Our professional input must not be bypassed by commercial expediency
Community pharmacists need to become more commercially entrepreneurial if they want to take control of their destinies and realise their professional aspirations
It has been with some interest that I have followed the discussion in Electronicjuice in recent months about the professional status of community pharmacists, and how pharmacists feel that their professional status is being undermined by their employment conditions, with onerous bureaucracy, heavy dispensing workloads, a shortage of support staff and aggressive target setting by non-pharmacist managers.
Given the training they undergo, and the unique knowledge and expertise that they have, it is right and just that community pharmacists should be designated professionals, and it is to be hoped that the Royal Electronicjuice, as the professional body, and the Pharmacists Defence Association, as the union/defence association, will do their utmost in their spheres to maintain the professional standing of pharmacists.
However, at this point in the history of community pharmacy in the UK, it is worth reflecting on what a profession is, what professionalism is, and how the professional standing of pharmacy can be restored and advanced. First, it is worth noting that there is a distinction between the profession and professionalism. The profession denotes the externals of a job — the organisational structures, the regulatory and practice framework, the privileges and the remuneration. Professionalism, however, denotes the internal behaviours and attitudes of the individual in an occupational or professional practice setting. These relate to the affiliation, identification and socialisation that individuals have with their professional peers and community. Although they are distinct, it is clear that profession and professionalism are interrelated.
Is pharmacy a profession?
Sociologists have, over the years, developed criteria to define what occupations can be classed as professions and what cannot. A number of key criteria have been described, such as specialist training and restrictive registration/licensure, self-regulation and relative freedom from lay evaluation, ability of the profession itself to set standards of education and practice, professional control over legislation affecting the profession and over the working processes and working environment, and high income and status in society. Again, it is clear that some of these factors are interrelated.
By these criteria, a number of developments in recent years have eroded the status of pharmacy as a profession. The modern regulatory environment has meant that all professions, not just the profession of pharmacy, are increasingly open to public/lay scrutiny and there are often lay members or patient representatives on regulatory or professional committees.
In pharmacy in particular — but in other health professions, too, such as dentistry — business ownership has moved away from the profession and into the hands of commercial companies. Many pharmacies now are owned by multiples, with non-pharmacist directors and managers, rather than by individual pharmacists, and in these companies, pharmacists are employees. In this context, the responsible pharmacist Regulations have led to pharmacists being professionally responsible for people and processes outside their control, and few pharmacists feel that they have the genuine authority to make changes to enable a pharmacy to operate safely and effectively. Furthermore, pharmacy professional services, such as medicine use reviews, are being exploited as commercial revenue streams and the provision of these services is being driven by the corporations, not the profession.
In any case, pharmacists in all pharmacy business have little control over their dispensing workload, which is governed largely by the activities of doctors and other primary care professionals, and the commissioning priorities of the local NHS.
So while pharmacy may now have the regulatory framework for a modern profession, the reality is that pharmacists have little control over their working environment, and any professional authority they have is being subsumed to the diktats of non-pharmacist policy-makers or the commercial interests of their non-pharmacist employers. Pharmacy is often disregarded as a profession by the political establishment, as is evidenced by the “methadone millionaire” comments of Jenny Marra, MSP, and the claim by Philip Lee, MP, that pharmacists are just “Smartie counters”.
The Government may pay lip service to pharmacists being “well placed” to provide a range of new services, and the profession’s leaders may opine about the “professionalism” of pharmacists. But this rhetoric will only go so far when, on the ground, the professional status of pharmacists is being undermined. Until pharmacists are working in an environment where they have real professional responsibility, authority and control, as well as accountability, morale will continue to decline and good pharmacists will continue to leave the profession for careers where they feel they can take the initiative and make a difference.
Restoring professional status
To restore their professional status, pharmacists need greater control of the businesses they work in. Although there are still many independents and smaller multiples that are owned and run by pharmacists, there is a pressing need for more pharmacists in the community to have a stake in their businesses, rather than being salaried employees of corporations whose business interests go well beyond the pharmacy professional sphere.
A number of new models of pharmacy ownership have been discussed recently in The Journal, and include limited liability partnerships, as is the case other professional businesses such as law and accountancy, the John Lewis style employee partnership model, or co-operative ownership.
If pharmacists are more entrepreneurial commercially, they are more likely to achieve their professional aspirations. First, if there are more pharmacist owners and partnerships, the profession will have a greater influence over contractual negotiations, and the resulting remuneration and commissioning of services will favour the profession. Secondly, greater pharmacist control over local pharmacy business would ensure that the many technologies now available to support the medicines use process — pharmacy automation, smart packaging, telemedicine etc — are implemented appropriately in each locality.
This would increase the acceptance and adoption of innovative technologies in community pharmacy, and ensure that the technologies support the unique expertise of pharmacists in service provision, rather than bypass pharmacist professional input for commercial expediency. It is no accident that independently owned pharmacies are prominent in adopting new technologies to support their professional activities.
If entrepreneurial pharmacists in community pharmacy take up this challenge, the status of the profession will be enhanced, and the profession will be a step closer to greater public recognition. Pharmacists are professionals and should have professional status — professionalism alone is not enough.
Citation: Electronicjuice DOI: 10.1211/PJ.2013.11120744
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