Posted by: Mark Borthwick11 JUL 2018
There were signs of what was to come even before the collapse. With hindsight we can see the path we were treading, the conditions, circumstances and events that gave us glimpses of the coming disaster. Sharp rises in the cost of medicines, shortages of fundamental drugs, and a pervasive belief that a prescription was the standard outcome of a medical consultation.
Then came major stressors. Brexit and acrimonious trade wars between various economic blocs were bad enough, but it was a series of weather and geo-related natural disasters in the early 2020s that sent the biggest shockwaves through the world’s remaining fragile manufacturing capacity. Globally the supply of pharmaceuticals teetered, and then in 2025, totally disintegrated.
The world was plunged into a new reality and it is easy to imagine that the pharmacy professions would have simply been rendered obsolete. When medicine supplies slowed from a torrent to a trickle, what need was there for a pharmacy?
The truth of course, was pharmacy professionals didn’t ‘just supply’. Yes, some entrepreneurial pharmacists found ways of providing raw materials from backyard herb gardens, resurrected small-scale manufacturing and plugged some of the gaps. The impact of this was very welcome, and bespoke compounding expertise in high street locations became overtly valued. The far greater impact however, was that the pharmacist’s expertise was needed to gain every last drop of benefit from the remaining trickle in medicines supply.
‘Extreme clinical pharmacy’ was the only way to eke the most benefit out of the remaining resource. Pharmacists became the arbiters of who received a precious supply of medicines and who did not. A diagnosis no longer automatically generated a standard prescription, according to some protocol or other. Pharmacists would take the diagnosis, work closely with patients and come up with treatment plans embodying the greatest likelihood of success within limited resources. Deprescribing became an essential tool of practice.
Pharmacist-led follow-up was, and still is, of paramount importance. The consequence was that centralised shared record-keeping became the norm, to guarantee the provision of clear care plans easily available to healthcare professionals and patients alike. Pharmacists from the UK in particular, but also from North America and Australasia, were already recognised as world leading from a clinical standpoint and so their expertise was highly sought from around the globe. ‘Script Chambers’ sprang up to manage demand, becoming centres of expert medicines practice and acting as prescription-clearing houses before onward transmission and dispensing from fully automated distribution hubs.
A new lucrative trade emerged that centred on training the world’s pharmacists in medicines optimisation. This coveted expertise contributed hugely to the UK’s economy, and even now in 2039 is a significant replacement for the loss of the financial services sector two decades ago.
Nowadays wherever there is a medicine, there is a pharmacist. A full partner of healthcare, trusted by patients, valued by society and very much the aspirational career. Pharmacy is a profession whose symbol is no longer a big green cross, but a big green tick. What could have been a calamity, has become a salve.
Mark Borthwick, consultant pharmacist in critical care, Oxford University Hospitals NHS Foundation Trust.
Mark’s piece is the winner of our 2018 writing competition ‘Future Pharmacist’. He will receive an Amazon Fire tablet for his entry. Read more entries here.