When the former chair of the English Pharmacy Board recently said community pharmacies don’t make the best use of technicians, she patently got it wrong, says Sid Dajani…  

More of us will agree that pharmacists are clinicians by vocation rather than practice location and that we are competent to do a wide variety of screening and medicines optimisation.

Some will agree the transfer of pharmacists from pharmacies to GP surgeries is expensive, wasteful and disruptive because that work could easily be done by funding smaller numbers of second pharmacists in the community and it would mean helping patients stay away from surgeries and closer to their homes without appointments.

If we are to realise our potential and be the guardians of patients and carers, we need good national leadership support. How can we say we have that when one of our own leaders says we can’t even manage our own staff and be efficient in our own pharmacies?

According to reports, former English Pharmacy Board chair Sandra Gidley told the All-Party Parliamentary Group that we don’t make the best use of pharmacy technicians to free up the pharmacist to deliver extra services. 

Her comments will make others think they cannot rely on community pharmacists as local leaders of others if they cannot efficiently manage their own pharmacies. Moreover, it tells others we cannot be included in strategic planning because we are being too inefficient in our pharmacies to have any time to contribute anything.

Sandra Gidley’s opinions are not facts. With the right support, we can be more than capable. We all know every member of every frontline patient-facing, up-skilled pharmacy team has been pulling their weight to maximum effect day in, day out.

Every bit of the pharmacy team is straining to pull services through a difficult period, meeting complex needs with a fragmented workforce, service breakdowns, poor commissioning, funding cuts, service withdrawal, shortages and workload stress.

It is not the inefficient use of technicians but a multitude of other reasons causing us drag and that’s what Sandra Gidley should have focused on. But she didn’t.

Is it any wonder gaffes like this make pharmacists think the RPS is irrelevant, out of touch, no longer serves the needs of community pharmacy and doesn’t fight hard enough for members’ rights?

Flying suppositories

Back in the late 70s when I was still a lad in shorts, I used to accompany my surgeon and physician father on private patient house visits.

As we’d travel between patients and pharmacies, he’d tell me about medical conditions and treatments and I’d ask him all sorts of questions.

Many things still stick in my mind to this day and I still use some of those 40-year-old pearls when advising patients on, for example, medicinal administration.

Recently I was asked to review some medical literature and explained that I’ve always advised patients to insert suppositories blunt end first because that’s what my father told me. My dad explained inserting them pointy end first would mean trapped gas could expel the suppository so fast that they’d pop out easily and there would be a good chance of catching them.

However, inserting them blunt end first would diminish the chances of flying suppositories and reinsertion. Then it struck me. What if he had been joking with me back then? After all, his sense of her humour was second to none.

After a surreal conversation and much finger-pointing laughter with my fellow PILs checking pharmacist, I believe I was vindicated. He dug deep and unearthed some evidence that stated “suppositories are usually placed rounded end first as in some cases the suppository was expelled before the medication was absorbed.” At last…reprieve.

The review of the literature appears to show that evidence adduced for inserting the suppository blunt end foremost derives from one study published in the Lancet that challenged “common sense.”

Historically suppositories were inserted pointed end first and the publication of this study (Abd-El-Maeboud et al, 1991) changed nursing practice overnight. Not only is retention improved but the authors also suggested patients self-administering suppositories may find the blunt end more acceptable owing to the squeezing action of the anal sphincter against the apex which pushes (sucks) them into the rectum, hence there would be no need to insert the finger into the anal canal.

While this had a fundamental effect on nursing practice, it has not been subject to scrutiny and the advice given in the Lancet article differs from that currently given by most manufacturers of suppositories, which involves the terms of their product licence.

Hence, there is a potential for problems with legal liability should an untoward event arise. To add to the surrealism, the same research lends weight to inserting the blunt end first - especially if the suppository is for a systemic effect, as rectal absorption is more effective lower in the rectum as veins draining from this part of the rectum join the internal iliac veins.

This means medication returns directly to the inferior cava, bypassing the portal circulation (Waugh and Grant, 2007). Who would have thought inserting a suppository could be so convoluted, complicated or controversial.

Perhaps Sandra Gidley could comment on how best we could utilise technicians on this matter!

Sid Dajani is a community pharmacist based in Hampshire. His views are not necessarily those of ICP.

Picture: LumiNola (iStock)