Suggested Learning

An institutional prejudice

An onlooker's notebook

AN INSTITUTIONAL PREJUDICE

Seeing an article in the Daily Telegraph of December 27, 2016 by the chief nursing officer at NHS England (Jane Cummings) about doing more to treat patients at home made me wonder whether Keith Ridge, the chief pharmaceutical officer, would be able to write an equivalent piece. Ms Cummings makes much of the great pressures the NHS is facing and about it having to adapt to meet the ever-growing demands on it. She talks of more resources going into general practice and other facilities. What would Dr Ridge be able to write? How, in the face of unprecedented demand on the NHS, funding for pharmacy is being reduced, so that pharmacies are forced out of business and those that remain cut services like monitored dosage systems and free deliveries of medicines – the very things that make home treatment a feasible proposition? How would such an article look in the pages of the Telegraph?
I think the Department of Health has a problem. It has a poor view of community pharmacy in England. I would go so far as to say that an institutional prejudice exists. A change of heart is needed. And quickly!

EVIDENCE

And if you are seeking further evidence for that institutional prejudice you need look no further than the recent announcement that large sums are to be spent on embedding clinical pharmacists in doctors’ surgeries in England. Why? Throughout the country there are community pharmacists who have gone to great lengths to qualify as independent prescribers only to find that they have precious little chance to exercise their skills. They would welcome the opportunity to work hand in glove with their GP colleagues dealing with such issues as prescribing for chronic conditions. But it seems the DH is intent on bypassing them by placing pharmacists in surgeries. If the DH wants to kill off the development of community pharmacy it is going the right way about it. I don’t think I have ever been so angry about official policy in my life.

VOICE OF DOOM

The chair of the Royal College of General Practitioners, Dr Helen Stokes-Lampard, has, like, previous holders of her post, been issuing dire warnings about the pressure that GPs are under, saying that patients might have to wait for several weeks for an appointment for non-urgent matters like lumps or bleeding problems. Such symptoms could be signs of serious disease, she points out. But should we be persisting with this “eye of the needle” approach, with GPs as the only conduit into specialist follow up. Community pharmacists have already shown that they can pick up serious conditions. In Doncaster, for example, this was the case for COPD, lung cancer and emphysema.

ANOTHER SENTENCE

Another pharmacist has been convicted after supplying the wrong medicine on prescription. This time in Northern Ireland. A patient died after taking propranolol instead of prednisolone – a tragic outcome from a dispensing error, which underlines the crassness of the remarks made by the chief executive of NHS England about pharmacists simply doling out medicines. The supply of medicines, which can kill as well as cure, is a skillful and demanding process and the consequences of error can be lethal.

Mistakes can end a career as well as a life. The pharmacist in the NI case was sentenced to four months in prison, suspended for two years. He is now full of remorse, living on benefits and has no wish to ever again be a pharmacist. The same outcome was seen in the previous case of a dispensing error that ended with a conviction, though in the latter case the error did not cause death.

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