The 1986 Nuffield Report on pharmacy should act as a reminder to those in power: machines cannot replace pharmacists without compromising safety.
What has changed in pharmacy in the past 30 years and what has changed in the past 180 years? We do tend to think that modernity and technology provides us with a safety so that delegation is entirely acceptable.
In 1986, it was said that the face of pharmacy would change over the following decade if the recommendations of the Nuffield report were put into effect. Wise counsel from a range of eminent advisers suggested that much was to be done in order for pharmacy to succeed. Central to all of this was releasing the pharmacist’s potential as a clinical professional; whether this be in health education, in care homes or in GP practices.
Hansard, the official report of the proceedings from both the House of Lords and the House of Commons, chronicles Lord Hunter of Newington’s debate in the House of Lords. In this fascinating transcript of the various speeches made, one of particular note is that of Lord Ardwick. As a former Labour member of the European Parliament, having been unexpectedly appointed (as was the case in 1976) after a career as a journalist with The Mirror, he was well acquainted with pharmacy across Europe.
The noble Lord was relieved “that the law should continue to require pharmacies to be under the personal control of a pharmacist, but that the requirement should be satisfied if, while absent on other professional work, he can be contacted”. Ardwick’s humorous reference to Dickens’ Pickwick Papers — a convenient allegory — takes us even further back in history; to 1836, when Dickens’ Pickwick Papers were published.
In the trial of Mr Pickwick, on charges of breach of promise brought by Mrs Bardell, his landlady, the local chemist, Mr Thomas Groffin, pleaded with the Judge to be excused. After interrupting the Judge swearing him in, the chemist explained that he had no assistant to run his shop. On further questioning from the irascible Mr Justice Stareleigh, the chemist went on to say that he could not afford an assistant, and that “there’ll be murder before this trial’s over”. Again the judge was unimpressed. The chemist went on: “I merely wanted to observe, my Lord, that I’ve left nobody but an errand-boy in my shop. He is a very nice boy, my Lord, but he is not much acquainted with drugs; and I know that the prevailing impression on his mind is, that Epsom salts means oxalic acid; and syrup of senna, laudanum.” There was no subsequent remonstration from the chemist, as he “prepared himself for the worst”.
There is now a clamour to position pharmacists in care homes, accident and emergency departments and GP practices. At the same time, it is reported that there “could be facilities…capable of dealing with two-thirds of dispensing volume in community pharmacy.” (
Pharmaceutical Journal 2016;296:205). Who will be in control of these automated dispensing facilities while the pharmacists are busying themselves with clinical roles, which are yet to be defined, least of all funded?
In any civilised society, ready access to medicines is a feature of daily life. Not only does one expect to be able to obtain a medicine quickly when needed, but there is an expectation that the medicine is the right one for the condition being treated. Can a machine accurately differentiate Epsom salts from oxalic acid any better than an errand boy?