Editorial: Pharmacy idea a hard pill to swallow

Go to a chemist these days and you are likely to be interviewed about your ailment before being introduced to a range of treatments on the shelf. In providing this standard of service the pharmacist is doing no more than we should expect, and no more than we receive from, say, wine shops and other specialised retailers.

Yet the Pharmacy Guild is now asking for public funds for providing more of this sort of attention for its customers. Citing pharmacists' role in the swine flu emergency, the guild is seeking to "incentivise" the contribution they make to public information and healthcare.

Health Minister Tony Ryall sounds sympathetic. Discussions are under way. "The new Government does think pharmacists can play a greater role in the primary healthcare system," he says. "Pharmacists already work closely with general practice ... They are an under-used resource."

Careful, minister. Your Government faces a recession with a deteriorating Budget deficit and a blowout of public debt that could take decades to reduce. This is not the time for additional service commitments that are not truly needed and which, once given, become politically difficult to remove.

The pharmacy lobby is proposing a classic case of "service inflation". With the right incentives, it says, it could provide private facilities for interviewing customers, monitor their progress, even make home visits to see that their diet and lifestyle was in accord with the treatment. All of that attention might be much appreciated, so long as it came at no extra charge. But do we really need it? The most reliable way to answer that question is to ask ourselves another: would we personally pay for it?

If there was a genuine need for this standard of care, chemists would not need public funding in order to offer it. They could advertise private consultations and case monitoring for those who could afford it. If the better-off found it worth the price, pharmacies might be able to make an argument in equity for the state to subsidise that standard of service for the rest. But they have not tried to ratchet up demand in that way and it is doubtful that they could.

Pharmacists already receive public funds for filling prescriptions. Their guild proposes that initially they be funded also for four additional services: nicotine replacement programmes, prescription compliance monitoring, dispensing the emergency contraceptive pill and helping patients manage their medication for chronic conditions such as diabetes, heart disease and asthma.

Each of these may be worthy projects but the Government needs to be careful it does not begin paying for services that good pharmacists already provide, or that duplicate the costly work of doctors, or that open the public purse for potentially much greater commitments.

Pharmacy is a privileged business, licensed to sell products that others cannot, and for too long it acted like one. Customer service was minimal. A business that behaves like that is ripe for deregulation and a few years ago Governments were asking why over-the-counter medicines could not be sold from any sort of store.

Supermarkets and others were keen. The additional competition from firms offering economies of scale would probably have lowered prices to the consumer.

Pharmacy interests strenuously lobbied for the retention of trade restrictions and won. Now they are beginning to offer the customer advice they promised. They are a valuable contributor to our health services but pharmacies should not need public incentives to provide a reasonable standard of care.