Pharmacists may at last claim their rightful place in the health delivery landscape, thanks to the NHS plan. Jeremy Davies reports

The under-utilisation of the pharmacy profession has been part of the NHS furniture for so long that one might almost have expected the NHS plan to hoover round it.

But in truth, pharmacy got the full Milburn redesign and is about to be transformed into something shiny, modern and fit for the 21st century. At least, that's what Pharmacy in the Future: implementing the NHS plan would have us believe.

In a nutshell, there are two main strands to the government's plans (see box right). The first is to make better use of pharmacists' knowledge of drug therapies to make sure patients get the most out of the treatment they receive. The second is to harness technology to improve the efficiency of pharmacy bureaucracy, giving the NHS better value for money from the drugs it buys.

Broadly speaking, the profession has welcomed the plan. Beverley Parkin, head of public affairs at the Royal Pharmaceutical Society - the registration and continuing education body for Britain's 42,000 pharmacists - says the government's ideas closely reflect the society's aspirations.

Most pharmacists would happily sign up to moves towards a more proactive role in medicines management by, for example, helping to ensure patient compliance with drug regimes, monitoring dosages, greater involvement with repeat prescriptions and access to pharmacy advice separate from the supply of drugs.

But looking behind the headlines, pharmacists are under no illusion about the enormity of the job in hand.

'This is a huge cultural change, not just for the NHS but also for many pharmacists, some of whom have invested their life's work in the service and are now being told it's all got to change, ' says Ms Parkin.

GPs argue that evolution rather than revolution should be the name of the game.

'There is much in this document that we would be in favour of, and there's no doubt that pharmacists' role needs to develop, 'says British Medical Association prescribing sub-committee chairman Dr George Rae, a Newcastle GP. 'We already know that 50 per cent of patients are non-compliant with drug treatments.

Pharmacists could be a big help there. '

He wants to see a bottom-up approach: 'Local medical committees and pharmaceutical committees need to start talking to each other, and that takes time to bed in. And without wishing to sound like a Luddite, how are we supposed to make e-mailed prescriptions work properly, when we haven't even sorted out the electronic patient record yet?'

For pharmacy contractors - pharmacists who run high street pharmacies, which are also small businesses - the plan could pose serious threats. Like GPs, pharmacy contractors invest their own money in the buildings and infrastructure through which community pharmacy operates, and work to an item-of service based NHS contract which, even its strongest advocates agree, contains perverse incentives. Basically, it is not in contractors' financial interest to persuade GPs or patients to use drugs more rationally.

Under the plan, 'local pharmaceutical services' pilots will, subject to legislation, be set up to examine different ways to reward pharmacists for services hitherto not supported by the contract. There are strong parallels to the personal medical services pilots currently being promoted within general practice, and talk of the pilots has raised similar concerns about threats to independence and an increasing corporatisation of services.

The possible expansion in sales of over-the-counter drugs via the Internet, e-mailing of prescriptions direct from GPs to pharmacists and the development of pharmacies within 500 NHS-subsidised walk-in centres are also big worries for contractors.

'We believe the government should be building on the existing strengths of community pharmacy, like patients' accessibility to local services, 'says John D'Arcy, director of the National Pharmaceutical Association.

The government plans to invest at least£30m over the next three years 'to ensure that patients get more help from pharmacists in using their medicines'.

Three pilot sites for electronic transmission of prescriptions, each to run for six months, are due for approval in March 2001. Beyond that, detail on how the government plans to move its rhetoric into reality has yet to emerge.

Pharmacists wait with bated breath.