Opinion piece by Hervé JOUVES, 4 June 2024
Dispensing pharmacists are not just "medicine logisticians"
Unfair remuneration, medicine shortages: pharmacists in danger
The French healthcare system is suffering. The pandemic severely impacted all medical sectors and, today, pharmacists are no exception. Strikes, pharmacy closures (330 in 2023 and already 100 since the beginning of 2024) and the lack of recognition for the job illustrate a profession undergoing a crisis. Pharmacists have seen the scope of their public health tasks become increasingly broader, and this is something positive, but the time has come to structure these new responsibilities to support our pharmacies. Today, pharmacists are actively involved in vaccination and screening campaigns, and provide teleconsultation services. Despite this greater commitment, their remuneration is still inadequate and creates dissonance between the responsibilities taken on and financial reward. The new tasks they are entrusted with give rise to disparities in their remuneration. By assigning them with these broader roles, the French State makes substantial savings at the expense of the profession. For example, for a rapid diagnostic test or rapid antibody test, pharmacists are paid only 10 euro if the result is negative, whereas a medical consultation with a doctor costs 30 euro. Likewise, a vaccination costs 9.60 euro in total when carried out by a pharmacist and 60 euro when carried out by a doctor. An unbalanced financial situation, worsened by working conditions that are deteriorating due to a lack of staff and to pressure to remain open from Monday to Saturday. Pharmacies also have to bear the cost when it comes to procuring expensive medicines, which puts a strain on their cash flow. At the same time, the opening up of the online sale of medicines threatens to destabilize the network of dispensing pharmacies.
To round this all off, a double shortage is looming. First of all, a shortage of pharmacists (1,110 places remained unfilled in the second year of pharmacy studies in 2023). Lack of knowledge about the pharmacist profession and a general disinterest add to the complexity of the situation. The French PASS (health science specialization during the first year of studies) and L.AS (degree with a health sciences option) programme pathways are totally inappropriate and discourage our young people, while neighbouring countries (Belgium, Spain, Romania and Portugal) are filling up with French students who do not always return home once they have graduated. Secondly, a shortage of medicines, which is affecting us severely. The system is under considerable strain due to the decline in mature medicines, which are needed to finance pharmaceutical innovations, resulting in shortages of essential everyday products. As such, some 5,000 medicines (antibiotics, insulin, anticancer medicines, etc.) are currently out of stock. It is unacceptable that patientss pay the price for this situation, especially since we (France) are the 7th largest economy in the world and that health and healthcare are major concerns for us all.e puissance mondiale et que la santé est une préoccupation majeure pour chacun d’entre nous.
What solutions can we imagine for tomorrow?
If we want dispensing pharmacists in France to take back their rightful place as the first healthcare point of contact and to be considered at their true value as a key player in this revolution, we must enable them to regain their status as "Doctors of Pharmacy". Because, above and beyond their initial training (a minimum of 6 years of higher education), dispensing pharmacists also carry out a variety of healthcare tasks, which include primary care, prevention, screening, diagnoses, treatment, patient treatment management and follow-up, guidance as regards the healthcare system and the medical-social sector, and health education. It is therefore vital that the general public's view of the profession changes, so that confidence is renewed and skills are more widely acknowledged. A fair re-assessment of vaccination, screening and consultation procedures is also vital so as not to jeopardize the financial stability of pharmacies and to encourage pharmacists to expand their scope of action.
Furthermore, the French State is under an obligation to improve the security of supply of healthcare products to ensure the availability of medicines and guarantee industrial sovereignty over the longer term. It is also essential to reconsider the sales space in pharmacies to include spaces dedicated to healthcare (consultation, teleconsultation booth). The currently-tested OSyS (Orientation dans le SYstème de Soins (guidance in the healthcare system in France)) pilot must be rolled out on a nationwide scale with all its tasks to relieve pressure on emergency facilities and remedy the lack of doctors. We should also draw inspiration from practices that work for our European neighbours and gradually integrate artificial intelligence to become more efficient.
An ambitious plan for healthcare, without compromise
As a fervent supporter of healthcare for everyone, it is urgent for the French Government to become fully aware of the dysfunctions in our healthcare system and propose a realistic, ambitious plan. French citizens must be able to look after their health, without compromise. Every healthcare professional's commitment must be recognized at its true value and used to complement each other.
The French 2030 Healthcare Innovation Plan must herald a transition from curative healthcare to preventive healthcare, and the focus must be placed on 4P healthcare: personalized, preventive, predictive and participative. Pharmacists have a key role to play in this transformation, that of a sort of "marshalling yard", a sorting station, to detect and prevent illnesses before they require more extensive procedures and treatments.
We need to stop accepting this, it's time to take action!