ignoring it, the major professional organisations are excluding themselves from the developing future agenda of health providers.

The Government has attached a high priority to health improvement and put in place many new structures. It has also emphasised that it is a job of every person and organisation to share the massive workload to improve health and work together. We know from our local public's experience that there is a need for health, environment and community development ? preferably organised and co-ordinated locally ? to work together. We all know that solutions to improving health, environmental and community development are closely intertwined. It means recognising and dealing with the complex links between the social, economic and political factors that play a role in determining the well being of people. For that reason the London Health Strategy has three fundamental principles: that health can only be improved by working in partnership, that citizens and communities need to be actively involved, and that the sharing of intelligence about health and how it can be bettered is essential.

We believe that more pharmacists will feel part of primary care, and what is more important to the public is that the primary care team would be bettered when

(i) community pharmacy is integrated with a role in public health

(ii) it is involved in helping to reduce inequalities in health and education (particularly in science) at a local level

(iii) community pharmacists are more involved in establishing new and imaginative partnerships to improve the NHS

(iv) community pharmacists are helped to demonstrate key competencies to improve the health and well being of communities.

What pharmacy needs from the Department of Health is a capital investment strategy to improve pharmacy premises and make them fit for their new purpose, and a new contract that encourages the provision of pharmaceutical care and ensures that pharmacists are appropriately rewarded. For the benefit of local communities, the role of the pharmacy as a local health care resource should be supported. And, by means of suitable legal devices, locality planning must make sure that patient access to this service is maintained.

In the years ahead, in partnership with others, there is much work to do in serving our communities, in saving lives in a modern and dependable way and reducing inequalities in health, education and welfare. However, if LPCs (and there is no one else to do it) do not grasp the nettle of the changing agenda quickly (PDF 50K), as advocated by Hemant Patel (PJ, 16 November, p714), they will find themselves excluded and will end up being reorganised out of existence by bodies with no concept of their potential.

Alan Castell
North East London Pharmaceutical Committee

We must avoid past mistakes

From Dr B. P. Curwain, MRPharmS

Two items in The Journal of 23 November attracted my attention: that pharmacist prescribing is getting the official go-ahead and that the Pharmaceutical Services Negotiating Committee is concerned about pharmacists leaving the pharmacy while dispensing is happening. The latter sounds suspiciously like defending yesterday's territory. There are huge uncertainties and significant risks for community pharmacy at present and we must avoid repeating past mistakes.

The questions of skill mix and making better use of both community pharmacists and their staff are high on the Government's agenda for pharmacy. If we do not grasp this opportunity then it will not be there for long. Pharmaceutical input both to the prescribing process and to individual prescriptions can increasingly be provided by pharmacists working in medical practices and for primary care trusts. Shortly, three pharmacists in my PCT will begin seeing patients in medication review clinics. It is easy to see how this service could be extended to include symptom monitoring and dose changes or medication switches.

Where would all this leave community pharmacy? The danger is that, if community pharmacists are prevented by outdated rules and codes of behaviour from fulfilling the extended roles now being developed, those roles will be fulfilled elsewhere than in pharmacy premises. That process has already begun. As community pharmacy staff become more skilled, they will be able to take on a proportion of the pharmacist's advisory and educational roles. Some pharmacists already shun community pharmacy because they have to spend too much time on (important) technical tasks. In order to make the role fit for today's graduates, the rules, customs and practices of supervision will simply have to be re-examined. In surgeries, the process of nurse-led triage demonstrates that only about a third of patients who initially want to see a doctor need to do so. The nurse treats, refers or reassures appropriately. What about similar models for pharmacy?

We risk losing large parts of the community pharmacy network due to pharmacists voting with their feet and PCTs finding other ways to deliver the required services. This would be a great loss since a significant amount of health delivery can and does take place in community pharmacy. More pressure would then fall on the National Health Service and the public would lose a convenient route of access. You have to let go of one trapeze before grasping the next. OK, there is a small chance of missing it but the present one will go ever slower, leaving us dangling in mid air.

Brian Curwain
Chief Pharmacist
New Forest Primary Care Trust

Supervision and absence cannot coexist

From Mr A. O’Shea, FPSI

At the recent General Assembly of European Community Pharmacists of Pharmaceutical Group of the European Union, I listened to the report of the British delegation with disbelief. It was reported that the UK Department of Health proposes a radical review of the so called "skill mix" in community pharmacy such that an enhanced technician grade could operate a pharmacy in the absence of a pharmacist.

The pharmacist in question, supposedly supervising the pharmacy while absent from it, would be visiting patients with special needs or advising general practitioners on rational prescribing, among other things, in their surgeries. Simple logic and plain English tell me that supervision and absence cannot coexist.

In my opinion, this proposal is tantamount to selling the birthright of the pharmacist to hold the legal monopoly over pharmacy supervision at all times. The pharmacist's presence is essential for the level of knowledge and judgement demanded by modern clinical practice. Efficient and professionally effective community pharmacies do require well trained auxiliary staff, whose skills are valued and rewarded. If the National Health Service requires pharmacists to work beyond the confines of the pharmacy, then the solution must not be to devalue the professional control of the community pharmacy, where 99 per cent of daily drug use problems and questions are encountered and solved.

The community pharmacist is at the heart of day-to-day encounters with patients receiving prescribed and non-prescribed medicines, making value judgements based on the bond of trust between doctor, patient and pharmacist. If the NHS also wants journeymen pharmacists acting as district consultants to GPs, then let the NHS recruit them directly while maintaining the professional base of community pharmacy. If the UK wants to enhance the training and skills of pharmacy technicians, that too is laudable within the current supervisory framework.

I appeal to UK pharmacists individually and collectively to see the evident danger of these proposals, which to some may seem attractive in the short term, but which contain the seeds of extinction for the largest branch of the pharmacy profession. Speak up now before the mandarins of government rearrange your future ... permanently.

Aidan O'Shea
Cork, Republic of Ireland

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