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by Alexander Humphries*

If only community pharmacy had a true champion within Government who understood that we offer solutions to the problems of the unproductive, overspent and over-stretched hospital sector ...

Every day I see the tremendous difference that community pharmacy makes to people's lives. In just the last week, I dealt with three patients who really needed my help.

The first was a patient who burst into tears at the medicines counter and then threatened to kill himself. It was a dreadful moment. I've never received any training in crisis management for mental health, but as a human being, I did what I could for someone who was genuinely at a desperate ebb in their lives. I managed to track down a social worker and calmed the gentleman down.

I am sure this isn't what the powers-that-be would term a clinical intervention; after all I am only a community, not a clinical, pharmacist... But the real lesson here is that we must challenge some of the preconceptions about what a community pharmacist is and does.

For instance, how often are we told that the evidence for the value that community pharmacy adds to patient care is poor? What these detractors fail to see is that we prop up the NHS by being efficient suppliers of medicines, and many other services to boot, and subsidise, through any means necessary, the chronically underfunded contract. Community pharmacy doesn't want to change, they say. Wrong. So wrong.

Brilliant people

Community pharmacy is full of brilliant people who deserve both to be paid better and better valued by an NHS that has no sense of value. This is an NHS that will pay £1m to stick a dispensing robot in a hospital pharmacy on the basis of a capital expenditure business case predicated on a reduction of head count... only it never gets around to reducing the eye-watering wage bill.

As a hospital colleague put it, these robots are doing little more than ward top-ups, which would previously have been carried out by a technician on £9.50 an hour. Can we afford these vanity projects of puffed-up hospital chief pharmacists? Or should the NHS be thinking about how it can push discharge out into community pharmacy?

Discharge mess

Indeed, I had my first referral from a hospital pharmacy last week for a patient who had just been discharged. We sat down and I did a 'brown bag'-type review. Lots of medicines had been stopped during this person's admission.

I spent ages going through his medicines to help his understanding, but also to remove all of the old medicines from his out-of-date repeat slip and, more importantly, from his bathroom cabinet. It would have been better for him if he had just been given an FP10 and hadn't had to wait for four hours the previous day while his discharge prescription was processed in the hospital.

€Community pharmacy is more expensive than hospital€ is the notion that is frequently spouted by our friends in secondary care. Sorry, I just don't buy that. If there was more transparency about the true costs of head count, capital and overheads for hospital pharmacy departments, we could have an honest conversation about the 'whole system' cost of a hospital prescription. No wonder our hospitals are in such a mess.

Initiative

My third story concerns a patient from outside our area, visiting his mum. A recovering addict, he had come away without one of his medicines.

His surgery had faxed through a prescription for a branded generic, which, of course, we would have had to order. His mother was worried because he faced having to go without his medication. Our local GP practice was closed, so I did the only professional thing open to me, and that was to supply a different brand (at a loss, I might add) on the basis that the care of the patient was my primary concern.

I discussed it with the patient and his mother (who was a magistrate) and explained that I was breaking the law. However this was, in my view, the least worst option for his care. €Thank goodness I live here€ was her response. Centralised dispensing would not have helped this patient and might have robbed me of the option of using my professional initiative and supplying something other than what was prescribed because it was in the patient's best interests.

Can we afford the vanity projects of puffed-up chief pharmacists?

* Pen name of a practising community pharmacist. Alexander Humphries' views are not necessarily those of Pharmacy Magazine. What have you done recently that was above and beyond the call of duty? Email pm@1530.com