A pressure cooker waiting to blow

Someone on the phone, MUR targets to meet, out of stock drugs to source and five people waiting for their scripts to be dispensed - this is the reality of community pharmacy.  It is no wonder then that 85% of employed pharmacists say they have experienced stress in the last year.

Pharmacists are the funnel through which all of a pharmacy's activities must travel.  This may have been acceptable at a time when dispensing scripts was the sole role of a pharmacist but pharmacy is a changing profession. More clinical services are being sought by all pharmacists - apart from those actually working on the ground it seems.

When I first encountered this resistance towards clinical services I was a little surprised.  The opportunity it provides to apply more knowledge seems one to grasp.  But this desire is hard to reconcile with the realities of community pharmacy.  It simply is not possible to continue adding responsibilities without removal of others.  The stack of cards will eventually fall, and when it does it will be patients and the profession that suffers.

We're doing things backwards.  The machinery of the profession is pushing for services before pushing for the support.  What's more the people to support pharmacists are already present:  ACTs, dispensers, healthcare assistants - trained people waiting to be liberated from draconian restrictions.  The hospital sector appears to have got the balance between safety and skills right, community should be able to do the same.

If we continue in this way there is a risk that pharmacists will become alienated by clinical services.  Already MURs are seen as a burden when they should be seen as an opportunity for the profession to showcase its skills and, most importantly, improve patient care.  It's inevitable that when pharmacists are deciding who should be given an MUR the primary criterion is not who will benefit most but who will be done the quickest.

The PCT in my area has expressed concern that the wrong patients were being selected for MURs.  This is the other potential risk: the profession may no longer be trusted with providing services if they are perceived to be incapable of delivering them.  Those commissioning services will see the profession as lacking the necessary skills, they won't see it as a result of an excessive workload.

To make the vision for community pharmacy less romanticism and more reality this fundamental issue will have to be tackled.  It will require a paradigm shift which will not be easy but would certainly reap rewards.