Hi Ruth,
Like doctors, individual pharmacists vary in their attitudes. Most of the
ones that I work for are selective about which generics and which parallel
imports they use (A while back one of the importers had the bright idea of
pasting sheets of paper with the days of the week in English over the back
of the foreign foil packs - this made the tablets impossible to remove. We
tried them - accepted the complaints, and use them no more. Unfortunately we
cannot know until we've tried them). Most are responsive to the needs of
their patients.
Given that HMG only pays pharmacies for using generics when a generic is
prescribed and available, given that pharmacies are paid as if parallel
imports are used, what else can you reasonably expect a pharmacist to do.
I accept that I do not have quite the same conflict of interest as the owner
of the pharmacy. But that conflict, between making a living and the
interests of the patient applies also to doctors (as witnessed by some of
the conversations here) though it is not as obvious.
As far as the advice of pharmacists is concerned, times have for a while
been changing for the better. The pharmaceutical industry has been
castigating pharmacy for recommending generics when more profit is made from
recommending branded drugs (When did you last hear of a pharmacist
recommending Panadol? - Mind you, buying ibuprofen from Boots might prove to
be difficult). The makers of the H2 antagonists are disappointed at their
pharmacy sales . (If only more GPs tried prescribing Mag Trisil before going
onto H2 antagonists and PPI's)
As for paracetamol, fluids and rest for a viral infection. Well I've no
problem with that, I've previously argued that we should all be giving the
patients the same message. However telling me will make no difference. Try
to agree treatment protocols with your local pharmacist, but before you do
so ask yourself if would you be willing to accept responsibility for
treatment protocols in a pharmacy in which you had no stake and no control?
Ask if it is reasonable to expect a pharmacy to work with different
treatment protocols from different GP's? (Most pharmacies deal with more
than one surgery).
IMO this idyllic situation is most likely to occur in the case of a practice
partnership, in which shared care means shared responsibility and shared
interests.
Regards
Jeff
Regards
Jeff
Jeff Green
-Community Locum and Consultant Pharmacist-
[log in to unmask] <mailto:[log in to unmask]>
> -----Original Message-----
> From: [log in to unmask]
> [mailto:[log in to unmask]]On Behalf Of Ruth Livingstone
> Sent: 05 April 1998 12:20
> To: [log in to unmask]
> Subject: RE: Branded drugs
>
>
> Hi Jeff
>
> That GP (mentioned below) was me,
> being provocative of course :-)
>
> I never suggested the patient pass the blame fully onto the
> pharmacist, but, as you well know, some chemists are tempted
> to use very cheap parallel imports in shoddy packaging. Why
> should GPs have to deal with patients complaining about this?
> Why should GPs be pressurised into prescribing by brand name
> simply to secure reasonable service for their patients?
>
> I have even had patients come in bringing drug information inserts
> written in foreign languages, some time ago.
>
> As a community pharmacist, you have a slightly different role to
> a small pharmacist, who is, primarily, running a small business.
> If he/she doesn't make money, they go bust. I do understand their
> predicament, but it creates a conflict with their apparent role as
> an impartial advisor. For example, it is rare to hear of a chemist
> suggesting "paracetamol, fluids and rest" for viral illnesses.
> Patients are usually sold a variety of branded medications, fuelling
> the expectation of a pill for every ill.
>
> If pharmacists (and I mean the high street chemist, not yourself)
> want an extended role in the NHS, and wish to be treated as part
> of the primary care "team", then they must first address this
> problem of conflicting interests.
>
> Best wishes, Ruth
>
>
> ----------
> From: [log in to unmask] on behalf of Jeff Green
> Sent: Thursday, April 02, 1998 10:58
> To: [log in to unmask]
> Subject: RE: Branded drugs
>
> >When I first discovered gp-uk there was a message in which a GP wrote
> something to the effect that if a patient complained about a generic they
> passed the blame fully onto the pharmacist, and that it wasn't the GPs
> problem if the pharmacist supplied second rate generics.
> I would suggest that this sort of attitude is hardly likely to make for a
> good working relationship. All generics are licensed medicines,
> all are made
> to a standard. Sometimes they are made in the same factory that makes the
> branded version.
>
>
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