Thursday, April 03, 2008

Jade Will See You When She's Finished Her Pie

Pharmacists have never had it so good

Listening to the commissars' latest wheeze for dumbing down the NHS - getting pharmacists to replace GPs - you have to guess they've never visited Tyler's local chemist.

For one thing, it's always packed, with a queue snaking back to the door. And when they tell you your prescription will be ready in 10 minutes, they really mean 10 hours. In fact, it can be much longer than that because they routinely mislay the scripts and/or find they don't actually have the stuff in stock and anyway they can't get it at at the warehouse, or maybe Denise ordered it oh no she must have forgotten sorry it's taking so long but we've only just had our delivery and we've got three members of staff off sick and we had a pharmacist from Germany only he's had to go back home and I'm not sure where Jade is maybe she's gone on her break.

Jade is in fact hiding round the back of the shelves stuffing her face with what smells like a Chicken Tikka pie. She is immensely fat and has difficulty walking. Even though she's only about 25.

When she finally waddles back to the counter she has crumbs round her mouth and is chewing gum.

"Ah, Jade, I have... er... um... could I see a pharmacist?"

Sigh. waddle, waddle, waddle.

You see, you can't just see a pharmacist: they're all safely tucked away behind a shoulder high wall and you only see their heads - you talk the counter staff, and they act as intermediaries.

"Customer wants to see a pharmacist," Jade shouts.

The pharmacist doesn't look up, just shakes her head.

Waddle waddle.

"Pharmacist is busy at the moment. Can you come back?"

"Well, when?"

Waddle waddle.

Mumble mumble. Pharmacist looks exasperated.

Waddle waddle.

"What is it you actually want?"

"Well... er... look... ah... I've got this sore spot on my... er... well... you know..." Jade looks blank. I lean across the counter and drop my voice. "In the... umm... trouser department."

A dim light goes on in Jade's eyes. Is she smirking? She turns and shouts at the pharmacist: "it's another sex problem". Everyone looks up now.

Well, we get the picture.

Maybe local chemists in Surrey are unusually poor. Maybe they pay national wage rates in an area where that only buys Jade and moonlighting German pharmacists with a shaky grasp of English. But I sure ain't going to switch to them for anything more than the usual coughs and sore throats.

So how much is this "plan" meant to save?

We have no idea because they haven't said. But I guess we all know GPs now get paid £5m pa, so pharmacists on £35-60K have to be cheaper. Right?

Almost certainly wrong. For one thing NHS Redirect shows us precisely what will happen with anything other than coughs and sore throats: patients will waste time speaking to a pharmacist who will then simply refer them onto a GP. As the National Audit Office discovered, far from reducing NHS costs, NHS Direct actually increased them by around £100m pa (see this blog).

Plus of course, if the pharmacist does diagnose but gets it wrong - highly likely with anything other than coughs and sore throats - we will see a further splurge of emergency hospital admissions (just as happened with the Gershon "efficiency" cuts in hospital stays, and the loss of GPs out of hours service).

Judging from the White Paper, the underlying point is that the commissars have convinced themselves they can force pharmacists to deliver more for the huge amounts of money they get from NHS prescriptions. The WP says:

"Public investment should not provide a permanent reward system for service providers who are prepared simply to deliver the bare minimum levels of service or whose focus is on patient throughput rather than patient satisfaction and not on the benefits of improved health outcomes within a service delivered to high quality standards. This is unacceptable when the taxpayer invests nearly £10 billion a year in pharmaceutical services overall." (para 8.45)

They've already tried to force chemists to do more. For example, they introduced Medicine Use Reviews (see here), whereby chemists get paid to summon their regular customers in for a meeting, during which they tell them to stop using so much medicine. Just one problem- although the number of MUR meetings has exploded (see chart below), there is zero evidence it's cut costs; in fact the pharmacists seem to use them as a way of earning even more. Doh!

Another nice little earner

And what do we think will happen if pharmacists - the very people who benefit financially from selling more medicine- are given authority to prescribe drugs? And how do we think those nice people at Big Pharma will ensure they don't encourage overprescribing by providing huge additional incentives for chemists to maximise sales? Hmm?

Finally, ask yourself this question: next time Rockin' Al gets a sore spot in the trouser department, do you reckon he'll be popping down to join the queue at his local chemist in Hull?


(See the Doc for much more on the special NHS treatment only available to our rulers).

PS Tyler's first regular paid job was working as a Saturday assistant at Boots the chemist. He was one of just three males on the staff, the others being the manager and the pharmacist. So although he worked on the photographic counter, he was often approached by men wanting to buy contraceptives, who were too embarrassed to ask the young ladies on the pharmacy counter. Naturally, one of the great perks of the job was to shout out to the girls that the customer wanted some Durex. How very grown up. (Yes, I know, but for most people, the sixties were a much more buttoned up age, and such things were not simply chucked in with the rest of Sainsburys shopping- they were kept out of sight in a special drawer at Boots).

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