Be sceptical of the capitalists

Asda's own brand aspirins, a chemically identical product, are sold for about one sixth of the price of Anadin.

The pharmaceutical companies and the pharmacists are truly grateful that consumers are so illogical. Their stupidity fills the sellers' wallets nicely.

The impact of the abolition of RPM will be that the local chemist will no longer benefit from its subsidies and that pharmaceutical profits will decline.

Until the restrictive practices court decides otherwise, RPM is the law and any wicked price cutting by Asda and its rivals will be prevented by court injunctions. The price of Anadin and other over-the-counter products is set by an industry that regards competition as a threat to its very lifeblood. Remember, dear friends, capitalists are always and everywhere the enemies of capitalists.

Yet the industry is protected by patents and the pharmaceutical price regulation scheme. Mechanisms such as these give excellent (over-generous) rates of return. Is the industry's defence of RPM merely a manifestation of that old problem of greed?

The industry argues that RPM is an essential device because profits from the sale of over-the-counter products keep the cornershop pharmacists in business. Thus it is the 'duty' of the industry to protect the consumers' access to the pharmacist by keeping otherwise uneconomic pharmacies afloat. When self-interested capitalists say they are protecting consumers, we need to be sceptical and put our wallets in a safe place.

The main business of pharmacists is NHS dispensing. The over-the counter sale of RPM-protected pharmaceuticals is a nice little earner, but of marginal significance. If these earnings disappear the amount of public subsidy necessary to maintain pharmacy income, if this was an efficient policy, would be modest. But the public access objectives, when it comes to the distribution of community pharmacies, are an issue.

There are alternatives to company shops. For example, chronically ill people will increasingly have prescriptions made up by mail order.

The GP's receptionist will e-mail or fax the order, and the mail-order company will deliver to the patient's door. Many chemists already offer delivery services and these could be publicly subsidised as an alternative to RPM.

The access argument for the retention of RPM seems weak and the case for its abolition seems strong.

Abolition would allow Asda and its rivals to buy Anadin in bulk and offer discounts. Supermarket users would see a significant fall in the price of branded products as well as access to cheap 'own brand' products.

In addition to the drug industry's loss of profit, pharmacists might also lose out. RPM's abolition would add to the uncertainties associated with the practice of their valuable trade. This uncertainty needs to be managed carefully by the Department of Health.

Increasingly, GP groups are employing pharmacists. Their role will be more than the control of primary care drug budgets and the avoidance of inappropriate prescribing - after all, they know more about drugs than many (most? ) GPs.

Primary care groups could also be given permission to dispense. The big pharmacy groups, like Boots, might do this within a big practice.

The DoH should use the dispensing payments to achieve explicit access goals rather than vague policies. It should take account of the potential of ma i l order, the supply of vouchers for infirm people who want home deliveries, the efficient use of pharmacists and - that nice earner for GPs - practice dispensing.

With the requirement of demonstrable cost-effectiveness for inclusion in National Institute for Clinical Excellence practice guidelines - heralded meekly in the recent quality discussion document - the role of pharmacists may be enhanced, particularly if PCGs are developed effectively.

The fate of PCGs is now in doubt, however, due to health minister Alan Milburn's mistaken sell-out to British Medical Association trade unionists.

Instead of confronting the militancy of the GPs, as Nye Bevan did in 1947-48, he has meekly ceded power to these professionals, leaving them to undermine the creation of efficient management systems in primary care.

This cowardice may have produced a tranquil 50th anniversary celebration but may preserve gross practice variations in the 'primary care-led NHS'. Can the drug industry provide a pill for ministers who sacrifice efficiency for a quiet life?

Another move avoided by ministers is the development of an integrated workforce policy and appropriate incentives. While ministers contemplate increasing medical school intake, they ignore the 'scarcity' of nurses and the 'abundance' of pharmacists.

In time, the politicians may use scarce workforce resources better.

Until then, pharmacists will remain anxious about their post-RPM fate and our dear friends in the pharmaceutical industry will harvest these anxieties to oppose the abolition of the RPM system and keep the price of over-the-counter drugs artificially high. Strange old world, eh?

And another thing. . .

A reward of£50 is offered for the identification of the plonker who 'invented' waiting lists and waiting times as a pre-election pledge by Labour. Evidence (a pre-suicide confession note? ) will be needed to identify this sinner.

Prime minister Blur may augment this reward with a gong as no one will confess to him. As they say down in Whitehall village: 'It wasn't me, guv.'