Politics - Dear Pharmacist

Dear Mr Pharmacist,

You know, you chemists are an odd bunch. Oops! Sorry, I am treading on toes already. You have progressed, gone up in the world and don’t like to be known as “chemists” any longer despite the fact that the NPA magazine is called “Chemist & Druggist” and the word “Chemist” is emblazoned on hundreds of stores throughout the land. Sadly, I am afraid that the GBP will always see you as chemists just as they will always see us as “GPs” rather than some grandiose title some colleagues would like to dream up.

You know, I have been a dispensing doctor now for upwards of thirty years and closely involved in dispensing/pharmacy politics for twenty of them, as a few chemists – there, I’ve done it again – pharmacists may recall and, by George, there have been some changes.

The younger members of either profession may not recall the early, fierce days of Clothier when the battles fought were bloody and bitter, involving whole, local populations.

My old Dispensing Doctors Association, which I founded specifically for the purpose of defending colleagues against pharmacy predations, was, I think, pretty successful. One or two pharmacists retired with bruised knuckles but, many were the occasions when my colleagues retired hurt but, at least there was a contest.

The odd part is that I recall the great Tim Astill of the NPA joining forces with the government to condemn doctor dispensing as being unsafe, but more of that later.

A major stumbling block for potential dispensing doctors was the old NHS chant:

“Doctors shall prescribe and pharmacists shall dispense, each according to their own particular sphere of training”.

Any recently qualified pharmacist ever heard of that? Of course, not. With pharmacists now demanding to prescribe from a larger and larger list of drugs the chant has been hypocritically quietly dropped as being inconvenient. Mind you, I am not aware of any greater training for pharmacists than there was all those years ago.

What I am aware of is the undoubted fact that the government has so miscalculated its approach to general practice that there is a dire shortage of doctors now and somebody has to do these things.

Never fully aware of the big picture the doctors’ General Practitioners’ Committee agreed to government’s entreaty and acquiesced to pharmacy’s hypocrisy as it quietly dropped the mantra to begin to permit pharmacy prescribing.

But that wasn’t the only hypocritical action from the chemists’ leadership over the years.

The older pharmacist will recall the shrieks of horror about all the unsupervised dispensing which apparently went on in doctors’ dispensaries. Self importantly, you pharmacists extolled the virtue of the pharmacist being present to supervise all dispensing. Dispensing just is not safe without a pharmacist being there all the time, you said. Doctors’ are never there and their staff are not trained, you said.

This, despite the DDA beating pharmacy into a cocked hat about training their dispensary staff against the fiercest of opposition from the Pharmaceutical Society. The Society and other pharmacy bodies later said the DDA course was not safe because there was no pharmacist input (there was). At the same time, the Society attempted to prevent any pharmacists from being involved in designing or examining the DDA course. So much for patient care, then.

Only in recent years has pharmacy, with the help of Communications International Ltd and others, insisted on their own staff being trained and qualified. Dispensing practice staff have been qualified for many years.

But I will say this for the NPA and PSNC, they know which way the wind blows, recognising an opportunity when they see one.

Suddenly, the filling out of prescriptions became a rather mundane, demeaning part of the profession. What was it they had previously said about dispensing practice? However, there were many great and interesting matters for chemists to do in the community but, without a second pharmacist they could not be done. The pharmacist was needed to supervise dispensing, was he not?

Of course, the government, still in a fix about the declining numbers of GPs was only too pleased to play ball with pharmacy and help them wriggle out of the fix they were in.

With an overwhelming burst of hypocrisy supervision was rejected.

Of course, there was a good reason, there always is. The government said:

“The current legal framework governing personal control and supervision limits the extent to which pharmacists are able to develop their professional role and should be changed”.

So, the much proclaimed patient safety element of having the chemist’s continuous supervision was all rubbish, after all, was it? Or just inconvenient?

“Ah, but we will be delegating certain activities to registered and suitably qualified staff in the pharmacy”.

Just what the dispensing doctor has been doing for years and just what you chemists have been hypocritically complaining about. So, Mr Pharmacist, what, precisely is now the difference between a chemist and a dispensing doctor?

In their own absence, both professions delegate dispensing to qualified staff. There’s not a cigarette paper between us. Especially in these days of hi-tech dispensing.

You see what I mean when I said it was a very odd affair indeed?

Well, there’s nowt so queer as folk, is there?

Yours very sincerely,

David Roberts

(25/1/05)