Pharmacists state ambition to expand their role in community health

BMJ 2011; 342 doi: (Published 17 January 2011) Cite this as: BMJ 2011;342:d274
  1. Geoff Watts
  1. 1London

A persistent failure to make full use of the knowledge of pharmacists has long been one of the profession’s recurrent preoccupations. The latest attempt to revive it was launched on 13 January with a morning seminar on the future of pharmacy, followed by two evening lectures, events organised by the University of London’s School of Pharmacy.

The school’s professor of pharmaceutical and public health policy, David Taylor, told the seminar that he foresaw a bright future for GPs and community pharmacists in collaborating to improve public health. But some problems first needed to be overcome, he said.

“Our challenge to bodies like the Royal College of General Practitioners,” he said, “is about rising above sectional interests.” He advocated more discussion among bodies on how the public “can best be served not only by doctors in medically controlled partnerships but also by community pharmacists . . . working in other settings that people choose to use.”

This hint of interprofessional rivalry found a more overt expression in the opening presentations of the seminar and of the lectures. Both sets of events, held at the Royal Society, began by examining the role of the pharmacist in the Victorian era. Nicholas Barber, the school’s professor of pharmacy practice, said that he’d been intrigued to discover parallels between then and now.

The doctors of 150 year ago served the needs of wealthy people, he said. Poor patients relied on the pills and potions of the local pharmacist, whose activities were often scorned by medical practitioners. But those Victorian pharmacists provided a range of affordable remedies and free advice during long opening hours, often for seven days a week. This forerunner of today’s “retail model” of pharmacy practice encouraged people to look after their own health, fostered the spread of knowledge, and made healthcare more patient centred.

Professor Barber’s point was not that medicine and pharmacy are still at war but that the easy availability of remedies and quick advice are elements of pharmacy practice that continue to figure prominently among the benefits offered by today’s practitioners.

The latest body set up to blow the trumpet on behalf of community pharmacy is the new organisation Pharmacy Voice. Its chief executive, Rob Darracott, pointed to the role that pharmacists could have—and in some cases already do—in the management of chronic health problems such as obesity, smoking, and asthma.

A role for pharmacists in promoting drugs not to treat but to prevent disease was suggested by Nicholas Wald of the Wolfson Institute of Preventive Medicine, London. He is an advocate of the polypill, a mix of drugs, including a statin and an antihypertensive agent, intended to reduce the taker’s risk of cardiovascular disease (BMJ 2003;326:1419, doi:10.1136/bmj.326.7404.1419).

“Complicating access will deny access,” Professor Wald said, arguing that community pharmacists are ideally placed to pose the few questions (the most important of which is simply, “How old are you?”) that would need to be answered before polypills were sold over the counter.

But are pharmacists willing to undertake extra duties? They are, Mr Darracott asserted. He claims that new entrants to the profession are especially eager to see their role expanded.


Cite this as: BMJ 2011;342:d274

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