Opinion: What would you put in pharmacy's Room 101?

More logical way?

A much more logical system would be one where medicine supply was enabled. A diagnostician would – post-diagnosis – refer their patient to a pharmacy to receive treatment. That treatment would be within a framework (often a cost framework) and the pharmacy would agree with the patient a treatment plan within that framework. After all, this is what used to happen before those pesky patent medicines kept being adulterated with opiates and cocaine.

What started at the turn of the 20th century was being regretted by the end. By 1995, the same Society that encouraged the legislators 100 years earlier was urging for a return to treatment plans and frameworks of care in their Pharmacy in a New Age initiative, belatedly recognising the box in which community pharmacy was trapped. 

A prescription is also a form of payment, and aside from a small block grant, it is worth remembering that hospitals are paid similarly. After referral by a GP, they receive a fixed payment under a framework for treating a condition. 

It seems incontrovertible that some of the pressure primary care is under right now would be alleviated if the bottle neck that is imposed by prescriptions was removed. A simple review of the number of serious shortage protocols over the past two years would support that view. Transitioning entire therapeutic areas to treatment plan referrals rather than prescription-based episodic care could be transformational.

Long have stood the heckles that the commercial interests of pharmacists de-legitimise their role in such systems. But a solution that moves the conversation on must be found, for if a solution is found for community pharmacy, then it is found also for primary care.

The current proposal is that flooding the system with prescribing pharmacists will bring salvation, but that is a smoke screen. There have been independent prescriber pharmacists working in community pharmacy for decades. Yet they can’t actually work as prescribers because the guardians of the treatment budgets won’t share. And without reform of those financial controls, nothing will change.

The same reforms needed to enable the new pharmacist prescribers are those that would enable the devolution of prescribing to treatment pathways. And it could happen now. It is not about the prescription; it is about who controls the flow of money. So let’s get rid of prescriptions and sort out what is really important – the money patient.