The neighbourhood community pharmacists are most often the first point of contact for people for their healthcare needs. The community pharmacies are not just retail medicine sale units but are resource service centres. Medicines are undoubtedly the second most important component of the healthcare after the qualified and trained health workforce. The community pharmacies and community pharmacists deal with medicines. They improve the access of medicines as large number of people in the society are dependent on private sector healthcare. Unfortunately, there are some attempts at this point of time to dilute the qualification required for manning these pharmacies. There has been a move to give training to the non-pharmacists (unqualified persons) and make them qualified as equivalent to pharmacists. This article aims to look the various angles of such move in the interest of public health of the country.
Let us look at the background and the provision of current regulations governing community pharmacies. Way back to pre-independence era, there were situations where everyone was free to start a shop claiming himself chemist and selling even the deadliest drugs which might well harm the public. The Drugs Enquiry Committee’s Report (Chopra Committee), and the subsequent report of Dr. Anderson, the then Secretary of British Medical Association, raised the concern and need of regulating drugs and pharmacy.
In his report Dr. Anderson says “There is a lack of adequately qualified men among those who take up profession of pharmacy and there is absence of any restrictive laws preventing the practice of pharmacy by unqualified persons”. These two reports laid the foundation of the regulatory frame work of community pharmacies in the country. The two legislations: Drugs and Cosmetics Act 1940 and the Rules 1945; and Pharmacy Act 1948 and the Rules; govern the community pharmacy functioning.
The Drugs Act clearly says “The supply, otherwise than by way of wholesale dealing, of any drug on the prescription of a Registered Medical Practitioner shall be effected only by or under the personal supervision of a registered Pharmacist”. Similarly the Pharmacy Act mentions “no person other than a registered pharmacist shall compound, prepare, mix or dispense any medicine on the prescription of a medical practitioner”. Now the recent addition to these is the Pharmacy Practice Regulation 2015 which recognizes the terminology of community pharmacy. The regulations are enacted not to provide professional protection to the community pharmacists but to protect the public health likely to be endangered by the mishandling of medicines.
With time, the role of community pharmacists have undergone a sea change. They are not mere medicines sellers. The World Health Organization, even as early as in 1988, outlines the activities of community pharmacists as: processing of prescriptions, caring of patients, monitoring of drug utilization, extemporaneous preparations, responding to symptoms of minor ailments, provide medicine related information to patients and healthcare professional, and participating in health promotion. Among these, the processing of prescription is perhaps the most important and difficult task.
The pharmacist(s) verifies the legality, safety and appropriateness of the prescription order, and checks medication record of the patients before dispensing (if record available with community pharmacy). The community pharmacists ensure that the accurate quantities of the correct medications are handed over to the patient or his/her representative. The pharmacists provide counselling too on medication use. In fact, several studies have generated evidence that pharmacists’ counselling promote medication adherence. On an average, medication adherence is less than 50 per cent globally. Medication adherence is of paramount importance to derive the benefits of medication use and reduce the development of bacterial resistance.
With increasing development and availability of very potent medicines including genetically engineered products, biosimilars, biotechnology products and radiopharmaceuticals, it becomes more difficult to manage them without appropriate education and training. The pharmacists have this qualification, training and expertise. But the pharmacist alone cannot manage a pharmacy and the services of many others are needed for effective functioning of community pharmacy. At present these supportive staff are called unqualified staff. The present attempt to improve their skill upgradation cannot be ignored. Skill upgradation is not only essential for the unqualified persons to perform better but are required even for qualified persons (pharmacists) as there have been paradigm shift in the roles of pharmacists from mere dispenser to provider of care.
The dispensing job has been delegated to less qualified persons like pharmacy technicians. This has been the practice in many countries.Perhaps, now time has come in India to have similar cadres of less qualified persons to work under the supervision of the registered pharmacist. They can take the responsibility of inventory management and dispensing. Pharmacists can spend more time on patient care including counselling. Patient counselling provision has been legalized under Pharmacy Practice Regulation.
Community pharmacists are now made part of the National Tuberculosis Programme at least in some parts of the country. They provide DOTS therapy in the pharmacy promoting medication adherence by the TB patients, usually a challenging job. Non-adherence to TB medications is one of the main reasons of emergence of multi-drug resistant TB. Currently the strategies are being developed to make the community pharmacists to be part of the medicines safety monitoring programme of the country.
While the pharmacists are professionally qualified to shoulder all the above responsibilities in the interest of public health, there are lot of initiatives required to improve their images from traders to service providers.
The good pharmacy practices are to be adopted in all pharmacy activities starting from infrastructure (like air conditioning facilities for storage of medicines) to performing professional activities (like providing counselling). The continuing professional development programmes should be made mandatory for renewal of license.
The updating of knowledge is very essential not only in professional interest but also from patients’ safety point. The days are not far away when the professional pharmacists would be dragged into litigation for dispensing inappropriate medications (even if prescribed). Improved services are essential for the survival of community pharmacies as the threat of e-pharmacies are just a step away. The community pharmacists can conduct the survey on customers’ expectation and try to satisfy them to stay in business and continue to be relevant in society.
The effective healthcare system requires adequately qualified and trained staff without which quality care is not feasible. While the government’s efforts to improve the skill of the people working in community pharmacy may be viewed as a measure to improve the services, it should not be used to make the unqualified persons qualified to obtain the retail sale license. Throughout the world, the minimum qualification to become a pharmacist is higher than India. Many countries including countries like Pakistan have adopted Doctor of Pharmacy (PharmD) as the minimum qualification to practice pharmacy. When we are not able to raise the minimum qualification to practice pharmacy like other developed countries, perhaps due to our socio-economic issues, let us not dilute the qualification further in the interest of public health.
(The authors are faculty, Department of Pharmacy Practice, Annamalai University, Annamalai Nagar, Tamil Nadu)