Dear Pharmacist,

The New Year and the time to look to the future has arrived and, if I were a community pharmacist, like you, my seasonal wish would be that the inevitable does not hit me too soon.

But, I’m not a pharmacist and I do not have to worry that my purpose in life, professionally at least, is coming to an end.   The wheels are turning and one after another your core services are being eroded or wished away and will ultimately leave very little for the university trained community chemist to do.   Unless, of course, that training is modified to such an extent that the chemist becomes a doctor, a nurse or a social worker.   After all, you pharmacists are being misled into dabbling in all these professions whilst being encouraged to neglect your own but it strikes me that it’s a little late to be wishing to be a doctor after having opened a High Street shop.

Sometime soon it will hit somebody in a position of influence and authority that the NHS is paying expensive rates for pharmacists to trot out into the community to carry out tasks other professions are already doing whilst, at the same time, indirectly paying less for well-trained technicians to do the job for which chemists were invented and for which they are, presumably, overpaid.  Namely, dispensing medicines and answering patients’ queries about them.

Now, as a recently retired dispensing doctor, I see nothing wrong with well-trained technicians dispensing medicines.  It was the original DDA under my chairmanship which initiated the first ever training course for technicians to ensure that they were safe.  I seem to recall that one of the less intelligent but very typical decisions of the Pharmaceutical Society was to absolutely prohibit any pharmacist from helping develop that course, by the way.

No, I see nothing wrong in it but I do have ground into my mind the litany which assaulted my eyes and ears from pharmacy representatives so often when my colleagues applied to dispense.  

“The doctor shall prescribe and the pharmacist dispense, each to their own area of special training”

Nothing there about pharmacy dispensary assistants dispensing yet what do we see now but that there is a Bill about to go through Parliament, after a great deal of pharmacy pressure, which permits chemists to leave the dispensing to highly trained technicians whilst they leave the premises.

Incidentally, you chemists are happy to leave your/our patients' dispensing totally in the hands of distance-learned techies but don't consider doctors with full medical qualifications, including pharmacology, employing equally qualified technicians suitable.  A bit of hypocritical bigotry there, eh?

However, in the meantime, the “responsible chemist” and his mobile phone may be approaching the 7^th –tee, sunning himself in Bermuda or swanning about the district carrying out paid tasks for which he may well have had no more practical training than my cat. (It was rats, last time).    As an example, a recent BMJ paper, by a pharmacist, indicated that where a pharmacist intervened in the community care of elderly patients, there was a 30% increase in their admission rate to hospital

Either way, what the chemist is doing is sending out a huge signal to all and sundry that dispensing and chatting to patients about their medicines over the counter is now a menial task well beneath him and that there is somebody much better trained to do that – the technician and at a lower cost to the NHS.

Returning to the Litany, there is nothing in that, either, about pharmacists prescribing. Yet, again, what do we hear but that pharmacists wish to prescribe from the entire British Pharmacopoeia.   The ability to prescribe safely involves the ability to diagnose correctly and for that it is essential to have a multi-year medical training.

For goodness sake, get a grip on yourselves.   Two weeks at night-school and a distance learning course will not turn you into doctors but once again, it does emphasise your desire not to dispense.

Then, looking at the new pharmacy contract, for virtually all of the enhanced services, the advanced services and some of the essential services the pharmacist will need to be trained from scratch before going on to learn on the job.   

To say that community pharmacies are stuffed with appropriately trained and under-used workers is a lie.   What there is is a bunch of intelligent people who can be given a modicum of training before being flattered into temporarily filling some of the gaps created by a government-inspired shortage of the appropriate health care professional, doctor, nurse, social worker and others.

But government statistics, if you believe them, are showing that those gaps are being closed quite quickly.    What then for the highly paid bare-foot chemist who patrols the district having shown with his feet what he thinks of his raison d’etre, dispensing and advising about medicines?

The dispensers will dispense, the nurses will nurse and the chemist will…  Well, what will he do?

As I said, if I were you I’ would have got my lucky sixpence out at mid-night on New Year’s Eve and wished.  It might work.   On the other hand, what’s going to happen, has a habit of happening.

(7/1/06)