By Rob Darracott
For a profession that prides itself on accuracy, it’s amazing how imprecise we can be when it comes to policy, and how certain issues become causes célèbres as a result.
I realise that an editor who talks about ‘accuracy’ is taking a risk, but imprecision, like an untruth, can become accepted as reality or an inevitability if repeated often enough.
In the 1980s, it was the ‘final check’. I can’t remember who was suggesting that prescriptions needed to be checked at some stage in the process rather than at the end, but the ‘final checkers’ marched on the Society (well, they walked in an orderly fashion from the tube station) and won the day, for a while, in a special general meeting.
In the 1990s and 2000s, the world was going to end if Pharmacy (P) medicines were on open display in a pharmacy. Pharmacists, we were told, would be unable to prise medicines they considered inappropriate out of patients’ hands once they had plucked them from the shelves. The public safety of P medicines is implicit in their classification, but for years, the Royal Pharmaceutical Society’s Council maintained that open display was ‘unethical’, even though every time the ‘gentlemen’s agreement’ was renewed, the Council was reminded by a lawyer that it would lose if challenged in court.
In the 2010s, we had the argument that every prescription needs a clinical check: it was an article of faith for one distinguished President. Does it, though? Even the entirely routine, nothing-has-changed fourth repeat for a long-term condition? Professionals are paid to deal with the complex and the tricky, not the routine.
Today, we’ve got the ‘solution in search of a problem’ that is hub and spoke. For me, clarity is not served when an MP who knows pharmacy, in a debate, conflates hub and spoke operations with large, automated centralised dispensing units, and says proposals to remove the restriction that bars independents from exploring options similar to those already operated by chains could be “a total stitch up that leaves community pharmacy...‘jilted at the altar’”. (No, I don’t know what that means, either).
Everyone wants to create time and space for more community pharmacy-delivered clinical services. It’s unfair that independents cannot even think about having another company assemble routine prescriptions for them, because that would be illegal.
Hub and spoke is a principle. It does not necessarily mean large, automated operations. Community pharmacies who joined forces in a local hub (automated or otherwise) for all their residential care and adherence supported patients would count.
A preoccupation with one issue risks missing a better option. You could, for example, keep your tech very local (see here); the Chancellor might even help pay for it (see here).
Just because something becomes possible does not mean you have to do it, or that you will be forced to do it. Any change could open the door to more attractive (cheaper) solutions for commissioners, but if 60 or 70 per cent of providers can develop those more attractive solutions now then it’s even more unfair that 30 or 40 per cent cannot.