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It’s wrong to suggest 1975 saw the end of the professional-commercial debate within the pharmacy profession. This debate will rage on for another century, says Terry Maguire…

The Pharmaceutical Society of Northern Ireland’s (PSNI) 100^th birthday celebrations are being marked with a series of events and podcasts.

Three podcasts have appeared to date which I can recommend as good listening. Past-president Tom Eakin, who achieved global success with his stoma care business which he started from his Belfast pharmacy in the 1970s, is such an inspiration and still goes to work most days at the age of 91.

He sat down with current president Geraldine O’Hare to discuss his life and work.  

The past a different country

Registered in 1951, the pharmacy practice he describes will seem Dickensian to current registrants. Completing an apprenticeship based on a curriculum set out by the PSNI council and offered at Belfast Technical College, he was one of 130 student apprentices in his year.

A few of his contemporaries took a different route, completing a BSc at Queen’s and then a forensic examination offered by PSNI. He fondly describes practice in the 1950s and 1960s when most medicines were compounded in the pharmacy, with 90 per cent being liquids produced from the Galenical’s on the pharmacy shelves.

How things have changed. In Northern Ireland in 1971, pharmacy became a degree entry profession and it was then the School of Pharmacy was set up at Queens. Tom was president in 1975 during the 50^th birthday celebrations and remembers the debates and discussions on modernising the profession that were the focus of that year.

Some viewed the need to be a move to greater professionalism, embracing clinical roles, while others argued pharmacists needed to make a living and needed to stick to commercialism. This debate was settled amicably, he felt. I’m not so sure.

The Debating Chamber    

I was a student in 1975 and when I entered pharmacy politics a decade later, these debates were still raging and the protagonists on each side in 1975 were still in the Council chamber.

Two colossuses were Josh Kerr and Tos O’Rourke and newer members Terry Hannawin and Ronnie McMullan while from hospital practice, there was Sean O’Hare. All were considerable sparring partners in any debate.

I joined the fray in 1986 and got bruised regularly attempting to establish standards for CPD, introducing the pre-reg examination and getting consensus on Vision 2020, our future strategy published in 1999.

For me, then and now, the essence of all pharmacy politics is a struggle between the professional and the commercial. Our professionalism is the professional standards we set and adhere to in our day-to-day work. These standards are in the interests of the public and this gives us special privileges.

Our commercialism, what we are paid for, gives us our living. When properly balanced, we succeed. Out of balance, we fail and where we fail, the public loses out.

Out of those debates, going back to at least to 1975, we were achieving the necessary modernisation through standard-setting and implementation. Pharmacy has always been professional with high standards of practice and we now focus on a wider professionalism involving our clinical roles.

We also remain commercial, which is a good thing as we run extremely efficient businesses that are open and accessible to the public, unlike so much of the modern health system.

Health Plus Pharmacy

One particular debate in recent times, not strictly linked to PSNI, was the struggle to implement contractual standards in a scheme called Health Plus Pharmacy (H+P). Based on the English Healthy Living Pharmacies model, H+P aimed to provide a commissioning framework for the public health roles pharmacy was developing.

There was enthusiasm from the DoH, the Health Board and Public Health Agency and indeed pharmacists generally. An Assembly was formed from key stakeholders and we worked hard over many months to agree a framework.

Key to the framework was a set of standards required to be in place so a pharmacy could be designated a H+P and then commissioned to deliver public health services. One of these standards related to the products Health Plus pharmacies could not sell, including vapes, sunscreens below SSP 30 and non-medical confectionary.

Community Pharmacy Northern Ireland kicked back strongly, viewing this as commercial restriction and Boots unilaterally made it clear they would not be participating.

It was disappointing because there was great support and enthusiasm and over 18 months, I provided the course that delivered the training standards for the scheme and was completed by the vast majority of community pharmacists.

With the raging debate on commercial restrictions however, Health Plus Pharmacy was quietly dropped. But it was not all for nothing.

From this, we did get our commissioned Living Well service and we went on to get vaccination and more comprehensive Pharmacy First offerings but without the Health Plus Pharmacy accreditation and its associated standards.

Clearly Tom Eakin was somewhat wrong that 1975 saw the end of the professional/commercial debate within the profession. This debate will rage on for another 100 years. Happy 100th birthday PSNI.

Terry Maguire is a leading community pharmacist in Northern Ireland.