Changing role of the pharmacist

Mar 7 2008 by Our Correspondent, Western Mail

Pharmacists were the first port of call for many sick people before the advent of the NHS. In the past 60 years their role has changed dramatically from pill maker to public health adviser, as Cath Savage explains

THE face of pharmacy in Wales has changed beyond recognition since the birth of the NHS in 1948.

While many still have a role supplying medicines to the people of Wales, the way in which pharmacists have evolved to become an integral part of the healthcare team might never have been imagined 60 years ago.

In the past six decades we have made major developments in medicines and the pharmacist’s role now impacts on every stage along the path of drug development, manufacturing, prescribing and supply.

Today pharmacists provide a range of innovative services to the Welsh public, working closely with other healthcare professionals.

This includes providing people with advice on healthy living, signposting them to sources of information or helping them understand more about how their medicines work.

The introduction of the NHS meant free access for all to health services and medicines, with costs met from public funds.

When it happened, doctors and pharmacists were overwhelmed by the surge in demand for their services – it seems the public were more than ready to claim free healthcare.

An editorial in The Pharmaceutical Journal just after the NHS began says, “The only parties completely prepared were the members of the general public who, with great promptitude, immediately asserted their rights and claimed what they thought they were entitled to.

“Doctors’ surgeries were besieged; chemists were overwhelmed with prescriptions.”

In just one year – in 1949 – the number of prescriptions that pharmacists supplied in Wales more than doubled.

Before the NHS, a visit to the doctor was a last resort unless you were rich.

So the high street chemist – now known as a pharmacist – would have been your first port of call for advice on medical complaints and medicines.

In those days, pharmacists were expected to prepare a wide range of products for their customers and this took up much of their time.

These would include medicines like painkillers, sedatives and cough mixture, but also toiletries such as shampoo and toothpaste, perfumes, cosmetics, and even rat poison.

In those days remedies didn’t come ready made in bottles and packets – the pharmacist made up the medicines from the raw ingredients.

Until the early 1950s tablets were made in the pharmacy using tablet machines, while powders had to be individually wrapped in paper and secured with sealing wax.

An expert dispenser would have dealt with around four prescriptions an hour in 1948 – imagine the chaos that would cause today. What’s more, they had to make sense of the doctor’s handwritten instructions in Latin.

The pharmacist would have handwritten every label, but as a patient you had no idea what you were taking – it simply said “the tablets” or “the mixture”.

It is only in the last 30 years that it has become law to include the drug name on the bottle.

Visit your local pharmacy today and you won’t find the pharmacist hidden in the dispensary mixing up medicines.

Today, medicines are all produced in factories and many pharmacies now have technicians whose job it is to make up prescriptions.

And because the whole process is now computerised and medicines pre-prepared, an average pharmacy today can dispense 265 items a day – a far cry from four an hour in 1948.

Today the pharmacist’s role is so much more than a dispenser of the doctor’s prescriptions.

Like their 1948 counterparts they still have a key role in advising patients on which medicines to take, but these days that role extends to advising people on how to stay healthy and also helping them understand their medicines better.

Over the last 20 years an increasing number of prescription medicines have become available over-the-counter for patients to buy, such as treatments for thrush, anti-biotic eye drops, athlete’s foot cream and cold sore cream. This means many more patients can go straight to their pharmacist for advice and for treatment for minor ailments, thus helping reduce the burden on family doctors.

Today almost one in six visits to a GP surgery could be more appropriately handled by a pharmacist.

Community pharmacists come into contact with people who are healthy as well as those who may be ill and so are ideally placed to provide information and advice to those people who may not otherwise go to a GP or nurse.

They now provide health advice services such as stop smoking counselling sessions, helping patients to lose weight and in many cases offering patients tests for diabetes, cholesterol and high blood pressure.

If the pharmacist can’t give you the treatment or help you need, they will refer you to another health professional, such as a GP or physiotherapist, or to social services, or even a local support group.

Medicines are your pharmacist’s area of expertise and many pharmacies now offer their patients a medication review – a chance to chat to your pharmacist, in a private consulting area, about the medicines you are taking and any side-effects they might have.

This gives the pharmacist an opportunity to check that you understand how and when to use your medicines and for you to ask any questions you may have about them.

We are also moving away from the days when only a doctor was allowed to prescribe medicines, with the advent of nurse prescribers and now pharmacist prescribers

Pharmacist prescribers can be based in a GP surgery, hospital or in some cases a community pharmacy and have the power to write prescriptions for medicines.

These pharmacists have undergone extra training and gained a further qualification to enable them to do this.

A pharmacist’s specialist knowledge of how drugs work and interact with other medicines makes them ideally placed for this prescribing role.

The hospital pharmacist in 1948 would have been confined to the basement spending their days filling up bottles of medicines and making tablets.

Rarely seen by the patients, the pharmacist certainly wouldn’t have dared offer advice to either patient or doctor.

The expertise of the pharmacist was in taking the ingredients and making them into the medicines that were agreeable to take or use.

Crude drugs such as opium, liquorice root and cascara bark would be bought in bulk and the pharmacist would turn them into tinctures.

The hospital pharmacy team would make up mixtures in five to 10 gallon batches and make tablets such as aspirin, codeine and buto-barbitone (sleeping tablets). Even injections were made on the premises.

The job of the hospital pharmacy was to make and supply medicines.

Today you are just as likely to meet the pharmacist on a ward round as in the dispensary.

Pharmacists in hospitals accompany doctors when seeing their patients and support the clinical team by offering advice on medication.

In some outpatient clinics pharmacists see patients to monitor and adjust their medication.

While the pharmacy team is still responsible for the medicines supply, a technical revolution has been brought to the hospital pharmacy process in recent years with the introduction of robots that are used to store and retrieve a variety of medicines.

This frees up more time for the pharmacist who can spend his or her time advising patients.

When you are admitted to hospital, it may be a pharmacist who talks to you about any medication you’ve been using and checks what you have been taking.

On the ward you may see a pharmacist who will talk to you about the medicines you need to take, so you understand how to take them and to help adjust the dose to suit your own particular needs.

Pharmacists have never played a more important role in the health and wellbeing of the people of Wales than they do today.

They are accessible right across Wales – in hospitals, high streets and doctors surgeries, providing advice and care to patients.

Looking ahead we are going to continue to see huge developments in pharmacy in Wales, with more and more innovative services on offer to local people.

This is even extending to keeping people away from taking their medicines.

Pharmacists have an increasing role in ensuring that people avoid getting ill in the first place, providing healthy living advice and pointing people in the direction of healthy lifestyles.

It is a saying that’s even older than the NHS, but prevention really is better than cure.

Cath Savage is the Royal Pharmaceutical Society of Great Britain’s director in Wales