The Pharmaceutical Journal Vol 265 No 7106p127
July 22, 2000 Broad Spectrum
By W. G. Peberdy
After some 64 years in the profession, I can afford to look at changes over that period and contemplate its future. The secundum artem on which I qualified has all but disappeared and we seem to seek as a replacement an enhancement of our counterprescribing role. Currently, there is a requirement for more primary medical care than the National Health Service can provide. How well is today's new pharmacy graduate equipped to fulfil this need? Very well in relation to treatment, but hardly at all in relation to diagnosis. The prime requirement of any new patient is an accurate and differential diagnosis and this is an essential foundation for treatment.
Altering the pharmacy degree course by introducing a substantial period of clinical work with some teaching of anatomy and pathology, all of which are needed for diagnosis, would result in a course virtually indistinguishable from the medical degree course. My fundamental suggestion, therefore, is to abolish the present pharmacy degree course and make the medical degree course the entry qualification to both professions. Since the object is to produce a larger output of doctors who are quite capable of dealing with the day-to-day work of general practice while offering a foundation upon which to build higher qualifications if desired, it may be possible to reduce the length of the course to four or four-and-a-half years. This would be followed by a two-year work experience programme, the first year of which would be in the hospital houseman situation. At the end of this first year, the candidate would become registrable in medicine. The second year could be divided, with everyone spending the first six months in a general practice teaching attachment. During the second six months, specialisation would begin to be introduced. Those who wished to remain in general practice medicine would continue in that area, those wishing to go into pharmacy would do a six-month attachment either in community pharmacy or hospital pharmacy, and those wishing to advance in medicine would remain in hospital (as at present) while embarking on further study.
So far as development of the hospital pharmacist is concerned, there would be a full medical specialty of "pharmacist and pharmacologist" to work towards and chief pharmacists would be full consultants in this specialty. Under the chief pharmacists would work the present information and ward pharmacists as registrars and senior registrars, and these pharmacists would also supervise the dispensary, as at present. Large teaching hospitals would no doubt have more than one consultant grade post. Consultants in pharmacy and pharmacology could presumably also find their way into pharmacology-intensive areas, like anaesthetics, pain clinics, etc.
The aim of this article is the logical improvement of basic primary medical care. As more suitably qualified doctors enter it, there would be an expansion of the group practice concept. Some of those who have gone down the specialisation road could return to general practice and they would be a useful addition to to the primary care team, bringing their specialised knowledge of treatments with them. If, as seems likely, more pharmacies become attached to health centres, these people could provide a bridge between the two professional areas.
In community pharmacy, the first need would be for legislation to permit registered medical practitioners to assume the privileges of pharmacists. After that, the precise endpoint is hard to predict, and it would need to be guided as it developed into the best possible outcome. For the foreseeable future, there will remain a need for self-medication products to be sold over the counter and there will always be a need for dispensaries. In the present climate there seems to be little future for private pharmacy as we have known it. Already the multiples and the supermarkets are making great inroads and they seem set to continue to do so. Also, as in general medical practice, multi-pharmacist pharmacies seem inevitable. Will the medically qualified pharmacist wish to work in any of these situations? Undoubtedly, if he does so, his potential for providing basic primary care over the counter will be unassailable and one could imagine general practice surgeries appearing in registered pharmacies.
What if our newly medically qualified pharmacist does not want to work in a multiple or a supermarket? Where will the man in the street go for his prescription or his bottle of Benylin? The dispensing assistants and pharmacy technicians are already flexing their muscles on the sidelines. With further training, technicians would be quite capable of counting tablets and dealing with the man and his Benylin. And it would be difficult for them not to be involved in some form of recommendation when asked, but there would be no question of them prescribing over the counter. It may be that their establishments would be known by some name other than "pharmacy".
So what of teaching infrastructures and the position of the Royal Pharmaceutical Society?
As regards teaching, it would not be too difficult for most of the preclinical teaching in the new medical/pharmaceutical course to be dealt with by the present schools of pharmacy, thus freeing the medical schools for clinical teaching. The most obvious places to pilot the new arrangements would be those universities where medical and pharmaceutical degrees are taught in near-adjacent premises. Schools of pharmacy would also be well placed to provide courses for technicians and dispensing assistants, and to provide postgraduate teaching leading to specialist qualifications.
So far as the Royal Pharmaceutical Society is concerned, its first professional interest would be to act as a royal college in relation to the suggested pharmacy and pharmacology specialisation. It may be that the Society would split into two bodies. One would become the Royal College of Pharmacy and Pharmacology, which would have members and fellows. The other would deal with the community aspects of pharmacy and inspection and registration of premises. It would also be responsible for the supervision and advanced training of dispensing assistants and technicians.
All in all, here is an interesting and challenging prospect.
Citation: The Pharmaceutical Journal URI: 20002285
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