A Change of Heart: Guest Post by @aptaim


 

I’m taking advantage of being a guest blogger to do something that doesn’t always come naturally, and that’s to admit that I’m wrong. Actually more than that, I’m confessing that I’ve been exactly wrong for more than the last year.

 

A couple of weeks back I was at an intimate strokey-beard meeting on commissioning with various representatives from the DH, NHS Commissioning Board and such, and it was there I realised just how wrong I’ve been.  The meeting was tabled as a discussion on the place in the new NHS of Local Professional Networks – designed in principle to be pools of subject experts that could be pulled upon by the NHS CB for input into the commissioning process – but it transpired that for various reasons they no longer exist in the new NHS framework:  a three-in-the-morning decision if ever there was one.  This, and the recent news that pharmacy commissioning representation in the Local Area Teams of the same Board is absent, made me realise my folly.

 

Because right now, who will commissioners go to for pharmaceutical advice?  More importantly, who will champion the role of pharmacists so that commissioners even know that they are a viable option?  Some may seek support from their emerging CSU, others will house some expertise in their CCG. But how many of them fully understand the breadth of pharmacist’s potential and the services that can be offered by pharmacists, and more so in the easily accessible sites that are retail pharmacies?

Perhaps some of you will suggest our governing body the GPhC. Well personally I’m not so sure, after they responded to my P-medicine self-selection query.  So what about Pharmacy Voice? The PSNC perhaps? The AIMp? The legendary Chemist and Druggist Senate? The NPA then? The CCA? The PDA? The UKPCA? No? OK, surely the PCPA? The GHP?  The PPRT?

And herein lays my concern: there are too many organisations that ‘represent’ parts of pharmacy, and too few that represent ‘pharmacists’.

 

In 2010 I decided that the Royal Pharmaceutical Society wasn’t worth my money, mainly after hearing a local (then) RPSGB branch member say that the cleaving of professional and regulatory functions wouldn’t actually change anything other than their logo.  But now in late 2012 I know that was the wrong decision based on someone else’s flawed attitude.

From my experience so far the RPS has changed. It is not always the speediest or responsive of organisations (their statement on 3-for-2 offers was praise-worthy, but I think we’re still waiting to hear their position on salbutamol by PGD?) and their coverage doesn’t extend fully to all sectors including my own speciality in community services, but that’s down to individual members, and the pharmacy ‘representatives’ above, to influence.  But what they do deliver on is media engagement, and this is important for three reasons.

 

Firstly, it cements pharmacists into the mid of the general public as a healthcare professional. I know that more people visit a pharmacy than any other healthcare setting, but this weekend I watched a couple agonise over which two pharmacy-only medicines to buy so they could get a third free, only to suffer their backlash when I intervened to say three boxes of Nurofen Plus – whilst not illegal – was not something I was prepared to let out of the front door.  Retail pharmacy is our most often visited sector, but it is most often seen as a shop not a centre for healthcare.

 

Secondly, increasing general public opinion of pharmacists as a healthcare professional increases the support the profession gets from patients. In the NHS, old or new, patients aren’t the same as the public, but certainly in the new NHS patients have a greater voice, if not a greater influence on decision making.  The more patients regard us as professionals, and talk about us as such, then the more this message will drip-feed, or directly feed, into commissioning intentions.

 

Thirdly, being an expert pharmacist is good for business: predominantly retail, but this will extend further as more roles and opportunities in primary care emerge.

 

Throw into the mix their extended joint-working initiatives over the old RPSGB such as the RCGP Joint Statement,  Transfer of Care initiative and the standards for in-patient prescription charts, and the RPS is emerging as a strong leadership body for pharmacists.   Things are currently moving rapidly and uncertainly in English healthcare, and I envisage the ‘pharmacist trilema’ becoming more relevant to our every working practice: you can deliver any balance of quality, time or return on investment, but if you want more of one, at least one of the others must be sacrificed.  I sacrificed return on investment for my employer (and my own ear-drum) on Sunday when I put quality first and denied the Nurofen Plus sale, but this individual action can only go so far.

 

It appears the current government remains committed to reviewing the principles of remote supervision, and the only certain outcome of this passing will be a squeezing of posts or remuneration for retail pharmacists.  The GPhC seems not to worry unduly about the requirements of the individual pharmacists they regulate, so it will be organisations like the RPS who must – and I now think can – deliver the right message to policy makers and healthcare commissioners that pharmacists are, and must remain, the universally accessible frontline clinical provider of all aspects of pharmaceutical care.

 

So my change of heart? Well the first thing I’ll do with next month’s wages is join the RPS.

 

I can only hope that other non-members will do the same.

 

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2 thoughts on “A Change of Heart: Guest Post by @aptaim

  1. In the US, physicians are represented by the AMA American Medical Association, which is regarded as a very strong professional organization which as far as I can tell, most physicians belong. They are effectively positioned as a union for physicians.

    When the AMA body says that they want Congress to increase members’ Medicaid or Medicare reimbursement, or it publishes results of research in Journal of American Medical Association JAMA, or makes a statement in disciplining a member in some way, everyone has to listen.

    Unlike the pharmacy profession which is splintered into work situation organizations such as hospital pharmacists, retail druggists, chain drug retail druggists, compounding, and consultant pharmacists, as well as different national, regional, and local pharmaceutical associations; there is no unifying organization which represents the whole profession’s pharmacy interests.

    This has has had a freezing effect on collective representation to the national governmental bodies, especially as most pharmacists report to State Boards of Pharmacy, which have 51 or more different sets of laws in the US.

    The only place where the laws are the same is if a pharmacist works in government facility such as in military, Public Health Service, Veterans Administration. However, even there a pharmacist must hold at least a valid State license and maintain laws for that state.

    Because pharmacists’ loyalties are scattered in an artificial manner, it is very difficult to build consensus. Some pharmacists find their interests represented by unions such as United Food and Commercial Workers, United Steelworkers, Service Employees, International Union, and others.

    United we stand, divided we fall, and that’s pretty much the clout that the registered pharmacist working directly with patients finds themselves; fallen individuals and can’t get up.

  2. I am a US pharmacist that has worked in academia, hospital (in- and out-patient), and independent pharmacy retail. There are very different views of pharmacy in these different areas, and like Ingletina said, the different National groups are fragmented. Big Pharma is also incredibly large and loud. If there was one loud lobby that truly did recognize the “needs” of all pharmacists in their respective positions, that would be nice (understatement). I’m glad you are working towards that in the UK. It seems that we share this problem across the sea–you are adding to our global voice. Thanks for writing.

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