Just Imagine A World Without Pharmacies..

Pharmacists came under fire from all sides last year, but imagine a world – and a health service – without them…

Pharmacists have been facing criticism from all sides, says Pharmacist Hyacinth, as he imagines a world – and a health service – without them…

From methadone millionaires to smartie counters, during 2012 it seemed pharmacists suffered more name-calling than an X Factor contestant.

Sometimes this has been for valid reasons, such as December’s BBC footage of pharmacists allegedly handing over diazepam without prescription. But in most cases there seems to be widespread misunderstanding about the value of community pharmacy.

In the UK, Tory MP and practising GP Phillip Lee made headlines when he called for GP surgeries to take over dispensing from pharmacists. While his proposals were justifiably shot down by GPs and pharmacists alike, they raise the question of what would happen if pharmacies were actually erased from the NHS map.

It takes some imagination, but close your eyes and picture what would happen if the Nigerian more than 14,000 pharmacies vanished overnight…

The Doctor’s appointment:

Imagine the scenario: you’re going on holiday tomorrow, but you’re prone to terrible sea sickness. Hyoscine(buscopan) works for you, but when you check the cupboard an empty blisterpack falls out – you forgot to get a prescription yesterday.

There’s no option but to phone the doctor to book an appointment, despite the knowledge you will have to take time off work. Gone are the days of dropping by the local pharmacy at your convenience.

Myths about pharmacists: •Dispensing is like counting smarties

“Pharmacists are the experts on medicines and the act of supplying medicines to patients is a highly skilled activity”

Martin Astbury, president, Royal Pharmaceutical Society

“I’m afraid the next available appointment isn’t for three weeks,” says the Doctor’s receptionist with a sigh. “In a world without pharmacists, doctors now have to dispense the 960 million prescriptions a year by themselves,” she adds. “Trying to juggle the dual responsibilities of dispensing and dealing with patients means consultation spaces are severely limited.”

She reminds you that even before pharmacies vanished, visits to the doctor for conditions that could be treated by self-care cost the NHS £2 billion a year, with doctors receiving more than 5 million visits a year for blocked noses alone.

“Without the minor ailments services offered by pharmacies, doctors have become inundated with patients seeking help with everything from coughs and hayfever to skin conditions and shallow cuts,” she groans.

Myths about pharmacists 2:
They are methadone millionaires who put business before patients

“Often pharmacies are providing this much-needed service to their community to the detriment of other parts of their business” Mimi Lau, director of pharmacy services, Numark

After expressing sympathy, you tell her you’ve decided not to book an appointment, remembering that every unnecessary visit to the surgery adds to the workload for your long-suffering doctor. You’re also concerned the contents of your prescription may not actually be what you need: a study by the University of Nottingham found one in every 20 items prescribed by a doctor contained an error. Without the vital safeguard provided by local pharmacists, there is nobody to check the medicine before it is handed over.

A trip to A&E:

The receptionist suggests you pick up an emergency prescription from the hospital instead. On arrival, you’re confronted by a queue of patients stretching out of the hospital doors and down the street. Without pharmacies, A&E and walk-in centres are the only trusted source of face-to-face health advice outside of business hours.

As you make your way to the back of the queue you find yourself spluttering through a cloud of cigarette smoke. Smoking cessation services offered by pharmacies helped 33,000 smokers quit between April and June 2012, according to NHS statistics. But without them, nicotine addiction has started to rise.

Myths about pharmacists 3: They are glorified shopkeepers

“The PDA does not support the idea that you can pile them high, sell them cheap and, while you’re in the middle of dispensing and supervising P-medicines sales, you can run to the other end of the counter and deliver… a clinical service to the patient”

Mark Koziol, chair, Pharmacists’ Defence Association

To pass the time you ask your fellow patients what services they are waiting for. You’re surprised to find many of them are queuing to receive moderate painkillers such as codeine and larger quantities of paracetamol.

“No pharmacies means there’s no P category,” explains one man. “Gone are the days when I could buy my painkillers over the counter from my local pharmacist.”

Lack of services:

The woman standing next to you is an asthmatic who’s been having trouble breathing. “Without pharmacies to provide accessible advice and review our medicines use, the 15 million patients with long-term conditions have nowhere else to turn,” she complains.

Even before pharmacies disappeared, 2 million people visited A&E with a minor ailment every year, with unnecessary visits costing the NHS £136 million. But pharmacies appeared to offer a solution – a study on respiratory conditions suggested MURs helped reduce emergency hospital admissions.

You notice that some of the people standing in line look embarrassed at your question and don’t want to answer. You assume they have been forced to travel to the hospital with a sexual health query. In the past they had been able to access the discreet and non-judgemental services such as HIV screening and contraception offered by pharmacies. This was especially true in Scotland, where 80 per cent of consultations for EHC took place in pharmacies.

Myths about pharmacists 4: The role of pharmacists could be taken on by Doctors

“The more we make use of pharmacists’ skills, the more that will be to the patient advantage” Nick de Bois, chair, all-party parliamentary group on primary care and public health

After a long wait in the cold you finally get seen by a nurse who hands over your medicine. As you take the tablets gratefully you spare a thought for the thousands of patients for whom medicines adherence is an issue. Nice guidance suggests that as many as half of patients don’t use their medicines as recommended by their prescriber, potentially wasting £4bn a year.

But pharmacy’s new medicine service helped increase adherence in a third of these patients, according to a PSNC report. Without the support and expertise of pharmacists, many non-adherent patients will never complete their full course of medication, leading to avoidable complications.

And non-adherent patients are just the tip of the iceberg. What about those populations reluctant to even set foot inside a GP surgery or hospital, such as south Asian communities at high risk of diabetes? These communities rely on the targeted interventions of proactive pharmacists who take their services into the community to reach people who can easily fall through the cracks of the NHS.

You cast your mind to the 197,000 patients recovering from drug addiction. What will they do without pharmacies to offer a convenient and non-judgemental way to pick up their methadone?

It all becomes too much and you return home depressed, before drifting off into a fitful sleep…

When you wake up you realise with relief that it was just a bad dream. A world without pharmacists is a nightmare scenario that isn’t likely to become a reality. But next time Dr Lee calls for pharmacists to surrender their responsibilities, perhaps he should be careful what he wishes for.