Pharmacists are the new doctors, pharmacy technicians are the new pharmacists

It is difficult to overstate both the scale of changes and the rate of transformation of pharmacy since the start of the 21st century. Driven by government policy, professional ambition and public expectations, they have been truly astonishing. The government’s new 15-year plan for the NHS workforce is extremely ambitious and, combined with the Royal Pharmaceutical Society’s (RPS’s) call for all pharmacists to be prescribers, represents a paradigm shift for pharmacy in Britain. Along with the boost in training places for pharmacists, the government’s targets for 2031 include a doubling of medical school places to 15,000 places per year and a 50% increase in GP trainee places, as well as an increase in the number of training places for physician associates to 10,000 places by 2036.

Pharmacy’s direction of travel is confirmed with the commitment to make all new entrants independent prescribers from 2026. The journey now underway seems to have an inevitable outcome — the return of pharmacy to the medical fold. The need to double the number of medical school places, and the likelihood of reducing medical training to four years, demands a massive increase in medical training facilities. An obvious solution is to combine medical and pharmacy training in the first four years, and to re-designate schools of pharmacy as medical schools.

Yet such an eventuality has long been on the cards. It dates at least from the 1960s, with the profession becoming more patient- and less product-focused. By the 1980s, clinical pharmacists were operating in most hospitals and, by 2000, all hospital pharmacists were expected to be clinical practitioners. By 2010, most community pharmacists were engaged in clinical activities of some sort and, by 2020, substantial numbers of pharmacists were working alongside GPs in GP surgeries.

These developments occurred within an explicit policy framework and were greatly facilitated by technological developments, especially the wide range of digital tools now available. They have enormous implications both for pharmacy education and technician training. Indeed, the expansion of education and training for medical students, physician associates — as well as pharmacists — will require a level of collaboration between existing institutions, such that schools of pharmacy will need to participate fully in the training of all health professionals.

Universal prescribing roles for pharmacists, combined with expanded roles in the diagnosis of a wide range of both acute and chronic conditions, brings their role much closer to that of GPs, and demands an education differing only in emphasis at the later stages. The inevitable outcome of this process is the inclusion of pharmacists on the medical register. Yet the fact that they are not already is largely a consequence of the RPS’s history. When Jacob Bell founded the Society in 1841, he was in no doubt about his aim; it was to establish chemists and druggists as a fourth branch of medicine, alongside physicians, surgeons and general medical practitioners (formerly apothecaries).

The relationship between pharmacy and medicine was a key theme in the medical reforms of the 19th century. The issue was clarified in the courts in 1828, when Mr Justice Park ruled that there were “four degrees in the medical profession — physicians, surgeons, apothecaries, and chemists and druggists”. In 1842, Bell noted “the position which pharmacy occupies, or ought to occupy, as a branch of the medical profession”. He repeatedly returned to this theme, stating that “we have always maintained that our body is and must be considered a branch of the medical profession, and that whatever regulations — respecting education, registration or protection — may be considered necessary for medical practitioners, the same or similar enactments are no less requisite in our department”.

But medical reform progressed slowly, and Bell was anxious to secure legislation to protect pharmacy; it was the 1852 Pharmacy Act that established a register of pharmaceutical chemists. Medical registration only occurred six years later, following passage of the 1858 Medical Act. Since pharmacists were already listed in a statutory register, they could not be included in the medical register. If the register for pharmaceutical chemists had not already existed, it is entirely possible that pharmacists would have been included as a fourth register under the Medical Act.

The future of today’s pharmacists is already clearly mapped out. Recent developments in pharmacy all point in the same direction; to the ultimate inclusion of pharmacists as “pharmaceutical physicians” on the medical register. They are already committed to a totally patient-focused role, dealing with the wide range of services and activities embodied in such initiatives as ‘Pharmacy First’ and ‘Pharmacy First Plus’. The implications are clear. “Pharmaceutical physicians” require the same basic medical education as physicians, surgeons and GPs, with each specialising after the fourth year. While GPs remain the key contact for new symptoms and acute disease, pharmaceutical physicians are increasingly the key contact for the management of chronic illness.

But if a central role of pharmaceutical physicians is prescribing, can they still retain a role in dispensing? History says that they cannot. In the negotiations for the 1911 National Health Insurance Act, Lloyd George found it necessary to “separate the drugs from the doctors”. The separation of prescribing from dispensing roles remained an issue for many countries throughout the 20th century. Any remaining elements of dispensing practice by pharmaceutical physicians will inevitably have to be discarded.

That role will need to be taken on exclusively by highly trained pharmacy technicians, who have been a registered profession in their own right for some years. Many already have substantial supervisory and checking roles and take the lead in pharmacy supply functions. Their roles continue to develop, and they have already taken over many of the traditional roles of the pharmacist. Further development of their education may be necessary to embrace all aspects of the supply function, perhaps to first degree level. In many ways, pharmacy technicians are already the ‘new pharmacists’.

Arguments on both sides of this debate have of course been ongoing for some time. Yet those who aspire to be pharmaceutical physicians need to cast off the shackles of supply once and for all. People will continue to obtain their prescribed medicines through community pharmacies, but the dispensing role will need to be separate and distinct — both contractually and in the personnel involved — from the prescribing role undertaken by pharmaceutical physicians, who may operate from the same premises.   It seems a distinct possibility therefore that, within 200 years of the founding of the Pharmaceutical Society of Great Britain, the register of pharmacists maintained by the General Pharmaceutical Council will have transferred to the medical register held by the General Medical Council. Pharmaceutical physicians will have been joined by the 1,500 current members of the Faculty of Pharmaceutical Medicine of the Royal College of Physicians in a new Royal College of Pharmaceutical Physicians. The journey has been underway for some time, and the destination seems inevitable. Jacob Bell would be pleased.

Stuart Anderson, emeritus professor in the history of pharmacy at the London School of Hygiene & Tropical Medicine and Fellow of both the Royal Pharmaceutical Society and the Royal Historical Society   

Last updated
The Pharmaceutical Journal, PJ, October 2023, Vol 311, No 7978;311(7978)::DOI:10.1211/PJ.2023.1.198984


  • James Harris

    While this article will stimulate intellectual discussion of the position of the clinical pharmacist in a historical context, the current debate around Physician Associates means the title is likely to be inflammatory, and not in the spirit of the article - it feels like clickbait. This is the Pharmaceutical Journal, not Pulse magazine

  • Graham Stretch

    The current controversy surrounding Physician Associates suggests we don’t need even allegorical muddying of roles between practitioners of pharmacy & medicine.

    Can’t we just celebrate being super pharmacists & pharmacy technicians rather than trying to draw parallels with medics?

    We owe it to our patients, their relatives, carers & to the public to be absolutely clear who they are seeing & speaking to.

    In General Practice, where we have expanded teams over last 5 yrs to include a range of professions this role identification is absolutely vital - I’m proud to be a pharmacist, I’m not a medic.

  • Amina Ali

    In the interests of patient care and maintaining best practice, I think that it's important that clinicians (any healthcare professional) practice within their expertise. There is little to be gained from adding further confusion by using a new term such as 'pharmaceutical physician' - often my patients will call me 'doctor' in my consultations or when they want to book an appointment with me - they will say 'oh, you should have been a doctor', my response is usually along the lines of 'well, if I was, I wouldn't be an expert in medicines' which is essentially what they have found useful or helpful about the consultation or my intervention.
    So advancing the pharmacy profession is not about taking the place of a doctor but excelling in what we do best - managing all aspects of medicines (including prescribing and therapeutics).

  • Howard McNulty

    Does the public not need to be clear what roles are required and who is trained to do what in their care pathways before finding boxes and titles for practitioners.
    Prof Anderson omits to mention consultant nurses who are undertaking medical roles too.
    Physician Associates roles are unclear to the public.
    RPS is focussed mostly on “clinical” and prescribing activities. There are many other roles for safe care provision. Managing resources, quality assurance, public health, manufacturing storage distribution compounding etc
    Should the many roles required in future not be identified first and allocated to those best trained to deal with them.
    It seems the public have no idea what these roles are and the team working required.
    There are dangers of black holes appearing where leadership and management is confused where roles are forgotten or taken on with inadequate training or quality assurance.
    What do doctors do in future as consultant nurses physician associates and pharmacists take roles over is key to the debate.

  • Peter Robinson

    Doctors should be doctors. Pharmacists should be pharmacists and technicians should be technicians.

    There are so many people prescribing these days that doctors must feel that they are losing control of patient care. That is not desirable or acceptable.

    Clinical pharmacy has acheived more workplace pressure, more training, more regulation, more stress and more pharmacy closures. The pressure on pharmacists to acheive what they never had a chance to vote against is intolerable.

    A pharmacist is a pharmacist - not a medic. Those intetested in clinical work should not force their ideas on every body else. They're welcome to the extra workload.

  • Nicholas Wood

    Stuart paints a cogent if alarming picture of pharmacy’s future. However, pharmacy is different. A physician, surgeon, or indeed an accountant, surveyor or lawyer, gets paid for an expert service supplied to their client. Uniquely, a pharmacist supplies that expert service almost always in relation to a physical product, the medicine or drug. And either they, or someone delegated by them has to curate that product either by dispensing, storing, manipulating or in controlling its supply and preventing misuse. An entirely clinical pharmaceutical physician would not be in the business of curating the product. Indeed (and I have form here) this has all happened once before when the English apothecaries of 1650 had by 1850, abandoned pharmacy for general practice medicine, their curating role being taken by the chemists and druggists. If today’s pharmacists become pharmaceutical physicians, pharmacy technicians should indeed step into the curating role: which would make them pharmacists or perhaps even “apothecaries”, derived, from the Latin and Greek for a storekeeper.

    • Malcolm Brown

      I support Professor Anderson’s historical perspective. Sociologists’ interpretations of professionalization endeavours, including of pharmacists, fill libraries. They suggest that certain aspects may well be associated with the most intense jostling. I outline some “red flags” for those who prefer the status quo to continue.
      What title will the new generation of doctor have? It must be neither doctor nor pharmacist. A new name facilitates new behaviours of occupations. I suggest “medico".
      Other symbols also matter. For example, today’s optometrists, who use ophthalmoscopes, have battled with doctors for that right. Will tomorrow’s pharmacists wear stethoscopes? Hospital pharmacists already wear scrubs. I have eye-witnessed a junior doctor running to get a stethoscope. Fine — but before going to the canteen shared by all staff?
      Tomorrow’s technicians need at least a bachelor's degree. Their present qualification at registration is BTEC level 3: equivalent to three A levels. The gap between that level and the master's held by today’s pharmacists is too large; I included that point in my articles in the PJ in 2003-4.
      Pharmacists are losing interest in making medicines; biologists and chemists are replacing pharmacists, notably as QPs in industry. Is that in the best interests of patients?
      If a drug is required, diagnosis and advice is worthless if the patient cannot get the empirical medicine. Medicines are corporeal things; pharmacists have stuck like limpets to their entitlement to possess those artefacts. Somehow, tomorrow's pharmacists must maintain that privilege, just as some of today’s doctors retain their birthright to dispense.
      However, AI-enabled robotics may well change or remove the professions of pharmacists, pharmacy technicians and doctors, as we know them, within 5-10 years.


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