Post code rationing - what's smart about smart cards?

So the endless frustration with commissioners of health care goes on, especially for pharmacy. A quick interogation of our database shows that on average, a locum pharmacist will work across ten PCT areas over a period of time, many of whom have come up with "local" schemes for EHC or Minor Ailments. The vast majority of locums, like their permanently employed colleagues, want to provide a full range of services wherever they work.

I may live a sheltered existence, but how is unprotected sex which requires EHC any different from one part of the country to another. We had some meetings in London this week and came away frustrated at the inflexibility of different PCTs to recognise a basic or "core" accreditation for EHC, with local variations built in e.g. some will provide the service via pharmacies only to under 19 year olds, others include condom supply, still others are providing material to "demonstrate" to youngsters how to put a condom on to a model of the "real thing" (I'm being as tactful as I can, if anyone dosen't know what I mean, please e-mail and I'll clarify in a more broad minded description; e-mail details on the main site).

I digress at this point. Back on message. Why on earth do we, allegedly well trained, motivated, professionals, who continually update our skills and expertise. The bulk of the questioning and advice and responses we go through are the same from one place to another, some minor local variations on procedure are not beyond our wit to recognise these. Perhaps we sign a fax and send it to say we've read protocols and let's get on with it. Why do I have to turn away a patient in Haringey because I haven't done their local training session but I can do so in Hartlepool?

Then there are smart cards - what's smart about them? Some places have withdrawn pesonal smart cards and have store cards only, others are rolling out release 2 even though many people do not have release 1 and can't get one because the PCT isn't providing them when it's convenient to the pharmacist to get there, and on it goes.

Whilst it's nigglig for us and inconvenient, the patients must wonder what the NHS is about sometimes. Can't get the morning after pill here but you can across the road, why? It's a different PCT, obviously.

You'll soon be able to air your views via our Members Area of the web site. Keep visiting as it will be along soon, along with a host of new things such as your own Private Area, on line booking and diary, Pharmacy Finder. I could go on, but you'll see soon enough.

GET ME OUT OF HERE, I'M A PHARMACIST!

I don't like to associate myself with the similar titled television offering, but for once, I have a lot of sympathy for the celebs. (I will say that only once!!)

The last month has been a roller coaster of activity behind the scenes, and whilst anyone checking the web site (www.locumpharmacistuk.com) might have noticed very little changing, behind the scenes, in the 99% of the site which the public can't see or use, we've introduced so many changes and improvements that I'm in danger of losing the plot.

I now know more about Active Server Pages and Comma Seperated Variables than most people, certainly most in Pharmacy, anyway. These and a host of other items are helping us make the site an interactive quantum leap forward from what we have been doing. So far. you may have noticed "Test data" where Available Bookings ought to be and much of the Urgent Bookings have been ignored whilst we test out the system.

Result? In 2010, pharmacists will be able to log in to their own personal page, or "Lounge" (User Name and Password Protected) and update their information; availability for locum work, interest in permanent vacancies, job search, and also manage their own professional and financial information relating to work done.

Clients (Owners, Managers, Area Managers and Locum co-oordinators) will have their own "Lounge" (also User Name and Password Protected) to help manage and request locum bookings or request the Recruitment Service for Permanent Vacancies.

All of this information will feed into our databases at the touch of a button and allow us to interactivley support you, whether you are looking for Locum Work, a new full time job or if you need a locum or manager.

There will be other special features only available within The Members' Areas which will be accessible only to Registered Users. Registration will be free. Anybody can rgister their interest by telephoning, texting or e-mailing with your contact e-mail address, so that we can notify you as and when services come on-stream.

We think it will make life so much easier for everyone who chooses to use it, that we can't wait for 2010 to come! Why not make it your New Year Resolution to join up and see the benefits this will bring to you? We'll be waiting in the New Year for you, but in the meantime, does anyone know how to get me back to 2009 - I don't want to miss Christmas!

BNP - have we learnt nothing from history?

I was shocked to discover that almost a million British people voted for the BNP (British National Party) in the recent European Elections. Seventy years ago a whole generation of young men (and women) combined from all parts of the world fought - and many died, giving their tomorrows for us to have freedom today. Those who fought against the horrors and evil of Nazism came from all countries, races, colours and creeds. A tide of humanity united against the atrocities that were committed against so many innocent people, and hoped that they had left behind a better world for us to inhabit.

Nick Griffin and his party have the right to free speech that we often forget is so precious to liberty - Napoleon Bonaprte was quoted as saying "Four hostile newspapers are to be feared more than a thousand bayonets". Free speech is a two way street, however, and whilst some of the questions and comments put to Mr. Griffin showed him and his beliefs to be at best, confused, at worst, abhorrent, my favourite quip of the night was from Bonnie Greer, who kept her cool admirably throughout, pointing out "All of us are descended from Africa".

I've always found pharmacy to be a very tolerant and meritocratic beast and have rarely come accross any racist tendencies with people I have worked with. I'm sure some individuals have experienced it in their time and I have been told by some during a recruitment process that they do fear it's effect and impact, which has a huge influence on areas where they might consider working and living. That is soul destroying to hear.

My favourite incident which highlighted the crass stupidity of people believing in racial stereotypes occurred a few years backm, when we recruited a man, we'll call him Geoff (not his real name) for an independent pharmacy, after considering posts with a small group and a major multiple. Geoff enjoyed three years in the job in a middle class, almost exclusively white populated area. His patients and customers really thought very highly of him, not just because he was so good at this job, but because he was a really pleasant, caring, dedicated man who would go out of his way for anyone. I don't know if it helped his situation that he spoke with a cut-glass English accent that would have fitted well on the BBC in the 1950's.

More than once after securing the job for Geoff, I visited the pharmacy to see how he was getting on. It never failed to make me smile when a ptient who had spoken to him on the telephone came into the pharmacy and saw him for the first time. After asking to speak with Geoff, they were told politley, "Hello Mr. Jones, nice to meet you at last. I'm Geoff". There would follow a moment of uncertainty as Mr. Jones would stutter, "But.. but..". "Geoff would help them out "Yes Mr. Jones, I'm black. I'm from Nigeria". A relieved Mr. Jones would reach out to shake Geoff's extended hand "But you sound so English!".

No Longer voices in the wilderness

One of the good things about my job is that I am in touch with more pharmacists in a day than most other people. If you act as a manager, owner or locum, you probably are the only pharmacist in a premises and don't get chance to exchange views or opinions and I know that many people feel that they are lone evoices in the wilderness, ignored and disregarded by the powers that be, unless they are unfortunate enough to fall foul of the regulations for some reason, RP being the most recent one to have caused massive confusion and anxiety. Many people have privately expressed the feeling that if they could find a job that kept them and their families in the same degree of financial stability and comfort that they currently experience, they would almost certainly take it. What a sad state of affairs that we have come to this.

Words often mean more when we know the people who speak them, and when their opinions strike a resonant chord with us. Two examples I can quote from people whom I know and who have put their words on record recently with regard to RP. Richard Rutter and Dorothy Drury have left comments on the PJonline for all to see.

http://www.pjonline.com/news/rp_regulations_should_be_applied_flexibly_says_doh

Please look at these and see if they make sense to you. Perhaps those who drafted the RP regulations and pressed for their implementation should have consulted the likes of pharmacist such as Mrs. Drury and Mr. Rutter, and thousands like them. It would surely have led to a better scenario than the risk of a criminal prosecution for such heinous acts of misconduct, such as forgetting to log out at the end of the day.

We hope to quickly establish a specific forum on this issue with an input from someone who has access to the powers that got us into this mess. Keep checking back to the main web site and join the debate. People often complain that they are ignored and that they have no voice - we aim to help remedy that, but it will take your contribution to achieve it. Don't settle for being a silent majority of one any longer: your opinion matters and can help to change things for the better.

Don't forget to sign out as Responsible Pharmacist

So there we have it-forgetting to sign out at the end of the day when you go home is a criminal offence under Responsible Pharmacist legislation. Inspectors from the RPSGB will take a pragmatic line, according to an interview in Chemist & Druggist, but does that make you sleep easy at night? After the Elizabeth Lee case and all that followed, this is potentially a step that could give a pharmacist a criminal record!

What do we do about it? I don't know, but will be e-mailing the one member of RPSGB Council whom I know and asking her to raise this matter urgently and see if a review of the legislation can be brought about to make it much more sensible. I didn't join this profession to be criminalised for something so apparently trivial, did you?

1st October, a momentous day!

1st October was a massive day in history.

• 331 BC: Alexander the Great defeats the Darius III of Persia at Gaugamela, making him master of Asia Minor.
• 1938: German troops march into the Sudetenland, Czechoslovakia, under the auspices of the Munich Agreement.
• 1949: The People’s Republic of China is proclaimed, following the Communist victory in China’s civil war.

Did anything else of note happen for you on this day?

AFTER ALL THESE YEARS, I'M NOW A RESPONSIBLE PHARMACIST

And I have a card to prove it! I haven't figured out how I've got away with it all these years, behaing irresponsibly. I guess that someday it was always going to catch up with me, and from today I must put aside all childish things and behave responsibly.

The trouble is, when I read closely all the different protoccols and interpretations being offered (imposed?) by different companies, I'm not that sure what has changed in reality, other than the long overdue farce that a pharmacy was hitherto breaking the law if sales of GSL medicines were allowed to take place when the pharmacist was not present, when the petrol station down the street could sell what they wanted. When I was getting some milk the other day from a supermarket which didn't have a pharmacy, I noticed Canesten Combi on the shelves on open display and available for anyone to buy. So, if a pregnant lady describes symptoms which match thrush, if it the first episode, we are obliged to refer to the GP to ensure that there are no underlying problems with the pregnancy. Or she can just walk to the supermarket and buy it to avoid the hassle, because in a previous pregnancy we did the same thing and the GP prescribed Canesten anyway and grumbled about our incompetence. When I later explained the referall protocol he (the GP) was non-plussed and clearly unaware, which speaks volumes for inter practitioner communication.

But, I digress. I have always worked on the basis of if I'm the pharmacist on duty, I'm responsible. I accept that where there are two pharmacists on duty, there needs to be a clarification of roles etc., but as we all know, that's a rarity. So what has changed? I now have a card telling everyone I am responsible.

I can't speak for anyone else, but I have never had a problem with patients/customers knowing I'm responsible, I make it plain. Whether it's tryingto make eye contact as soon as they are near enough, whether it's the interaction between the staff and myself, whether I just have one of those faces which says "I have a very responsible job around here - if anything goes wrong, I'm responsible!"

In practice, I think the way the regulations have been framed and get interpreted will make them unworkable. We now have too many chiefs and not enough indians. We have Pharmacist (Responsible or Second), Pharmacy Manager/Store Manager, in either capacity rarely a pharmacist but with poweres deferred or devolved (until it goes wrong, then everyone turns to the Pharmacist), ACT's and so on.

Who takes the wrath of the patient if an error is made? If the ACT gets it wrong but the Pharmacist has made the clinical check? The fact is, we all make mistakes, so to single individuals out will not work as it all too often allows us to evade accountability. To quote a football adage, "We win as a team and we lose as a team". This change in regulations may have created a Responsible Pharmacist, but is it in danger of losing accountability? Only time will tell.