Dispense with pharmacists

Spot on, funny, thought-provoking and simply the TRUTH - the whole profession is under duress from commercial pressures from shareholder plc - money grabbing waste of mr h wilkins

As a pharmaceutical adviser with a background in hospital pharmacy I am horrified by your comments. Apart from saving patients from inappropriate prescribing on wards and outpatients and saving doctors from ending up in court after they may have inadvertantly killed a poor patient by inappropriate prescribing there are the interventions that you don't see. I was doing a community pharmacy locum last year. A GP prescribed 10 x the recommended dose of paracetamol for a new baby. Whoops! I agree there are good and bad pharmacists just like there are good and bad doctors. Just remember,pharmacists are the most easily accessible healthcare professional. No appointment needed. danielle adams

Mind you Copperfield, we might start targeting GP's next. I mean they only prescribe NSAID and diagnos people as stressed or depressed. We could get rid of say 45% of them and replace them with Skilled nurse practitioners and then save the NHS millions in pensions and salaries. But then I am only drinking a short. kelston chorley

very funny, food for thought, and much appreciated ! c. ohare

As a pharmacist I cannot agree more with Copperfield. Community pharmacy is a joke, is under-skilled and will never be taken seriously by medics. My wife is a GP and (God bless her) she used to call the local pharmacist for advice on difficult prescribing decisions - only to receive the same answer... not sure, it's your call doc! What a waste of space! All these new activities are 'Emperor's New Clothes' services that can be completed by a HCA at a fraction of the cost. Unless pharmacy learns to behave and perform like a responsible healthcare professional i.e. REAL clinical input and responsibility, the joke will always be on them. flopsypharma

re Danielle adams we value highly our pharmaceutical adviser supplied by the PCT. But your comments I worked as a locum just about says it all there are some very good independant pharmacys but the chains almost always leave a lot to be desired in terms of the turnover of personell so yes the pharmacist might not have an appointment system but continuity of care - sorry the pharmacist is at tescburys today (I made that up)

paul smith

Why General Practice? Circa 1982 I was planning to sell my soul to the Pharmacuetical industry. At my interview, I was asked, by a tired and emotional psychiatrist, to challenge the notion that we should scrap general practice by moving practices (and their staff) into hospitals. That’s where the scanner is and is where patients want to go. Practices can have their own section, and bus or taxi the punters in.
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My answer was er.. er..

I blurted out that it was not a good idea as more people die in hospital than anywhere else, which they took as wit. I did not get the job.

That interview has been rattling my head ever since.

An now Copperfield states the bleeding obvious about pharmacists.

My conclusion is is GP consortia should selll up, move into the hospitals and use the one pharmacist there. And GPs should keep the change to make up the pension loss and hopefully a bit on top.

Gerard Bulger FRACGP FRCGP
Borroloola NT
Australia

+61458431451
Gerard Bulger

It is a great shame to me as a pharmacist that you are bang on target with your comments.
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Community Pharmacy (and Pharmacists) seems to be more than satisfied with a supply role and being highly paid shop keepers.
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MURs are a joke and profit seems to be more important than patients. Supply problems result in scripts being given back to patients for the GP to sort out without even bothering to offer an alternative that IS available.
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There are some good Community Pharmacies out there, but sadly they seem to be few and far between.
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That's quite possibly why I decided to get qualified as a prescriber myself and leave shop based work behind! Matt

With a background in community and primary care pharmacy I have a few thoughts on scrapping pharmacists - good luck in dealing with all the minor ailments, dispensing safely and accurately the 1000s of items per month (remember we take most of the responsibility), supervision of methadone and gently reminding you of overprescribing of benzos etc, extended opening hours including weekends, smoking cessation, EHC - the list goes on and on! I agree on the snake oil and the shareholder pressure but a good pharmacist (like a good GP or nurse) are worth their weight in gold so don't dismiss us all - you might just need us one day to present those solicitors letters!! Unless you've never made an error on a prescription that is Tony! funnyman

Why are pharmacists needed? As a safety net for GPs. My local GPs are good, but these are just a few of the situations I've intervened in over the last few weeks:
- patient on warfarin prescribed miconazole gel
- penicillin allergic patient prescribed co-amoxiclav
- patient who had had a first PE, on warfarin for seven months
- patient on 10mg prednisolone for six months and ongoing, no bisphosphonate.
These are just a few examples from many I could quote.

Unless you are a very small surgery you would need more than a cupboard and a part time member of staff. Why don't you go to a busy pharmacy and see how smoothly everything runs. You can come and visit my pharmacy if you like.

It also appears that you've not thought about the amount of capital tied up in stocking medicines - it's very expensive to stock a pharmacy.

Lastly, don't make the mistake of confusing pharmacy and pharmacists. Most pharmacists are employed and have little control over the pharmacy they run. I tend to hide supplements and homeopathic products in the corner where no one will see them, but I have more freedom than most. Steve

someone who obviously has an ivory tower as a surgery.
Ne te confundant illegitimi Chris S

There are many times when I have saved a GP embarrassment or even a complaint when they have made an error. It is about time General Practice should wake up to competition and prove it's real worth. Pharmacists have unique skills that GPs don't and some feel threatened by it. GPs have their place, of course, but get your own house in order before you start putting other professions down !!!!!!! Sam

I forgot to mention this earlier. I have no idea if this news ever jumped across the pond (and based on this article I'm guessing it did not), but anyway check out this study: http://www.theashevilleproject.net/.

I included the URL because this study has too many publications out to list them all. The study shows an economic benefit to having a pharmacist on board in the health-care team. I think for every 1 US dollar spent 4 dollars was saved (which is reasonable as it is much less expensive to prevent a heart attack with medication than it is to admit a patient into the hospital).
Additionally, these are just regular community pharmacists ( other publications exist in support of clinical pharmacists and clinical pharmacist practitioners who work collaboratively with physicians).

Enjoy! US PharmD

I'm from the US, so needless to say I have no experience in the UK, but for all practical purposes pharmacists know more about drugs than any other health-care provider. A GP has a semester of pharmacology, which is NOT equivalent to a PharmD. With that being said how long ago was it that you were in medical school? How many new drugs were approved after you graduated? Have you kept up with all of the most intricate details? Do you know which drugs cannot be given together by I.V administration due to the formation of a precipitate which may be harmful to your patient? Furthermore in the UK I understand there are pharmacists now with prescriptive authority. How many medical schools offer classes in pharmaceutics? The answer to that is zero. Can you give me an explanation of the SAR of ciprofloxacin or Erlotinib (yes we have to know foreign medications as well)? Do you know which carbon on ciprofloxacin needs to be protected in order to maintain efficacy by prevention of steric hindrance (its carbon 2 � if something attaches there you hinder the carboxylic acid group on carbon 1 which interacts with topoisomerase IV)? Although it may seem trivial these details simply are not. This dictates which drugs may interact with the formulation and dictates how to possibly make exceptions to these rules. Have you ever dosed vancomycin to a patient in renal failure - most physicians do not have the pharmacokinetics experience to do this and those who do have this knowledge often do not have the time. Additionally you seem to believe that all pharmacists work in a community pharmacy setting. This is not true. Ever wonder where those I.V bags came from? For instance I spend most of my time working in research and development looking at mechanisms of drug resistance and the development of new drugs to combat resistance. And now I'm going to finish this post with my own personal story. My father is a physician. While in medical school he was trained under a PharmD/ MD (yes that's right he had both degrees), and as a result of this lasting impression he encouraged me to pursue pharmacy school. As you clearly have no regard for a multi-disciplinary approach to medical treatment (which mounting evidence now exists to support) it is clear that you are willing to put the safety of your patients in jeopardy to satisfy your own personal agenda. With that being said I have serious questions about your ability to act as a health-care provider US PharmD

It makes you wonder why a GP does not get a pharmacist, a chartered accountant, a corporate lawyer, an MBA business manager and set up a pharmacy then give half the shares to any GP who wants to join! Martin Rankin

Before criticising in such an offhand and arrogant manner, Dr Copperfield should perhaps take some time to look at the harm being caused by prescribed medicines. Wrong drug, wrong doses, wrong diagnosis etc etc.

I could use those figures to denigrate the entire GP profession as he has done with pharmacy, or I could take time to think - we have a problem here - how can I work with my pharmacy colleagues, who are trained solely to be experts in medicines, in solving it.

I would be ashamed to be associated with any similar comments a pharmacist made about GPs, so hopefully most GPs will be equally disgusted. Otherwise this article says more about the attitude of good old-fashioned self-protectionism than any real concern the author may have for the health of his patients. PG

If you saw the amount of prescribing errors made by so called G.P.s that have to be corrected by pharmacists you wouldn't be spouting nonsense like this. Stick to diagnosing and let us worry about what medication is relevant. Peni Hargreaves

The way forward is with independent prescribing pharmacists running specialist clinics, and improving patients outcomes. Just completed my exams for independent prescribing and specialising in depression and anxiety spectrum disorders - and for 100% I will do a better job in managing patients with mental health than the GP I am working with. Just as Pharmacists need to up skill so do GPs. Jayesh Shah

The door swings both ways. How many times have the GPs turned a blind eye to dispensing errors. We work better as a team as no one is perfect and it's good to have someone watching your back.
Gankster

After a very strange consultation with my GP practice last year after my asthma had considerably worsened after swine flu, I took my prescription to the pharmacist who asked me quite a few questions and spent some time on the phone to the GP practice. The doctor had advised me to use my salbutamol inhlaer frequently and had newly prescribed belcoletasome 100mcg inhaler but warned me it was to be used sparingly ie a couple of times a week and put a PRN dose on the prescription. I also requested a steroid nasal spray and discovered at the pharmacy fexofenadine tablets had been newly prescribed instead (with no counselling whatsoever from the GP). The pharmacist spoke to a different GP and got my steroid inhaler changed to an appropriate strength and dose and sold me a steroid nasal spray. I for one am extremely grateful that there was a pharmacist to interevene. After speaking the practice manager to make a complaint I discovered that I had been seen by an F2 doctor on GP rotation dangerously left to his own ill-informed devices. Really unimpressed! PCT Manager