Apathy, antibiotics and axioms

By Outsider

Not axiomatic. It’s a favourite phrase in responses to new contract applications from existing providers and LPCs. Read enough appeals to the Litigation Authority and you’ll see it cropping up repeatedly. A bit protectionist, but that’s to be expected in these situations. In fact, it’s what the system is designed around.

Axiom is a lovely word. Unquestionably and self-evidently so. Heck, most words with an ‘x’ in are cool. And there are lots of axioms in pharmacy. In many ways it is a rules-based profession. Yet there remains the scope – no, the necessity – for professional decision making and the bending or flexing of those rules.

Erythromycin suspension is in short supply right now. And with any supply issue involving a relatively common product comes an anecdote featuring a relative or friend. This is no exception.

Here we go then, strap in. When said relative tried to get a dental prescription for erythromycin 250mg/5ml, it was a case of ‘computer says no’ at their local vertically integrated pharmacy. Side note – what is the point of being a vertically integrated international conglomerate if you can’t maintain supplies of erythromycin? 

Some shopping around later – gone are the days when the first pharmacy would ring round for you – some erythromycin was located. It was at an off-brand pharmacy, but still a reasonable name. Respectable. A short car journey later and they waited patiently to discover that the erythromycin suspension in stock was not the right erythromycin suspension. Now there are lots of possible outcomes to that situation. Not all of them are axiomatic.

There are many reasons not to substitute the erythromycin suspension you have in stock for the prescribed strength which you do not have. Some are reasonable, many are not. Few are self-evident. It took another two car journeys before the prescription was finally dispensed. For this patient, community pharmacy kicked itself in the shins. Which left me thinking: is this apathy a symptom or a cause? 

It is clear there remains a general malaise in community pharmacy – at every level. You see frustrated and demotivated people in pharmacies, in leadership teams, in LPCs and in national bodies. PSNC’s “Vision Project” aims to fix this, but how has it come to pass that community pharmacy needs to ask external think tanks what it should be doing? Shouldn’t we already know?  The truth is we do, or at least we did. In 2016, Pharmacy Voice published its Community Pharmacy Forward View. It was good, very good. So, what went wrong?

I blame the NPA. Well, I blame Jesse Boot, but that’s too long a story, so let’s stick with the NPA for now. Shortly after the publication of the Forward View, all the community pharmacy organisations entered full on campaigning mode against the recently proposed funding cuts. It was a very noisy time with petitions, posters and marches across London. Did it work? Well, not really. 

What it did seem to do was give the NPA a different sense of itself. Not long afterwards, the NPA pulled the plug on its membership of Pharmacy Voice, claiming it could spend its share of the budget better for its members. Was it arrogance? Hubris? I’m not sure, but if future historians were to pinpoint the start of community pharmacy’s decline in England, they would only need to study the 18 months from December 2015.

Let us wait and see what PSNC’s outsourced vision produces. Then you can print it off and add it to the reams of strategy and policy documents everyone under the sun is producing right now. The Royal Pharmaceutical Society, the Guild of Healthcare Pharmacists, the Association of Pharmacy Technicians, the Pharmacists’ Defence Association, the Worshipful Company of Apothecaries. The lot of them. Then you can feed them all into the shredder.

The Commission on Pharmacy Professional Leadership is due to report this month. It’s an odd name for an odd thing. Odd, because not since the 1840s has the government of the day needed to work out who the leadership of the profession is.  

It was established by the UK’s four chief pharmaceutical officers because when they needed to talk to pharmacy, they didn’t know who to listen to. They didn’t want to have to shop around different organisations like a patient looking for antibiotics; they wanted a singular voice and there isn’t one.

I don’t know what the Commission’s report will conclude, but I think we all know it’s self-evident – axiomatic even – that they won’t find what they are looking for.

Outsider is a community pharmacist