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Opinion: Pharmacy needs to clear the decks

Back in the 17th century, sailors would remove from the deck of their ship anything that could hinder success in a forthcoming battle. For pharmacy, clearing the decks is definitely just as pertinent, says Keith Ridge, former chief pharmaceutical officer for England.

If the profession is to finally achieve its long held clinical ambitions for community pharmacy, it must adopt a battle-ready approach — and quickly. 

So what is cluttering the decks of the good ship pharmacy? Some would say funding, but there are other more fundamental things. Let’s start with the most controversial: supervision of the sale and supply of medicines. What was so simple to resolve in hospital pharmacy has been seen largely as a ‘no go’ area in community pharmacy for the past few decades. 

Change anything, and the profession would come to a rapid end. Pharmacy technicians would rule the roost with employers taking the cheaper employment option. Family businesses would wain away. The shroud of reduced patient safety routinely waved. 

Then there is the dreaded hub and spoke dispensing. Surely such an abhorrence would consign local community pharmacy to the huge warehouse of global corporates. And finally original pack dispensing (OPD) – really? There was no way policymakers would ever allow registered health professionals to do anything other than waste time cutting and snipping away to exactly what a prescriber demands. It would cost far too much. 

The only ship these worries belong to right now is the ark... and I think the majority of pharmacy professionals now think the same. In the battle that the NHS and profession find themselves in, pharmacy’s decks need to be cleared and the clutter of supervision, hub and spoke, and OPD need to be consigned to history. 

We all know it. We’ve all known for a long time but I get a sense that the captains of the pharmacy armada are finally getting their act together. With primary care capacity straining at the seams, health inequalities starker than ever, preventative healthcare about to finally come to the fore and a pharmacy workforce crying out for chang – some would say about time too. 

Visible progress

For OPD, progress is already visible in the form of an agreement in principle. Government and Community Pharmacy England just need to sort out the detail. Just do that quickly please. 

For hub and spoke, I can feel a compromise coming that suits everyone and creates a level playing field – many are already engaging in this way of working – but it feels like supervision is still cluttering up the deck and getting in the way of the action. 

Sure, the relevant people are talking – but the talking needs to conclude with the various legal and professional issues analysed and addressed coherently, and the battle plan enacted. Accepting that delegation of relevant tasks to pharmacy technicians is feasible is a step in the right direction.

If all these things happen soon, then pharmacy will have the fundamentals in place to take on all-comers. The clinically enhanced, prescribing pharmacists of the nearish future will have just that – a future. 

Pharmacy technicians will have an even more rewarding career, pharmacy contractors who embrace the battle will come through, while Government will, in my view, think much more positively about whether the funding model and quantum is right for such a future. 

One word of warning to naysayers. While a bigger NHS workforce seems inevitable – and incidentally that isn’t the only answer to deliver the future NHS – more doctors will mean more needed for them to do. Unless pharmacy secures its clinical prescribing future soon, then the captains of medicine will make sure their new recruits do as much prescribing as possible. If that happens, pharmacy will have a very big problem indeed. 

More importantly, the public will lose out as the pharmacy ship is holed below the waterline. Delivering a Pharmacy First service for minor conditions is one thing – but the ship will only keep afloat if the world of long-term condition management is part of the pharmacy offer, albeit in an alliance with the good ship medicine.

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