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How do we reconcile our profession’s dual roles?

Dr Jekyll and Mr Hyde perished, unable to manage their conflicting natures, writes Peter Dawson, and pharmacists must come to terms with their own two roles if they are to avoid the same fate

The arguments around commerce and pharmacy practice continue. Of course, historically and economically, we have always been both retailers and professionals.

Robert Louis Stevenson famously described the dilemma of two distinctly different characters residing in one body. And, while not suggesting that retailing is an evil, or that professionalism embodies all that is good, there remains something of the Jekyll and Hyde in community pharmacy - 21st century schizoid man, as King Crimson once put it.

The C+D issue of March 24 had a story headlined "Pharmacy sales hold as painkiller purchases soar" – and the retailer cheers.

The C+D issue of September 19 highlighted the dangers of frequent painkiller use, with the estimate that one in 50 people in the UK experiences headaches caused by over-reliance on medication.

Shortly before the consequent revised Nice guidelines to help health professionals care for such people, Boots launched a nationwide three-for-two sales promotion that included P medicines – and the professional sighs.

How do we sort out these disabling conflicts? A good start would be to own up to our lines in snake oil

Mixed Messages. Conflicting goals. The duality within pharmacy lies at the heart of much of our discord. I experienced the conflict of interest as a proprietor and I witness it as a locum.

The professional would like to restrain the retailer but can't for both economic reasons – we'd go broke and legal precedent – Lord Denning ruled against it.

The retailer would rid themselves of the shackles of professionalism and commit to the free market, but the Royal Pharmaceutical Society retains some influence and a regulator lays down standards of conduct and premises.

So, how do we sort out these disabling conflicts?

A good start would be to own up to our lines in snake oil. We didn't require the recent Which? report to inform us that there is an absence of evidence for a proportion of our OTC business. But the Society's professional response has been to appease the retailer by hiding behind the cloak of "patient choice", stating that if a patient wants to buy a useless, admittedly harmless, product, then they have that right. I think they deserve better.

I would argue that a professional service is also a viable economic proposition. And that the lost income from placebo cough and cold products, homeopathy, aromatherapy and the like could be replaced successfully with sales of efficacious products and services.

We also need an urgent and dramatic shift in the nature (as well as the level) of remuneration. There has to be a complete independence of income and quantity of services, such as prescription numbers. Prescription rationalisation and medicine optimisation are not going to happen as long as they reduce income.

Remuneration should drive the changes required to improve patient care, not impede them. And anticipating that clinical commissioning will generate reliable income streams is on a par with purchasing scratch cards and lottery tickets.

In Stevenson's tragic tale both Dr Jekyll and Mr Hyde perished. Strong leadership is required if the retailing pharmacist is to avoid a similar fate.

Peter Dawson was recently described by a student as a pharmacist who must have seen a lot of changes. He has. Currently he is a locum pharmacist and Guardian and C+D columnist. He can also be found here or Tweeting at @peterdawson19.

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