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GP: Rethink the massive insult of the ‘retail pharmacist’ term

"Words are important, we should be careful how we use them"

NHS England must replace its ‘clinical’ and ‘retail’ pharmacist terminology when differentiating between those with additional training, says GP Toni Hazell

“I’ve made you an appointment at 3.20 this afternoon – you’re seeing the locum.”

The surgery receptionist who, a few years ago, said this to a patient in my earshot probably didn’t expect me to look up from my paperwork to address her communication skills. I gently pointed out that a patient who is told they are seeing “the locum” GP already has a more negative view of that doctor’s skills than the patient who is told they are seeing “Dr Jones, a new doctor who is working with us today”. Words are important, we should be careful how we use them.

I was reminded of this episode when I read about the debate over the term ‘clinical pharmacist’. The NHS England website describes them as "highly qualified experts in medicines [who] can help people in a range of ways". It includes in this group those GP pharmacists with extra qualifications who have a patient-facing role; for example, carrying out medication reviews, reviewing long-term conditions and in some cases prescribing medicines. Furthermore, a patient information leaflet produced by NHS England on ‘clinical pharmacists’ defines them as “health professionals who train for many years to become specialists in medicines...in the GP team”.

Pharmacists who do not work in a GP surgery or hospital are excluded from the title ‘clinical pharmacist’, even though other than their place of work they clearly meet both the definitions given in the previous paragraph. These apparently non-clinical professionals have also been called 'retail pharmacists'. This term implies that those who work in high street pharmacies are little more than salespeople, a massive insult to a group of healthcare professionals who have all done at least four years' training and who act as a vital safety net at the point of dispensing medications.

Most GPs, myself included, will have had that call from a pharmacist, gently enquiring whether they really meant to prescribe penicillamine for a sore throat or wondering whether the handwritten alteration to change 10 diazepam tablets into 100 might have been done by the patient instead of the doctor. Without the skills of dispensing pharmacists, there is no doubt that prescribing would be riskier than it is today.

All healthcare professionals should recognise the limitations of their knowledge. A pharmacist whose main work is in dispensing has a different skillset to one who runs diabetes clinics. Both are important for maintaining the smooth running of the NHS. It is unfortunate that the word ‘clinical’, which describes such a fundamental aspect of the interaction between patient and healthcare professional, has been reserved for those pharmacists with specific roles, to the exclusion of pharmacists whose main role is in dispensing.

I’m sure that NHS England didn’t intend to alienate an entire profession when they coined the term ‘clinical pharmacist’, but it has undoubtedly caused significant upset and maybe they need to rethink the terminology. Acknowledging that all pharmacists have a clinical role to play and finding another name for those with extra qualifications and skills would seem a long overdue move, which would show that NHS England fully recognises the training and skills of those who are at the frontline of the provision of medicines.

Toni Hazell is a GP based in a practice in London

10 Comments

Leon The Apothecary, Student

At the end of the day, it's a matter of public perception. 

Paul Dishman, Pharmaceutical Adviser

I was always a community pharmacist, never a retail chemist!

N O, Pharmaceutical Adviser

Excellent article. Hopefully the Cheap Cynical Pharmacist reads this article and stops promoting these titles. There are many Pharmacists who are just on the register for the sake of it and many work in different roles withing the Pharmacetical World. They don't even visit a community/ hospital/ GP Pharmacies. All they do is complete their CPDs and be on the register. Do we call them CPD Pharmacists?? 

Some other titles come to my mind (some do exist): Prison Pharmacist, Wholesale Pharmacist, Cosmetic Pharmacist, Hub and Spoke Pharmacist, Online Pharmacist, Sports Pharmacist, Glastonebury Pharmacist etc etc. The list can go on and on and on if we start identifying them by what they do!!

Dara Hughes, Community pharmacist

Thank you doctor for your insight and respect as a fellow health professional. It’s admirable. I make this comment as a proud, hard working and clinical community pharmacist.

Peter Williams, Community pharmacist

What a refreshing article.  Really well written and great to know that we are appreciated.

Joan Richardson, Locum pharmacist

Thank you for this - for too long community pharmacists have been regarded as second class citizens.  I attended a training evening a good few years ago where the speaker preceded every section with "I will have to explain this for those of you working in retail" as if we were too stupid to present let alone able to understand what the training was about!

Paul Dishman, Pharmaceutical Adviser

 

I would have had words with the speaker

 

Reeyah H, Community pharmacist

It’s so rare to see a GP who understands the whole system. We are all in it together and a part of me feels that so called ‘cinical’ pharmacists have a developed an air of arrogance by their new title. We are all pharmacists- in fact, we deal with patients on a level no one else can as we have the most contact with them. This well written article has made me think too. I won’t use the two locum pharmacist- rather, ‘my pharmacist colleague’ was covering, actually sounds better! 

Kevin Western, Community pharmacist

Thank you!

Raymond Anderson, Community pharmacist

I agree entirely. I have been saying for years, you don’t hear of a “clinical doctor” or  “clinical nurse”. We are all professionals working in different parts of the system bringing our skills to the care of the patient. We have pharmacists working in areas of oncology, paediatrics, cardiology, GP Practices, hospital and community. Practitioners including pharmacists should be  identified by their area of work, not by an extra training course they have done. 

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