By Pupinder Singh Ghatora
In this rapidly changing environment I often ask myself ‘why did I choose community pharmacy?’ Then a patient comes in and says the advice I gave was the best and helped more than anything else he or she had tried, including visiting their GP.
Do not get me wrong, I am not saying I am better than a doctor or cleverer than any other pharmacist out there. I just find it rewarding when the clinical advice I give makes such a difference. It is just a shame that our remuneration model is completely out of touch and out of sync with our expertise.
We are paid to supply medication, that is it. You can have all the PSNCs, LPCs, RPSs, GPhCs and any other organisation telling you that service provision is the way to get your income. Quite frankly, this is nonsense.
I am a contractor owner and I can tell you honestly most of your income comes from your dispensing service, not your MURs, NMS or any other (in my view) pointless service. I am not averse to carrying out any clinical service.
In my view the more responsibility put upon us will help the profession grow and develop into a leading clinical service provider for the NHS. However, if you are not going to pay for it or pay peanuts for it, how can you expect any pharmacist worth their salt put any significant effort into pushing these services.
All I keep hearing is how pharmacy must raise their game and show their worth, Dr Keith Ridge, who presented me with my Pharmacy Business Award, also being a culprit. How can we be expected to raise any game when we must dispense medication to provide our bulk income.
Now I am sure there will be people out there crying out, ‘you should have a checking technician, so you have time to carry out the other services.’ Please wake up. The money is no longer available to develop your business.
I have friends and colleagues making staff redundant because of these non-evidence-based funding cuts. So, there is not an opportunity to invest and grow the business or the profession.
I personally know that I am consistently giving valuable clinical guidance and advice to patients for free.
I am not paid to give clinical advice, this is a professional obligation, but at the end of the month if I do not have the funds available to show any profit, how am I to invest in the business and develop clinical services?
It is my strong belief that we need to get the individuals that keep telling us to ‘up our game’ to come and spend a day in the life of your typical community pharmacist. I can guarantee you would not be making such flippant comments about improving service levels or commitment to pharmacy ever again.
Now the latest threat to our existence and music to the ears of the large multiples is the latest supervision proposal. I believe it will take a patient or a number of patients to die as a result of an error without a pharmacist present before the NHS will realise this is a foolish option.
One would think that the deaths associated with the removal of the oxygen provision would have been enough of a deterrent to even consider something as fundamentally flawed as having a pharmacy open without a qualified clinical professional available.
However, what do I know? I have just been working at ground level for the past 14 years. We will leave it to the purse holders to dictate where the profession goes rather than evolving for the best patient and clinical care.
There have been occasions where we have had patients being prescribed two of the same type of diuretic. In this instance if a pharmacist is not available to carry out a clinical check and the patient is taking these drugs together for a significant amount of time, it could end up with a hospital admission.
Even now we have to let patients and doctors know about the risk of rhabdomyolysis with macrolides and statins. This is something we as clinicians pick up very quickly as we have been trained as such.
If our clinical expertise is not on hand to deal with such issues, where does that leave the patient?
From dermatology, I have had patients advised that they should use nothing on their dry skin except water. Some may agree with this view but my clinical training and opinion advised the patient to use a moisturising facewash. Moisturise the skin as this prepares it to receive other topicals you may need to use.
A week later she came in and said my regime had completely resolved her skin problem rather than using water alone.
I have had patients come in distraught because they cannot see a doctor. It is my clinical training that helps them and, I mean this with no disrespect, not my staff who are trained to a high standard.
There is a reason why pharmacists spend five years training to do their job. You cannot replace clinical expertise, you cannot replace a pharmacist with a computer or someone who is not as qualified.
Our professional representation is a mess and has no influence. We as a profession are too busy and too weak to stick together. Everyone has their own agenda and it is very rarely for the benefit of the patient.
Pupinder Singh Ghatora, community pharmacist, Woodlands Pharmacy, Oxford