When I was little, I used to dream I had superpowers and could fly. Proper arms-outstretched, legs-back flying – so much so that I would sleep laid out in the Superman pose. Of course, when I grew up I never imagined I’d actually need powers to use in an emergency.
But an Emergency Powers Act really was passed by parliament in 1920, to secure the supply of essentials such as food, water, fuel, or power, and used primarily to break strikes that threatened coal supply or rail operations. Almost a century later we’re more likely to worry about the supply of Netflix and Spotify, but recent Brexit discussions have brought the realisation that medicines may also be vulnerable essentials. In the last few months, we’ve seen an exponential increase in the number of unavailable prescription drugs.
So according to wholesalers and the Royal Pharmaceutical Society, pharmacists need emergency powers to substitute drugs on prescriptions in the event of a no-deal Brexit. That’s a great idea, and very commendable, but so long overdue that we shouldn’t wait for Brexit – whenever that may be. Deal or no deal, we should have that ability now.
How often do we make pointless calls to a GP asking for a script for two lots of 20mg furosemide, because 40mg is unavailable? Or ranitidine to replace the seemingly discontinued nizatidine. Surely, we can safely make such decisions – especially now that we have access to drug intolerances on the summary care record.
But before we’re too grateful for the mere suggestion that we ‘retail’ pharmacists might be trusted to make the same decision as those superior beings, the ‘clinical’ pharmacists, let’s ask why it always takes an emergency to advance community pharmacists’ powers?
Look back over the last 20 years, and despite the change in the profession and the development in our clinical responsibilities, and it seems nothing less than an emergency or an imperative will drive the Department of Health and Social Care to action.
It took Dr Harold Shipman’s atrocities for amendments to controlled drug regulations to be made so that we could amend 'minor typographical errors', and the swine flu pandemic of 2009 for the emergency supply regulations to be changed to increase the permitted supply of medicines from five days to one month. Then Elizabeth Lee’s momentary loss of focus – and its tragic consequences – meant that the law criminalising inadvertent dispensing errors was slowly reconsidered. More recently, the lack of GPs has opened doors for pharmacists to become embedded within surgeries.
So why does the opportunity to develop our profession only come when there’s a crisis? Where is the planning by our leaders and our negotiators? Why are we always crowbarred into new roles and obligations, solely to account for a problem or a tragedy?
That is no way to plan the advancement and development of our clinical skills and responsibility, and it’s high time NHS England’s pharmacy leaders had the courage and foresight to properly redesign our services around patient needs, patient care, and patient outcomes. It feels as though I’m more likely to grow wings and fly before that happens.