From crisis to evolution: Community pharmacy’s transformation
Following ITV Tonight’s documentary on community pharmacy, Malcolm E. Brown shares his thoughts on the underfunded sector
The ITV programme on January 11, ’Pharmacies — the New NHS Frontline’, highlighted the crisis of community pharmacy: eight are closing every week. Here is what I see through my sociologist's spectacles.
I agree that community pharmacy is underfunded but I cannot help feeling just a little bit sorry for politicians because they are in an impossible position. The NHS started in 1948 underfunded and a continuous uproar of complaints about lack of money arose from every single part of it. No wonder politicians seem deaf to the entreaties of health professionals!
A health minister politician is like the pilot of a plane who knows exactly what to do; unfortunately controls seldom work. Do something! To reorganise the NHS (again) is their default mode. But there, as a retired pharmacist, my sympathy ends.
The underfunding means that community pharmacists' income falls. Social class is material and connected with money; status or prestige is symbolic. Spending money stylishly, but only stylishly (and not in a kitsch or naff fashion: overextravagant or lacking aesthetic sensitivity), will raise class position. I am sure you can think of examples.
People like prestige and a high income. Witness, for example, the dedication of hospital medical practitioners to achieving the highest possible NHS salary by taking industrial action.
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Put brutally, a part-time NHS hospital consultant (who also has income from part-time private practice), for example, is not used to being number two but expects to be "on top of the pile"; I am not uncomfortable with that. But pharmacists, including those in the community, expect and also deserve, a higher-than-average income.
But there lies the problem. Pharmacy today is a victim of its own success. Pharmacists have so much choice in their working situation that community pharmacies have become less attractive. If a pharmacy closes, staff in a nearby pharmacy will become busier and maybe more stressed; extra income does not adequately compensate. They become more likely to leave and so on.
Using systems terms, that is a vicious downward spiral of feedback. Using the perspective of the social psychologist Solomon Asch (1952), the survivors, tending to follow the herd, will feel isolated and think that they, too, should leave community pharmacy. Such pharmacists can "vote with their feet" to work in other branches of the profession.
They can become clinical pharmacists within a GP surgery; that removes the stigma of trade. An extreme illustration is a pharmacist working within a pharmacy located within a food superstore where all customers have to pass the star attraction: the assistant manager bathing in a bath full of baked beans. But remember well that a GP, just like a community pharmacy, is a small business.
Consultant pharmacists practice as a member of a multidisciplinary team in hospitals, with a salary that may exceed £100,000 a year, plus associated prestige. Moreover, they benefit from platinum-plated pensions: equivalent to substantial extra income.
Pharmacists could work in industry, for example, in quality control, production, drug information, research and development or sales and marketing. The apex quality assurance professional is a qualified person (QP) who certifies approval of batches of medicine for the market. They also certify investigational medicinal products including for healthy volunteers in Phase I trials. QPs co-operate with regulatory authorities, inspectors and so on. This position can be stressful.
QPs must have a minimum of just one year's pertinent industrial experience and have passed an oral examination before representatives of the three professional bodies: the Royal Society Pharmaceutical Society (RPS), Royal Society of Chemistry (RSC) and the Royal Society of Biology (RSB). Note that the General Pharmaceutical Council (GPhC) is not involved. QPs are highly paid. It astonishes me that so few pharmacists today seem to be interested.
Another little-publicised, but prestigious and highly-paid position in the industry, is the qualified person for pharmacovigilance (QPPV); pharmacists with two years of pertinent experience are eligible.
Some community pharmacists are teacher practitioners with the School of Pharmacy of their local university so they work partly in the community and partly for the university; the most able may be afforded the prestigious title of professor.
All this may seem like a very dark place for community pharmacy, but there is hope. The Promised Land is the sunlit uplands—following the Pharmacy First process. Just hang on in there for a couple of years.
To facilitate, it seems logical for some pharmacy technicians to dispense more autonomously; presently they are qualified at BTEC level 3, which is academically, “only” equivalent to three A Levels. I urge BSc or BPharm level credentials as soon as possible; some pharmacists may find that contentious. Pharmacy technicians will become tomorrow's community pharmacists.
Today's community pharmacists will become the new GPs, responsible for all but major illnesses or very complex, difficult or enigmatic patients. What’s not to like?
Dr Malcolm E. Brown is a retired community, hospital and industrial pharmacist, and is a sociologist and honorary careers mentor at the University of East Anglia.