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Community pharmacy (2)
Wed, 15/07/2009 - 15:16 — Gowan Clews
See earlier postings in Community pharmacy
Hello guest, welcome to PJ online
gateway to the world of pharmacy and medicines
Working in antiquated and unprofessional surroundings
From Mrs S. A. M. Beaumont, MRPharmS
Part of my role as community pharmacy facilitator for Brighton and Hove Primary Care Trust is to make contract-monitoring visits to all of our local pharmacies.
For the most part, this is a most enjoyable exercise and I am impressed how most pharmacists have risen to the many challenges they have had to contend with over the past 10 years. It has been a steep learning curve for all of us.
However, I do find it difficult to understand that, when a pharmacy goes through the upheaval of a shop-fit, all the effort is put into the “front of house” and the dispensary is left as it has been for the past 20 years or more.
It is good that customers and patients are greeted by a clean, bright and up-to-date pharmacy when they walk through the door, but I find it disgraceful that little or no effort has been made to make the dispensary and back areas fit for the 21st century.
Many are small and cramped with little bench space, which may have been adequate for dispensing 20 or 30 years ago, but is certainly not for today’s workload and for the number of people that are needed to deal with the ever-increasing number of prescriptions that are generated.
Pharmacists are professionals and neither they nor their staff should have to work in antiquated and unprofessional surroundings.
It seems to me it is shortsighted that the area which generates most income should be treated like the poor relation during a shop refit.
Sheila Beaumont
Community Pharmacy Facilitator
Brighton and Hove Primary Care Trust
Who is in charge?
From Mr M. J. M. Lord, MRPharmS
I recently applied for a lease on an empty unit in one of the out-of-town shopping centres exempt from control of entry, only to be informed several days later that an existing pharmacy, one of the large multiples, within the development has an “exclusivity clause” in its lease.
This effectively prohibits any competition and ensures it enjoys a monopoly in that location, which is in direct contradiction to Government policy. How many more of these “exempt” locations are controlled by the cabal of big businesses?
So, who is in charge — the Government or the multiples? Perhaps the answer has always been clear even with this smoke screen of “a balanced package of measures”. The playing field is far from level — it is practically vertical.
Michael Lord
London
Boycotting pharmacies
From Dr L. R. Kayne, MRPharmS, and Dr S. B. Kayne, FRPharmS
In his Broad spectrum, Terry Maguire (PJ, 15 August 2009, p178) wrote: “If certain pharmacists are advising the public to use homoeopathy, I would suggest the public would be best avoiding these premises.”
We will limit our response to some simple facts:
So, it seems that the Medicines and Healthcare products Regulatory Agency, the Veterinary Medicines Directorate, the NHS and the EU all consider homoeopathy to be a valid system of medicine. Are patients with NHS prescriptions for homoeopathy to be simply turned away from our pharmacies? Are they to be followed by patients with NHS prescriptions for other medicines?
For example, the value of aspirin in the primary prevention of vascular disease has been shown to be “uncertain” at best. Is Dr Maguire suggesting that colleagues should refuse to dispense aspirin prescriptions and boycott any pharmacy which does so?
Targeting such a tiny percentage of colleagues with an implication that they are unprofessional, denigrating their practice and actively advising the public to avoid their pharmacies is, in our view, unacceptable.
L. R. Kayne
S. B. Kayne
Glasgow
National accreditation
From Mr S. J. L. McNeilly, MRPharmS
Karen Hassell touched on extending the role of pharmacists into areas that have little to do with medicines. This highlighted to me the lack of direction within community pharmacy. There is a wide range of enhanced services that can be offered by pharmacies yet provision of these could be described as patchy. I am concerned that, as we try to extend our roles, the public are not sure what to expect from us.
By having a nationally recognised set of standard operating procedures and by allowing pharmacists to be accredited nationally to offer services (rather than in each individual primary care trust), we can offer a more consistent service.
Also, I see accredited checking technicians as being crucial to the future development of community pharmacy and would like to see more being trained. They will be the people who help us balance workloads as we pharmacists step further away from the dispensing role.
Sebastian McNeilly Prescot, MerseysideWhy do pharmacists not sign the “checking box”?
From Mr H. S. Badwal, MRPharmS
From time to time I notice that other pharmacists, both locums and managers, do not sign the “checking box” on the labels of dispensed medicines. There are many reasons given for this, such as “I’m the regular pharmacist” or “the date of dispensing identifies who dispensed it” and the popular “it saves time”.
Although some may accept these excuses, I believe it indicates a distinct lack of confidence from these pharmacists. I suggest that if a pharmacist does not have the confidence in his or her ability to initial the checking box, it may be that they do not believe they are competent to perform the job.
Hardeep Badwal
Derby
Community pharmacists do care
From Mr P. S. S. Badham, MRPharmS
Alan Roger’s assertion that community pharmacists in England do not want to develop, or do not care about developing, a more clinical role (PJ, 17 October 2009, p413) is unjust and untrue.
I, like many of my colleagues, have fully embraced the new contract and I, for example, undertake in excess of 100 quality medicines use reviews per year.
Since I qualified in 1976, I have done my utmost to assist in changes in the profession. I have worked in a local pharmacy development group and, more recently, in a local pharmaceutical committee.
I am saddened to see little or no change despite all of the White Papers that have come and gone and all of the empty promises and pledges from leaders in our profession. We have all been told that we are moving in a brave new future where we will not lick and stick but use our expertise fully.
Also, I am frustrated that the situation in England does not mirror that in Scotland, where pharmacists are clearly seen as adding substantial value to the care of their patients and as key members of the clinical team.
I agree with Mr Rogers that we should focus on providing high quality and properly funded paramedical care management, and that we cannot wait any longer.
It is my concern that, unless change happens now, other sectors of the health service will take up our new roles and pharmacy will be left without any material function in the future.
Peter Badham
Badham Pharmacy Ltd
Cheltenham, Gloucestershire
Take our rightful place in the healthcare team
From Mr S. R. Gabell, MRPharmS
I agree wholeheartedly with the Agenda article by Alan Rogers (PJ, 17 October 2009, p413). At present, community pharmacies offer little to patients with chronic illnesses. They may get a medicines use review once a year, which may or may not be of value.
This simply has to change. We must take control of the pharmaceutical care of patients with long-term conditions and not just passively dispense their prescriptions.
Only by using our specialised knowledge to provide pharmaceutical care can we secure the future of community pharmacy and enable community pharmacists to take their rightful place in the healthcare team.
Stephen Gabell
Chatham, Kent
Pie in the sky
From Dr R. C. Jacob, MRPharmS
In his Agenda “Community pharmacists still don’t care” (PJ, 17 October 2009, p413), Alan Rogers writes: “It is a travesty that community pharmacists in England are still not commissioned to provide pharmaceutical care. It is a tragedy that they do not seem to care.”
Is it any wonder? Most community pharmacists work under near intolerable conditions. Many put in too many hours without adequate breaks and have huge volumes of prescriptions to deal with.
Then they are asked, for example, to counsel for this, counsel for that, visit residential homes and are confronted with the seemingly chaotic issue of how to interpret the effects of the responsible pharmacist Regulations. This is all in addition to conducting medicines use reviews and recording continuing professional development.
Some bright spark now and then comes up with the suggestion that two pharmacists per pharmacy would ameliorate matters somewhat. This is true but is pie in the sky. It is precisely here that the pies will meet the heads in the clouds.
R. C. Jacob
Non-practising Pharmacist
Orpington, Kent
Dispensing is our core service
From Mrs E. E. T. H. Hopkins, MRPharmS
At the 2009 Pharmacy Show in Birmingham, I was disappointed that Sue Sharpe, chief executive officer of the Pharmaceutical Negotiating Services Committee, was pursuing the policy of seeking remuneration for services and seeing us as provider of services rather than dispensing pharmacists.
Legally and financially, I believe dispensing is our core service — and it must remain so. Therefore, why are dispensing fees so low?
In her presentation, Mrs Sharpe said she visited a pharmacy that was providing 18 services. How many patients would one need to test in a year to make the business viable?
Has the PSNC done its homework of the impact on contractors in pursuing services remuneration to the detriment of dispensing fees?
E. E. Hopkins
London
PSNC responds
From Sue Sharpe, chief executive officer, Pharmaceutical Negotiating Services Committee
The PSNC remains committed to supporting the essential role community pharmacies play in dispensing medicines, but the role has never been confined to dispensing alone. Patients rely on pharmacies to give advice and to help them manage their conditions.
Our work is focused on building recognition of the services pharmacies already provide — and developing this role further.
In the pharmacy White Paper, the Government has set out its policy for using the skills of community pharmacists to support the NHS more effectively, and we must ensure that we provide the framework that allows these services to be implemented.
The present arrangements for commissioning enhanced services are unsatisfactory and the PSNC recognises the need for radical change to allow contractors to have confidence in any adjustment to remuneration that would allocate funding away from dispensing towards service provision.