politics

Electioneering

I'm after a soundtrack to this election day to get me in the mood, and its proving rather difficult. I think I may require your help- If you have any to add do let me know @SparkleWildfire. Oh, and no D:Ream please :)

Here's what I've scraped together so far:

Radiohead- Electioneering

Arcadia- Election Day. Worth it just for all that hair. 

Get Cape. Wear Cape. Fly - Daylight Robbery

Johnny Hobo and the Freight Trains- Election Song

And finally, one with a little bit of naughty language: 

Is pharmacy a good career choice right now?

I always wanted to be an archaeologist, growing up. I knew, however, that this was probably a pipedream- partly because I dislike creepy crawlies, but mostly because I was pretty sure in my childhood brain that everything interesting would have been dug up already by the time I was old enough to work.

Turns out I was wrong about that, but I’m still really proud of the profession I ended up in. I remember wandering up to the local shops with my Mum when I was little. We were talking vaguely about the future, when we had a little nose around the local chemist’s shop, cooing at the colourful bubblebaths and hairgrips that they had in stock.

“I know”, Mum said. “Why don’t you become a pharmacist?”

“What’s one of those?”, I asked. As far as I was concerned, the chemist’s shop was a place to buy cheap make-up and bath salts.

“Well, they stand in the back and mix up the medicines”. That’s it, I was hooked. I had images of brewing potions, mixing up gloopy ointments, and all sorts of stuff that, it turns out, in real life you only actually get to do for a couple of hours as an undergraduate. But my decision was made, and all the rest of my life I knew I was going to be a pharmacist.

As I got older, and I started telling people what I wanted to do, I used to hear nothing but positive things. I worked as a counter assistant in my local super market, and locums always used to tell me “You’ll never be out of work. Everyone is always desperate for pharmacists.”

At the time I graduated (2006), it still hadn’t been that long since the Great Pharmacist Shortage. This happened because the old style three year degree now became a four year Masters degree- so there was one year where no newly qualified pharmacists came on the scene. Everywhere you looked, people were crying out for a full time pharmacist to work for them. Whatever happened, you always knew that you could locum as a back up, and earn a good wage doing so.

As university went on, and I started applying for pre-reg places, I got worried. Not because I didn’t think I would get a place- in actual fact I was being courted by several companies, all of whom were clamouring to fill their pre-reg spots. I think I did maybe 10 interviews, and I got job offers from every one of them (and believe me, some of those interviews I was really quite atrocious in). No, I was worried, because I wanted to do my pre-reg in hospital, and I knew that pre-reg places really were limited in my local area- only 7 for the whole city.

I was lucky, and I got in. My year was really lucky, as it turns out there were enough jobs going for each of us pre-regs- though I actually went elsewhere. Whilst community pharmacy jobs were plentiful, hospital pharmacy was a lot more difficult to get a job in.

Nowadays, it has changed so much. I don’t think I can ever really hear myself saying the sort of things I was told to an enthusiastic school child now. “You’ll never be out of a job” would just simply be a massive lie.

When I was choosing universities, there were only a handful that actually offered pharmacy as a degree. In recent years there has been a proliferation of universities offering it now though, and as a result, the number of graduates is increasing year on year. I’m sure this isn’t the whole reason, but we have now reached a point where pre-registration places are becoming really hard to come by. There is a group of potential pharmacists, year on year, who will simply never be able to get a place anywhere.

So what does that mean? Well, you can’t register as a pharmacist, so you can’t work in your chosen profession. You’ve still got a Masters degree- but you’re actually pretty limited as to what you can do with it. Sure, its equivalent or better than a pharmacology degree, but you’ll always have a question hanging over your career, whatever you choose to do: “If you’ve got a pharmacy degree, why aren’t you a pharmacist?”. There’ll always be a slight, unfair, cloud of suspicion there. It means, even for those lucky enough to get pre-reg places, that jobs are more and ore difficult to come by, wages are being lowered despite responsibilities and workloads being higher, and locum shifts are both hard to get and pay an awful lot less.

Several places that I do locum shifts for have an email alert system for new shifts. On several occasions, I have received an email, checked my diary for my availability, then rang back immediately only to be told that all the shifts have gone already. The good thing that comes out of this is that, once you get your foot in the door, there is an incentive to work hard and become known as one of the best, most hardworking locums, because then you will get offered shifts first. The bad thing is that its now really hard to get that first step on the ladder.

How do we fix it? I have no idea, as it’s a multifactorial problem. A cap on the number of students studying pharmacy does seem logical, but that’s already been stamped upon by the Minister for Universities, science and cities Greg Clark MP, who has said:

Having considered the evidence I have decided that it is not necessary to introduce a specific student number control for pharmacy. The government's objectives for pharmacy can best be achieved outside of a number control system. It is the government's policy to remove student number controls wherever possible to enable students to have greater choice and to encourage universities to offer better quality courses to attract students. I believe pharmacy students can and should benefit from this reform and not be restricted. Therefore there is no need to consider further options for a pharmacy number control.”

It seems to me that the one thing that Mr Clark isn’t considering is those students. Yes, they might have greater choice, but I wonder, if asked, where their priorities lie- would they rather have more choice, or would they rather have some security in their future. I wonder if it has occurred to him to ask them directly.

So it is that I, and a number of other pharmacists, are sadly starting to discourage students from looking at pharmacy as a profession. Its through no fault of their own, and its brilliant that so many young people want to be pharmacists- but its hard out there, and its only going to get harder. Our bright young potential pharmacists might be better off opting for a less focused, vocational degree.

Hxxx

 

Prescription exemptions and the bloody Mail on Sunday.

Today, I feel ranty. So ranty, in fact, that I can't even think of a clever title for this post.

Why? because the Mail on Sunday has riled me up with this story about how pharmacies are failing to check exemption statuses of patients. I have been weak, dear readers, and I have allowed the Mail to affect my emotions.

As a pharmacist, my job is to make sure that patients get the right medicines, can use them safely, and have all the information that they need. My ultimate goal is to make sure that my patients stay as healthy as they can for as long as they can, and to improve their quality of life.

My role is not as a fraud investigator, but as a healthcare professional. Its up to the patient to ensure that their exemption is correct and up to date, and its up to me to ask to see proof of exemption, and to train my staff to do likewise. So that's what I- and many, many other pharmacies- do, day in, day out.

What if a patient says they don't have any proof of exemption? I go right ahead and give them their prescription anyway. What am I supposed to do? Say no, sorry, you can't have this inhaler until you go home and get your exemption certificate and bring it back to me. And then what happens when the patient has an asthma attack on the way back to the pharmacy, and without their medication dies? Funnily enough, I suspect newspapers like the Mail on Sunday would just as gleefully report on my failure as a pharmacist to supply life- saving medicine to a patient, and how I was just being evil and money-grabbing instead of thinking about patient care. So we are literally damned if we do, and damned if we don't.

Of course, we can cross the box on the back of the prescription, which means that a small, random selection of prescriptions may be investigated. But this process is pretty murky, and the details of it are unclear to the majority of patients, pharmacists, and pharmacy staff. We get little to no feedback of any cases which are identified as fraud through this method, so it ends up seeming pretty pointless. You spend years and years of dutifully crossing the box, and you never see it making any difference. Perhaps if this process were clearer, and we could more clearly see some results from it, this would spur pharmacists on to continue with the box ticking exercise.

Ever tried to confront someone about the fact that they may be committing fraud? Ever tried to do so over a counter, when you're working on your own and have a queue of about twenty people behind the person you are accusing? A pharmacy is certainly not the correct place for such things to happen in- the personal security of the staff, the workload, and the potential for a patient to have to go without their medicines all mean that its practically something that we cannot do well, without a massive overhaul of staffing and how pharmacies are designed.

I suspect the reporters at the Mail on Sunday haven't ever had to stand on one side of a pharmacy counter whilst a patient asks which of their medicines is the most important because they can't afford to buy all of them. I have, and its heart breaking. Prescription medicines in the UK are £7.85 right now. We're currently in a time when Atos are merrily declaring- sometimes on very shaky grounds- that people who are crippled by a variety of medical and psychiatric problems are fit for work, and are stopping their benefits. There are people out there who cannot afford to pay £7.85 per prescription item, through no fault of their own, and these are the people who are likely to be taking a variety of different medicines. Do I therefore withhold their prescription, or tell them which is the most important drug for them to take and send them off on their way with a sub-therapeutic drug regime that is going to make them even less able to work and find means of paying for their medicines? I can't imagine the hurt and shame that a patient must have to go through to admit that they can't afford their medicines, but I know I don't want to have to put an already unwell patient through that.

I've had a friend worry how he was going to pay for his prescriptions because of problems with his benefits, problems that he had no control over and were to do with mistakes at Atos. Do you know what I told him? Go to your usual pharmacy, tick the box, and don't say anything. I know that's wrong, but given the options: he becomes very unwell vs a small risk he gets a fine of £100 at a later date when he would hopefully be able to pay it, I'm sorry dear readers, but I'm always going to opt for the former. That may be, as the Mail so charmingly puts it "scandalously careless" of me, but it doesn't feel like it. It feels like I am caring for my friend's health, and that's my job, and my personality. What would feel "scandalously careless" would be to force someone with no income through no fault of their own to choose between food or essential drugs. 

Forgive me if I would rather give patients their drugs and keep them as healthy as I can. Do forgive me if I put the quality of my patients' lives ahead of the fear of prescription fraud, which I can do very little about anyway.

This whole system of exemptions and payment is outdated and needs an overhaul. In the meantime, branding pharmacists as lazy debt collectors and desperate patients as robbing prescription cheats doesn't help. As a healthcare professional, my need to provide vital medicines to my patients transcends petty demonisation by a scaremongering newspaper. 

Here's an extract of the Mail on Sunday's report:

 

"Dr Clare Gerada, chairman of the Royal College of GPs, called for a ‘fundamental review of prescriptions’. But a spokesman for the Royal College of Pharmacists said it was ‘not their job to police the Government’s prescription exemption system’, adding: ‘Guidance is very clear that pharmacists must put the clinical needs of a patient first, and not deny someone access to lifesaving medicines because they haven’t got proof of exemption."

Interesting, really, given that the "Royal College of Pharmacists" doesn't actually exist. This is lazy, crappy reporting, if they don't even bother to get the Royal Pharmaceutical Society's name right. You can read how the RPS have responded to this article here. Its a perfectly reasonable response, and in my opinion reflects what actually happens in daily practice.

Hxxx

What the Ancients did for me

I remember very distinctly one school trip from my days at primary school. I remember weeks of preparation as I helped my mum to convert a white bedsheet into a tunic, mum doing the sewing whilst i gave artistic and historical guidance, and I recall spending many hours lovingly painting a design of snakes and hieroglyphs along the hem. I remember in-depth discussions about the issue of my hair: a light shade of ginger simply would not cut the mustard on this occasion, and a wig of black, glossy tresses was constructed using an old headband and a bin bag. This was also the day that my lifelong love-hate relationship with eyeliner began. 

This wasn't just any old school trip. I was going to meet King Tutankhamen, and I needed to look the part of a genuine Egyptian to fit in, not to mention the fact that I had been practising for this moment for a while- I was known to have Ancient Egyptian days at home where I would wander around with an old gold necklace on my head declaring myself to be an Ancient Egyptian princess, whilst quietly cursing my more Celtic colouring and lack of servants, wealth, and ancient palace to live in. 

I was-and still am- utterly enamoured by the Ancient Egyptians. Nothing quite adequately describes the thrill of being faced with a sarcophagus or two on a museum visit. My favourite things to pore over for an inordinate amount of time are the smallest things, the charms wrapped up with mummies. Small, shiny trinkets that were so highly revered they were thought to have magical properties; it perhaps explains why I am so easily distracted by glittery shiny things to this day. 

My point is that this love of a culture so exotically distinct from my own was started in school. I have no recollection of history teaching in my primary school because memory is so bad, but I was left with a fascination of all things ancient and foreign, and that fascination still shapes my life today. Once I moved from primary school to middle school (do they even exist any more?), I can remember the thrill and excitement of starting a new subject in history, and all the possibilities it could bring. 'Ooh, the Romans!' I would think, 'there'll be people being eaten by tigers and stuff! Brilliant!' The Ancient Greeks, with their alarmingly modern gods arguing about the pettiest of things fascinated me back then and have continued to do so throughout my school and adult life. I remember a school librarian being somewhat alarmed by me dusting off and taking home the copies of The Iliad and The Odyssey to take home to read "just for fun" when obviously I should have been drinking cider on street corners instead. 

Why am I wittering on about this on a blog supposed to be about healthcare? Well, because I just happen to have been listening to a podcast discussion about Gove's proposed new history syllabus. I am very demonstrably not a teacher of young people, nor do I require any history in my daily life (nor do I actually have any idea about the details or practicalities of Gove's syllabus), but I think this may make me weirdly qualified to actually comment on this subject. Gove wants a more Britain-centric teaching of history: well guess what Gove: British history is frankly boring. Its also not particularly British, given that we are a mish-mash of Angles and Saxons. Sure, Harold got an arrow in the eye, but in the face of all that exotic otherworldly-yet-just-within-our-grasp excitement of the Egyptians, Moors, Romans and Greeks, any child in their right mind would be bored of this country's history. Not every child is going to end up a history scholar: the majority of them will, like me, end up in a job where they don't *need* any history. But the key is surely to get them to engage enough with the subject when they're young that they end up *wanting* it in their lives and seeking it out. 

So here's the thing: children at that age, before any prejudices of the state or the people surrounding them have properly kicked in, are open to and utterly interested by other cultures. When I think about it now, it would seem that my love for urbanity and multi-culturism has its roots in those days as a child learning about people different to myself. To instil some passion for history in children is to instil a thirst for looking deeper beyond surfaces and for searching for the hows and whys. It seems to me to be a real shame to politicise and manipulate this so it becomes focused on a narrower understanding of one country, and a series of dates. 

There's quite a high likelihood that none of this makes sense, given that its very early in the morning and I'm typing this on my iPod. Apologies for all the errors and/or fallacies and oversharing of my childhood geekery


Hxxx

Oh, and FYI: Elgin Marbles tour guide available to hire, for the mere price of train fare, London-based accommodation and a pint in that pub i like round the corner from the British Museum. I'm often vague on the dates and things like that, but apparently quite entertaining on the important bits. 

P.S. King Tutankhamen was very impressed with my outfit on that visit, and allowed me to do the demonstration of mummy-wrapping. I think it was the hair that did it. He was less impressed when one of the boys who had put decidedly less effort into his ancient styling kept demanding to know why King Tut had a Geordie accent and no sun tan if he was supposed to be Egyptian. 

PPS. Clearly when I was writing this I had forgotten about The Tudors. They were quite cool, particularly Elizabeth I. I still stand by my point though that British history just doesn't have the panache or history from further afield.