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A Happy New Year to one and all - or is it?
It is very annoying to me, as a "columnist" contributing to this magazine when, after spending some time putting my thoughts together for the impending deadline, a news item starts off a new train of thought.
I don't know about my fellow contributors but this continually happens to me and I have to rush to get my offering to Neil in time.
Once again two pieces I read last week set me to thinking about where pharmacy is heading and completely changed what I had intended to write.

The first was a brief report on Medscape (www.medscape.com) about the US Health and Human Services approving trial drug dispensing/distribution via vending machines in remote area medical centres to overcome the lack of pharmacists.
The second source of concern was the British Pharmaceutical Journal (www.pharmj.com) where two issues were raised.

Firstly was the reduction, by the government, of community pharmacy dispensing fees at the same time as the profession was being expected to expand services (sound familiar?).

Secondly was a report on the benefits that pharmacists can bring to hospital administrators to obtain value for money in respect of drug usage this at a time when "one hospital pharmacist position in six is unfilled in the UK".

Thus, pharmacist numbers is an issue of major concern in both countries and continues to impact on how the profession will proceed.
Pharmacy is now rapidly approaching the crossroads as far as its professional existence is concerned and I fear that we may take the wrong path.
"Simple dispensers" of prepacked medicines or highly respected members of the health care team, which way are we to go?
If the former we risk being supplanted by computerised machines and if latter road is to be our destiny, we ask who is going to pay for the extended services and how?

The UK experience is not at all conducive to pharmacists extending professional services with dispensing fees being cut simply because doctors are writing more prescriptions than anticipated.
As in Australia, workload is increasing but government funded remuneration is falling, placing pharmacists in an intolerable position.

In Australia some progress has been made in the "who is to pay" question with DMMR, an added value service, being funded by government but this appears to have hit a snag due to consultant pharmacists appearing unwilling to carry out the reviews.
Doctors soon likely to become disenchanted with the DMMR programme and will, in future, be unwilling to participate and pharmacy will, again, be left with the doctor's servant image unless the problem is addressed without delay.
The "I don't have time or personnel resources to be involved" argument will threaten the profession's standing and will again force it to rely too greatly on the mechanics of supply rather than intellectual input into health care.

Where is the drive, supposedly coming from pharmacy, to get away from the dispensary and into "professional" activities?

If we are not careful I can see a future where, when we go to the pharmacy to see the pharmacist, we will be talking to a computer rather than a real living person for pharmaceutical advice.

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