Do we really need pharmacies? UK GP mag asks

doctor and pharmacist armwrestle

The editor of a UK GP publication has posed the provocative question, “Do we really need pharmacies?” on his blog.

Nigel Praities, editor of Pulse, admits that he is “deliberately being a bit provocative to stimulate debate” in publishing the column.

He cites the opinion of Pulse columnist Tony Copperfield, who suggested “Ten easy cuts to save the NHS” in July 2014 with “sack pharmacists” as step number one.

“Let’s face it, if you were designing the NHS from scratch, you wouldn’t invent pharmacists, would you?” Copperfield, whose bio reads: “Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder,” wrote at the time.

“They’re just GP wannabes who, medication-wise, duplicate what we do, but badly. To stock shelves and count pills, you just need a level of consciousness, not a pharmacy degree.”

Praities repeats the suggestion that anyone designing the NHS from scratch would not invent pharmacies.

He makes the point clear, however, that he feels pharmacists themselves should play a bigger role in the provision of health care.

“With so many more people living longer, and on a cocktail of medicines to do it, access to their expertise is badly needed,” Praities writes.

“They are brilliant at what they do, but I question the current position, where their skills are based in a building a few streets away, tucked behind shelves of corn plasters and toothpaste.

“Why are we continuing to support this bizarre arrangement when everyone recognises that NHS services must work better together to improve care?”

He says the General Practice Forward View, in which NHS England pledges that every GP practice in England would get access to a clinical pharmacist, could be much more ambitious if all practices had a fully-funded clinical pharmacist service in house.

He also questions the “archaic” restrictions on GPs being able to dispense.

“If pharmacies are able to set up – and charge fees for – services that compete with GP practices then surely every surgery should have the option to dispense medicines right there and then.

“Repeat dispensing could be done by post – so shorter opening hours would not be a problem – and the non-NHS ‘drug store’ part of the business would still exist in the larger chains.

“I am deliberately being a bit provocative to stimulate debate, but with the NHS facing a £22 billion black hole we have to think differently about how our resources can be used for maximum effect.”

Tim Logan, president of the Pharmacy Guild Queensland Branch, told the AJP that pharmacies in the community setting bring several advantages to the health landscape, and that prescribing and dispensing are separated for a reason.

“The more steps there are in the process, the more chances you have to detect errors,” Logan told the AJP.

“That’s not to say that if you have infinite steps you’ll be infinitely safe, but if you’ve got the same people being involved in prescribing and dispensing you’re losing that independent audit.

“A pharmacist might see a perfectly legal prescription for morphine 100mg and be aware that they’ve never had that strength of opiate before, and for an opiate-naïve patient it might be too much, even though the prescription is legally and rationally written in every other aspect.

“Having that separate set of eyes has paid dividends in terms of safety and the avoidance of harm on countless occasions.”

Logan says that pharmacies’ placement in the community pays off because they are highly accessible – Guild data has shown pharmacies are more accessible than GP surgeries, supermarkets or banks – and are not only visited by consumers when they are sick.

“Pharmacies are often accessed when people are not in acute mode – which is when they typically are attending surgeries or hospitals – but once you’ve got their health in maintenance and treatment mode. You don’t always need clinical services in those instances and it’s why you wouldn’t restrict pharmacy to just being in medical practices.

“I think you could file this column under the same genre as Professor King’s speech at APP: let’s ask some provocative questions, even though we’re pretty sure there’s a good answer to them.

“Let’s ask those questions, and just remind ourselves of why things are the way they are.

“While ever pharmacists are detecting misadventure from either one prescriber’s misstep or interrupting the bad consequences coming from two or three different prescribers doing two or three different things for one patient without one knowing what the others are doing, there’ll always be a place for pharmacists in pharmacies.”

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