FOR longer than I’ve been in this profession, there has been a debate around the supervision of pharmacies. A quick Google search will show the discussion has been around since the turn of the millennium. Pharmacy has changed so much since this debate started; pharmacies in England are now able to access patients’ electronic Summary Care Records and can receive prescriptions electronically whilst those in Scotland can make supplies of certain over the counter medicines free of charge to patients under the nationally agreed Minor Ailments Scheme. So why does this debate rumble on?
In my opinion, the NHS gets a fabulous deal from the current dispensing and supply model. We are paid a set fee and can make a guaranteed profit to pay for our services. But we are about much more than simple supply of medicines.
Whilst writing this article, I have made three emergency supplies of essential medicines, eased a mother’s panic when she thought her child has the rash typical of meningitis, done some running repairs to an 8 year old girls’ trapped finger and prepared a monitored dosage pack for a confused, elderly patient discharged from hospital with medicines in original packs. How much has all this cost the Treasury? Not a single penny.
The money received from “doling out medicines” (as Simon Stevens, NHS Chief Executive so eloquently put it) pays for us to be there, when and where patients need us. By having a highly trained expert in medicines and minor ailments in health centres, high streets and local communities, the very front line of the NHS is open at weekends and late at night, offering free, expert help and advice about a whole range of health issues.
We are continually hearing of the need for change to the community pharmacy contractual framework. The fact is in England we are seeing the Department of Health making sweeping cuts to the sector to try and make the sector more efficient. Of course, we all know that this means reducing the pharmacy numbers (as mentioned by the Chief Pharmaceutical Officer for England, Keith Ridge), possibly leaving some sort of Amazon type distribution model.
And this is where the latest chapter of this debate starts — does a pharmacist need to be on the premises all the time for the pharmacy to run safely? Myself and many like-minded individuals, the answer is a resounding yes. Responsibility and accountability for the safe and effective supply of medicines must remain with the responsible pharmacist. As stated in our letter  which was signed by over 650 of my colleagues, a pharmacy without a pharmacist is simply a shop. The people we work for, patients, expect nothing less than a pharmacist on the premises, there when they need them.
I agree all members of the pharmacy team should be allowed to develop their skills to maximise their role in patient care, but accessibility to a pharmacist is something that cannot be lost. Of course efficiencies need to be made, both to make sure the NHS is able to continue providing health care free at the point of need and also so that businesses providing that care remain viable.
However, emergencies and pandemics aside, there are absolutely no situations I can think of where the loss of a highly trained expert in medicines and minor ailments to the public is an acceptable trade off for efficiency. I am all in favour of allowing every member of the pharmacy team to train and develop their careers, to be the very best they can be and help with the health and well-being of patients.
I have helped to train and on a day to day basis continue to work with some fantastic pharmacy technicians and without them, I would not be able to do what I do now for patients. Technicians are highly trained and regulated health care professionals but to liken their training (a two year, part time distance learning qualification) to a rigorous, four year Masters degree followed by a year of hands on learning in a preregistration year is crazy, not to mention adding an unfair amount of responsibility to technicians themselves.
Currently, with no change to medicines regulation, there are plenty of examples where the personal involvement of the pharmacist is not necessary. For some time now, the final accuracy check of a prescription has been made by suitably trained pharmacy technicians, but this is only once a pharmacist has clinically assessed that prescription and used their expertise, judgement and responsibility to intervene if deemed necessary.
The smoking cessation services and Healthy Living Pharmacy scheme run in many of the pharmacies I work at and have next to no pharmacist involvement. Medicines counter assistants, dispensers and technicians run these and run them with confidence knowing that if any clinical issues outwith their competency arise, there is a pharmacist there, to act as a safety net, able to advise and intervene as necessary.
It is my belief that pharmacy technicians play a key role in pharmacies; I’ve gone on record in the past stating that, as registered health care professionals, pharmacy technicians should be allowed to sign patient group directions to allow them to administer ‘flu vaccines or supply emergency hormonal contraceptives, for example.
In closing, operating a pharmacy without a pharmacist on the premises simply cannot offer patients the same safe and effective service as they get now, nor the pharmacy technicians the same protection of operating under a fully qualified and experienced pharmacist, in times of financial constraint, now is not the time to experiment with the legal framework which has made us one of the country’s most trusted professions .
We must not allow the Department of Health to further deprofessionalise and depersonalise the supply of medicines and health care advice by removing pharmacists from pharmacies.
Ben Merriman is a community pharmacist based in Cumbria