If we, as pharmacists, don’t fully understand our identity – which I think we don’t – then we should not be surprised when the general public doesn’t either.
The last few days have seen a flurry social media activity.
Outrage. Shock. Disgust.
And probably rightly so. We are all quick to jump in and I’m afraid to say on this occasion I took the bait. The response to the #whatwedoinpharmacy hashtag has provided some short term optimism but when I reflect on where the power really sits in the profession of pharmacy I realise that this is nothing but a brief flash in the pan.
That said a fire needs a spark.
The trouble is as pharmacists I don’t think we have ever been able to operate autonomously within the healthcare system. For years we have been passengers. Our job has been to be the healthcare goalkeeper or more recently free up GP time. We have come a long way across a number of sectors but in my view, in recent years we have never been able to confidently get on the front foot.
Any progress made has been down to the selfless effort of the talented minority. Imagine how things could accelerate if we were all on the same page working to a common goal.
The systems within which we operate are designed for another time. The impatience played out in wider society is I feel seeping into our profession. Not before time in my view.
So what is the result of being pushed around for years?
Well, I think pharmacists have largely lost their professional identity to such an extent that we now exist to serve our respective commercial masters. Employer led practise and education. The apprenticeship debacle was a cracking example of how far we have veered off track.
What on earth is a pharmacist?
I had a very interesting conversation on this very topic with a colleague recently on our podcast. We are both experienced pharmacists and we drew a blank in terms of making a stab at answering this one.
This is one of many problems.
For years we have had the opportunity to carve out a professional identity for ourselves. But alas if you mention the term ‘pharmacist’ the general public will likely replace that noun with ‘chemist’ and make an immediate association with the retail environment. All sectors are to some extent tarred with this brush, unfortunately. The nuanced skill and expertise of a highly specialist consultant pharmacist is lost on the general public.
But a consultant physician is someone who is very important in their eyes.
This is another problem.
Recent history has actually been very kind to the profession of pharmacy across a number of sectors.
In 1948 the then Health secretary launched NHS. This move entitled people to free prescriptions, and therefore drastically increased dispensing volumes within community pharmacies. It heralded a hitherto unprecedented level of investment in the community pharmacy sector and has since driven the growth of a thriving community pharmacy sector. I feel this fact is often forgotten or not mentioned today.
The Nuffield report ‘cautiously’ suggested that, for the first time, community pharmacists might give advice to the general public from community pharmacies.
In recent years many have hailed Scotland as the visionary centre for innovation in community pharmacy practice. And I would agree with this. The Right Medicine was an excellent document and took many of the themes from the Nuffield report and began to create a plan to apply these principles using the concept of pharmaceutical care.
The Right Medicine document was ahead of its time.
These moves were the pre-cursors to Prescription for Excellence and most recently Achieving Excellence in Pharmaceutical Care.
I have succumbed to my Scottish bias here but I think we have been lucky north of the border that the Prescription for Excellence document was genuinely visionary. For example, it stated that every pharmacist in Scotland should be a prescriber.
When was the last time you read ambitious visionary rhetoric like this?
Nope, I can’t remember either.
But leadership, even here in Scotland, is still coming from outwith our profession. In the last 60 odd years, the Government both north and south of the border has been one of our best advocates. How fickle this support is now proving to be.
The Government appear to have called time on the growth of the contractor model in favour of the technology-driven players pouring into the supply market. Click and collect with little or no pharmaceutical care. This approach is happening at pace in England but will likely follow elsewhere.
Yet another problem.
I have veered towards an extremely brief curated history of community pharmacy but needless to say, there have been great strides in other sectors too not least academia, hospital practice and more recently activity by pharmacists in general practice.
Hospital pharmacy has forged ahead in recent times. Those talented individuals in the hospital sector have forged their careers by adding value and giving excellent advice. Pharmacists on ward rounds is now a thing. The early adopters of pharmacist prescribing were largely based in hospitals too.
The most recent political rouse has been the attempt to circumvent community pharmacy and place pharmacists directly into general practice. Honestly, if I hear one more time that the primary role of the pharmacist is to relieve the pressure on GPs I think I might spontaneously combust.
As the post-1948 supply function for pharmacists diminishes further where does this leave our collective identity?
Well, I don’t think the public has a firm understanding of what a pharmacist does and this is ‘our’ fault. We need to look to ourselves and the decisions ‘we’ have made over time.
Selling make-up, homoeopathy and more recently CBD products have not served us well as we strive to carve out a more advice-driven role for the profession. I bet if the general public is asked what a pharmacist does they will probably think of the larger community pharmacy company logos.
Should we continue to sell sub-therapeutic codeine over the counter and is WWHAM really fit for purpose in the era of the expert patient?
I feel the progression of our profession has largely been as a result of individuals existing in a system designed for and protected by medics or others and not geared up to put the pharmacist at the centre of the myriad of activities we now take part in. Given the demographics and epidemic of polypharmacy, this situation really needs to urgently change.
Unfortunately, the reason for this confused identity mess is largely down to the commercial pressures that have so far dominated the activity of the pharmacist. It is my view that a registered healthcare professional it is fine to engage with commercial organisations but we must make decisions within that interaction that support the patient who should be at the centre of everything we do. I’m not perfect. I need to put the dinner on the table like everyone else but those who know me well know that I think deeply about these decisions and try to do the right thing.
Follow the money and you will begin to understand the mess we find ourselves in. The large community pharmacy companies have had an influence on the top of our profession for decades. A profit-driven approach is fine to a point but the shareholder will always win. This is an important point because community pharmacy teams have become deskilled as a result of a long term lack of investment in the development, particularly of pharmacists.
Just compare the GP trainee career pathway with that of newly qualified community pharmacists and it becomes clear.
The result is a confusing picture of a profession struggling to find its core underlying visceral identity. Previous to the inception of the NHS pharmacists diagnosed, compounded and treated patients on the high street. They were out front talking to and engaging with their clientele. The cash injection and resultant supply function role after the NHS got up and running meant these industrious souls beat a retreat through the hatch into the mysterious world of the dispensary.
Everything has changed yet nothing has changed in pharmacy.
So what next?
Well, I think we need to come together probably in a way that we have not seen before. I wonder are the days of paid membership to a professional organisation almost numbered. Is there a subscription led charity type union professional body hybrid about to emerge?
Probably not but I think something has to change because it is quite clear that the status quo does not suit many, except those of course who have held privileged positions for years within the establishment as we have come to understand it.
We have no universal identity and therefore the general public has not got a clue what is going on. Perhaps those people who describe the role a pharmacist in a demeaning way are actually doing us a favour.
“All they do is put labels on boxes.”
“There they are selling make-up in their chemist shops.”
Who is responsible for this lamentable state of pharmacy affairs?
Follow the money and you will see.
Johnathan Laird is a pharmacist who remembers his own identity most of the time.
Our editorial board member Gavin Birchall is conducting research into pharmacist identity. He would welcome your views on his survey that is now live. Gavin will be publishing a book on the topic based on this research later in 2020. Click here to access the survey.