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Collapse of community pharmacy - again !
Those of us who have been involved
in dispensing politics over the past several years will recall the
favourite ploy of the pharmacy politician is always to claim that the
profession is on the verge of financial disaster. The author
well remembers the strident claims of the collapse of pharmacy in
Evesham if town doctors were to be permitted to dispense to their rural
patients. The contest was long and bitter but the outcome was that
the doctors were given permission and after a "decent
interval", one of the three pharmacists opened a third branch
within the town. The reason is that Milburn has imposed a 3.7% increase in the global payment sum coupled with a 10% cut in the dispensing fee. Sounds bad at first glance but general practitioners will be familiar with the "balancing" sums in DDRB reports. It appears that chemists were overpaid last year and the 10% cut is a temporary measure to recover that overpayment by April 2002 when the 87.4p dispensing fee will return to around 94p. Explaining this the Minister, Ms Blears, reminded chemists that in an earlier year they had been underpaid and that was made good the following year. All that cuts no ice with pharmacists and the NPA has threatened that chemists will not co-operate with Pharmacy in the Future until it is "resourced properly" and nor will they undertake any new roles such as repeat dispensing. At the same time, PSNC (the GPC of pharmacy) is threatening a judicial review of the fee imposition having found, they believe, another "loophole". It's doubtful that government believes this as both parties know well pharmacy's ambitions. Nevertheless, if the DDA Ltd is aware of these developments I wonder whether they have reminded the Department of the alternative dispensing service which is provided by dispensing doctors and may be expanded to include most GPs. Sad to say, I think it unlikely, the DDA Ltd being such close friends of chemists (who are still seeking every possible way to eliminate dispensing practice completely). Supervision
Over many years pharmacists have been eager to grab more and more extra-curricular jobs or, as they prefer to put it "additional roles". The main reasons for this are that the advances in pharmaceutical packaging, European Regulations, Product Liability and the pharmaceutical and computer industries have all gone to make the dispensing role so simple that it no longer requires a degree to carry it out. In effect, a competent and careful one-eyed bat could just about manage the chemist's dispensing role today. The chemists, however, have two problems before they can expand their "services". One is that they are not trained for anything other than supervising and dispensing; and the other is that the law requires them to supervise all dispensing. Adding to these problems are two others. One is a government not keen to pay them for their dispensing task in addition to extra roles; and the other is that without the supervision element there is nothing to distinguish the chemist from the dispensing doctor. That, unfortunately is less of a problem now since the advent of the servile DDA Ltd in 1997 virtually emasculated dispensing GPs who were previously eager to step into the dispensing role. Despite all this, pharmacy is torn asunder between those who think it opportune to relax supervision and those who fear doing so would remove their raison d'etre. The former spend their days nit-picking Section 52 of the Medicines Act 1968 for yet another "loophole" to let them scurry into the streets. The latter fear having to tell patients to return for their medicines when the chemist is back from his morale booster. They also worry that government may get to wondering why to have chemists if technicians can do it just as well. When a group of Northern community pharmacists was recently polled by Pharmacy Magazine (December 2001) the outcome was that 90% thought that the supervision regulations should not be relaxed. Northerners always did have more common sense ! Dispensing doctors of a certain age will recall with wry amusement the chemists' past fierce defence of the now inconvenient NHS mantra paraded by successive Secretaries of State: "The doctor shall prescribe and the chemist dispense, each according to their own specialist training". Nowadays GPs should expect chemists to press for more and more "in-house" expanded roles for which they may or may not be adequately trained. These will include prescribing, repeat dispensing, "repeat" monitoring, hypertension and contraceptive monitoring, asthma and diabetes control. - but only for additional fees. Pharmacist prescribing Dr Crown did accept that chemists would need some clinical skills if they were to prescribe with any degree of safety. These, she felt, might prove difficult to obtain but Continuing Professional Development (CPD) should take care of that, she thought. However, doctors had virtually no prescribing training whatsoever so, the inference was, what's the problem about pharmacist diagnosing? This argument was developed by Dr Crown who suggested that there should be a new register of prescribers - to include chemists and doctors. Recognising a problem when she sees one, Dr Crown said there must be some mechanism for catching incompetent or fraudulent pharmacist prescribers especially when they dispense their own prescriptions. This is a pharmacy argument chemists have against dispensing practice. Checking was important - but not by two pharmacists, she said, as that would slow down the process as well as dramatically increase the cost. Unfortunately, Dr Crown defeated her own argument for pharmacy prescribing by failing to find any mechanism to solve any of these highly important problems. Nor did she solve the vital question about secure access to confidential patient information which neither doctors nor patients want disseminated to every Tom, Dick and Harry chemist employee. Conclusion |
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