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It is hard to know where pharmacy is going. Are we at the beginning of the "Brave new age of clinical pharmacy" or "In the twilight of pharmacy as a profession"?
I have written previously that both of my offspring followed their father into pharmacy (despite everything I could do to dissuade them) so the incentive is there to keep up to date with what is going on overseas as this is likely to impact on Australia.
Early this week something my daughter wrote to us raised the suspicion that all is not well in the UK. She was telling us about the hospital in southern England where she is currently working and how the workload made it so difficult to carry out clinical ward pharmacy to her satisfaction. "….. so, I'll just do what I can and concentrate on my extra-curricular activities".
This from an almost obsessive perfectionist in relation to her profession came as a surprise.
What on earth is happening over there, I thought?

Off to the trusty internet to view the British Pharmaceutical Journal website and some interesting issues arose.
One article by John Wilson (Vol 268 No 7180) could almost have been written by our friend Roy Stevenson, and concerned the author's worries about continuity of service when a pharmacy is run by a series of locums.
This is apparently a major problem in the UK and relates back to ownership of pharmacy there.
The British government has also restricted the number of pharmacies, leading to takeovers by the major chains at the expense of single proprietors.
Young pharmacists can no longer buy their own businesses and are tending to "go freelance" as locums. Wilson is concerned that the lack of continuity is impacting on pharmacists' ability to be regarded as a member of the health care team.
As he writes, "the concept of pharmaceutical care has one essential component and that is continuity". Just five issues later Graham Southall-Edwards wrote (in relation to pharmacy ownership).

"A future as a proprietor is about as likely as a win on the National Lottery.
Indeed, the latter is probably the only way that most young pharmacists could ever hope to own a pharmacy-and then they would have to run it at a loss to get any real job satisfaction".

Let us hope that the legislators here in Australia consider the UK experience before making decisions on pharmacy ownership that will impact negatively on the profession.
It is also becoming imperative that local pharmacy boards enforce regulations about pharmacy ownership. Here in WA I am afraid that the Pharmaceutical Council is either unable or unwilling to enforce its own rules in this matter and "conglomerate" groups are forming.
As I read more articles of a similar vein, deep depression appeared to be setting in.
Then, just as I got ready to slash my wrists I found some "good news stories.
Clare Bellingham, in issue No 7183 of the PJ, discussed how pharmacists can help to reduce new junior doctors' prescribing errors.
A report from the UK Audit Commission highlighted an upward trend in the number of medication errors related deaths, especially when new doctors arrived to work in hospitals.
The Commission comments that:

"Pharmacists need to be integrated into the clinical team.
Pharmacists are experts in pharmacology and bringing them closer to the patient improves the quality of care and reduces costs.
They need to be used to anticipate medication errors."

It appears that someone, somewhere can appreciate the benefits that a good clinical pharmacist brings to patient care.
Keith Farrar, chief pharmacist of the Wirral Hospital, discusses how improved pharmacy services are necessary:

"If we aspire to be a clinical profession providing pharmaceutical care then we have to accept that pharmacy is a 24 hour a day, seven day a week job based at ward level".

Mr Farrar is an advocate of the better use of technology to improve patient outcomes, particularly electronic prescribing.
A brave new world, perhaps?

Medication management is gaining recognition in the UK, with the government's Pharmaceutical Services Negotiating Committee even prepared to fund trials to develop new practices , including greater use of pharmacy support staff and IT.
It is hoped that these new ways of doing things will release pharmacists from the mundane tasks and enable them to employ their expertise where it can be best used.
Consultant pharmacy is being recognised as having the ability to improve outcomes and reduce costs (governments love that) in the community, but we must think laterally if it is to be progressed.
This is just as important here in Australia, consultant pharmacy is pretty much in its infancy but problems are developing.
There are just not enough of us to meet demands especially as some, like myself, are not available for DMMR.
We need more consultants, in fact we need to tap into the biggest reservoir of competent consultant pharmacists in the country - ward pharmacists in the hospital system.
Last week I attended a CE night run by the state branch of SHPA to hear how one hospital pharmacist, also accredited by AACP, has prepared himself to be better able to deal with older patients.
He spent over $6000 dollars to become certified by the US association as a geriatric pharmacist, not specifically to progress his consultancy but to become a better ward pharmacist.
This may be a special case but it is indicative of the culture of the ward pharmacist and I say we need to better use these people in the community.
Next month I would like to expand on communication issues relating to pharmaceutical care/consultant pharmacy.
Consultant pharmacy is very dependent on working with others and how we communicate becomes critical.
Some good work seems to be coming out of the US so, until then.

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