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Brian Edwards CBE
Emeritus Professor of Healthcare Development
University of Sheffield
Over the years, the role of the pharmacist has grown and expanded despite attempts by other professions to limit it to the preparation and dispensing of medicines to patients on a doctor’s prescription. In many European countries, pharmacists are now important members of modern clinical teams, and in a team setting they can supervise the continued care of individual patients, particularly those with well-established chronic disease. In some areas of medicine, the pharmacist is one of the most valued members of a hospital ward round, as treatment is focused on selecting and calibrating the most appropriate medication. In community settings, the pharmacist can be the health professional of first contact for patients. In some countries, the move to allow health professionals other than doctors to prescribe medicines for individual patients has made the development path more complicated.
So how far can this process of role extension go? In a clinical team setting, it is not difficult to envisage professional pharmacists supervising the care of individual patients whose treatment programme mainly consists of taking specified drugs. This role will grow as new drugs become available that are related to the DNA of individual patients. A challenge arises when one considers that pharmacists could offer general advice to patients who walk into their place of business. One could argue that, as long as the patient understands the difference between a doctor and a pharmacist, the choice is the patient’s to make. This would, however, go to the heart of professional regulation, which is designed to protect the public from unskilled clinical practice. A more likely development path will be for the pharmacist to spread, with appropriate training, into other areas of community practice, such as eye testing and health screening. Commercial self-testing kits are now widely available to patients in pharmaceutical outlets for blood pressure, cholesterol levels and diabetes. Many patients will naturally turn to the pharmacist for an interpretation of the results, and it seems sensible for the pharmacist to give an opinion within approved guidelines. In time, this might extend to general health reviews of physical capacity, weight and diet.
Community pharmacy has always been shaped by the retail markets for nonprescription drugs and other health products. Large chains of chemists and hypermarkets, which now dominate this sector in most European countries, employ pharmacists in great numbers. Dietary advice will become, one suspects, an increasing part of the community pharmacist’s role, and here we may have a point of overlap, and perhaps tension, with professional dietitians. The dietary industry is huge and growing, and it will play a big part in the economics of community pharmacy in the future.
One area that pharmacists have been slow to exploit is the public’s voracious appetite for information on the internet. Many patients would like to know more about the medicines they have been prescribed and would value an independent opinion from a credible source. Current European laws, which forbid the industry to promote prescription medicines, are increasingly outmoded. Patients need help, not half-hearted protection that anybody with access to the internet can circumvent.
As with most professions, as the role expands, the need arises to appoint nonprofessional assistants. Here, problems begin in limiting their role to match their competency and ensuring that they have constant professional supervision. Trained assistants will eventually fall within the ambit of the regulatory bodies.
The development paths of the pharmacy professions vary across the European Community, but convergence is inevitable as progress is made to standardise training and licensing rules. Europe is good news for this profession.