Nuffield nonsense

It is often said that the report of the Nuffield Foundation on Pharmacy published in 1986 ended up on a shelf somewhere quietly gathering dust, the implication being that the report has had no effect. I am not at all sure about this, so I thought I would take a look for myself, making use of back numbers of the Pharmaceutical Journal, when it really was a journal of record. Great chunks of the report are to be found in the PJ of March 22, 1986, and it does not take long to find Nuffield recommendations that have been followed by change. The report called for an end to the totality of NHS dispensing income being paid by reference to prescriptions dispensed and for money to be made available for payment for other professional activities. That has happened. It called for an examination at the end of the pre-registration period. That has been brought in. It envisaged pharmacists lawfully leaving premises temporarily to do professional work. This has now been enshrined in law. It envisaged scope for medicines to be transferred from POM to P. Tick! It wanted pharmacy education to be changed to enable graduates to be able to communicate better with patients. Another tick! Clearly, the report was of its time and much of it now seems dated. But it does not seem to me to be appropriate to categorise it as having had zero effect. By no means all of Nuffield’s recommendations were put into effect, but some that were have had led to significant change.

More nonsense

My defence of the old RPSGB from the criticisms of my mate Graham Phillips seems to have struck a nerve. Does Graham really believe that the new RPS supports the entire profession “to the rest of the world in a way that the old body did not attempt”? Does he really believe that the old body was so bent on regulation that “it virtually neglected to provide any leadership or professional representation”? I can only put his views down to youthful ignorance. On the specific point of international relations, it is worth noting that the Society was a founder member of, and has always provided the secretariat for, the Commonwealth Pharmacy Association. On the general question of leadership, the Society during its long history has succeeded in “transforming the drug trade into the profession of pharmacy”. These are the words of SWF Holloway, the independent historian who wrote his history of the Society to coincide with its sesquicentenary in 1991. I suggest Graham reads Holloway’s book. He might learn something.

Stand by your beds

Those who have had service training might have had to undergo rigorous inspections of their kit. This often meant standing by one’s bed as the sergeant or a junior officer came round to make sure everything was as it should be – or rather how they thought it should be. Sometimes the NCO seemed to make up the rules as he went along, depending on how he felt about the serviceman before him. I can only hope that we don’t have that kind of scenario acted out when the General Pharmaceutical Council sets about its new inspection regime in the near future. Pharmacists will not have any book of rules to pray in aid to prove that they are doing all that is required. Rather, they will have to satisfy the inspector in unspecified ways under a series of broad-brush headings such as ‘governance arrangements’ and ‘delivering pharmacy services’ (see pages 4 and 12). The inspector will come in and set about getting the information he or she requires. And don’t expect any instant feedback. The inspector will go away and mull over their verdict, consulting back at the office as he or she deems fit. Then we will get the verdict – pharmacies will be rated ‘poor’, ‘satisfactory’, ‘good’ or ‘excellent’.

My worry is that, in the absence of clear criteria against which pharmacies are being measured, those found wanting might not know precisely what to do to bring their businesses up to scratch. And will pharmacies rated as ‘satisfactory’ be OK as they are, or will they be asked to aim for higher things? It all seems a bit subjective and ad hoc to me. Good luck!

In competition

Pharmacists are often left wondering why they get left out of NHS initiatives of one sort or another. It’s simple really. Doctors and pharmacists are in competition for patients and the supply of medicines. So don’t expect any favours from a service where the medics are in a dominant position.