Grey. We like grey. Squirrels are grey, many cars are grey, and numerous pulses have been set racing by Fifty Shades of Grey. There’s a lot to be said for this twilight colour – until we enter a grey area.
As well as grey, we also like science, which is probably what brought us into pharmacy. In science we have accuracy and precision, so the answer is either right or wrong. I certainly didn’t become a dispensing chemist for grey areas, and yet it seems even in pharmacy we can’t get away from them.
Sat at the local pharmaceutical committee (LPC) yesterday, there was debate about an application to open a new pharmacy. “To have their application granted, they have to demonstrate unforeseen benefits,” said the chair, and a long and protracted argument broke out about what constituted an unforeseen benefit.
The proposed new contract would give greater choice to patients, but then so would any new pharmacy. It was close to a new housing estate, but the journey for those householders to existing provision was less than a mile on the flat. Eventually a decision will be made and, of course, whatever submission the LPC makes will have little influence upon that.
I thought of this again as someone on Twitter astutely asked if the absence of a price concession for many generics was a deliberately covert way for the Department of Health and Social Care (DH) to expedite the closure of 3,000 pharmacies. I might agree if I believed anyone in the government was capable of such coherent forethought.
But, as with all good conspiracy theories, the answer is more probably incompetence, and this is likely to be seen by the health mandarins as a serendipitous omission to forward their publicly admitted – then publicly denied – objective.
Not only is this a faster and, for the DH, cheaper way to winnow the excesses of incompetence epitomised by the control of entry exemptions – with all due respect to any 100-hour pharmacies – but it avoids the inevitable legal challenge that would be made to decisions based upon a rational pharmaceutical needs assessment.
I suppose it’s a case of not getting the geni back in the bottle. For those contractors in place prior to 2005, when the entry exemptions were introduced, it’s easy to say: “Close them all and let them prove they’re necessary and desirable.” But every one of those contracts is someone’s living, someone’s mortgage payments, child’s schooling or pension. If it was challenging enough for us to agree the unforeseen benefits of one contract application, how much more of a grey area would it be for 3,000?
So we are left with survival of the financially fittest, and without the eons of evolution that normally accompany Darwinian choice, there remains this very unnatural selection. Some of us are forced to greater efficiency and improved working patterns by the oft-quoted ‘burning platform’ metaphor upon which we stand.
For the remainder, the outlook is not a grey area – it’s black.