DHMSA Course, Society of Apothecaries Saturday 21 March 2015 History of Pharmacy in Britain Stuart Anderson Centre for History of Public Health London School of Hygiene & Tropical Medicine 1

What does history of pharmacy cover? Development of the profession – Separation from medicine; – Emergence of pharmaceutical institutions. Location of practice – Pharmacy in the community; chemists’ shops; – Pharmacy in hospitals; prisons; military. History of medicines – Discovery, drug quality and safety; – Dosage forms, pharmaceutical technology; – rise of pharmaceutical industry. Transmission of knowledge – Education; Pharmacopoeias and formularies. 2

Outline 1.The Origins of Pharmacy before 450 AD 2.Very Early Pharmacy 450 AD to 1231 AD: Before the Edict of Palermo. 3.Early Pharmacy 1231 to 1617: Before the Society of Apothecaries. 4.Early Modern Pharmacy 1617 to 1841: Before the Pharmaceutical Society. 5.Modern Pharmacy 1841 to 1986: Before the Nuffield Report. 6.The New Pharmacy from 1986 to 2010: Before the General Pharmaceutical Council. 3

Origins up to c.450 AD 2000 BC- China, Shen Nung, wrote native herbal with 365 drugs, the Pen T’sao; 1500 BC- Egypt, Papyrus Ebers, 800 drugs; 300 BC- Greece, Theophrastus, father of botany, wrote about medical uses of herbs; 50 AD-Greece, Diascorides, Materia Medica, instructions how to prepare 500 remedies; 180 AD-Rome, Galen, defined drug as anything working on body to produce change. 4

Origins c.450 AD to 1231 AD 8 th century - Drug stores in Baghdad; 900 AD - Arabia, Rhazes, Liber Continens; c.950 AD - Leech Book of Bald, England; 1000 AD - Persia, Avicenna, Canon Medicinae; 11 th century - Pharmacy shops in Europe; 12 th century - medicines in Britain supplied by members of Guilds of Pepperers or Spicers. 5

Early Pharmacy 1231 to 1617 AD 1231 – The Edict of Palermo: – Clear distinction between responsibilities of physicians and apothecaries; – Applied to Sicily and southern Italy. 1490s -Guild of Grocers includes traders in drugs and spices – Nuevo Receptario (formulary); 16 th century- apothecaries emerge as significant group within Guild of Grocers. 6

Early Modern Pharmacy 1617 to – Society of Apothecaries founded; First London Pharmacopoeia 1618; Period characterised by a series of disputes between physicians and apothecaries; 1701 Rose Case: confirmed right of apothecaries to treat patients but could only charge for medicines; 1700s-Emergence of chemists and druggists; 1815-Apothecaries Act: confirmed apothecaries as general medical practitioners. 7

Pharmacopoeias London Pharmacopoeia: 1618; 1621; 1632; 1639; 1650; 1677; 1721; 1746; 1788; 1809; 1824; 1836; 1851 (thirteenth and last). Edinburgh Pharmacopoeia: 1699; 1722; 1735; 1744; 1756; 1774; 1783; 1792; 1803; 1805; 1817; 1839; 1841 (twelfth and last). Dublin Pharmacopoeia: 1807; 1826; 1850; 1856 British Pharmacopoeia: 1864; 1867; 1885; 1898; 1914; 1932; 1948; 1953; 1958 (5 years). 8

Frontispiece of London Pharmacopoeia

Modern Pharmacy 1841 to Foundation of the Pharmaceutical Society of Great Britain; to the professionalisation of pharmacy to beginning of the welfare state; to National Insurance to National Health; to Pharmacy in the NHS up to publication of the Nuffield Report. 10

Jacob Bell

Foundation of the Pharmaceutical Society of Great Britain 1841: Aims To benefit the public, and elevate the profession of pharmacy, by furnishing the means of proper instruction; To protect the collective and individual interests and privileges of all its members, in the event of a hostile attack in Parliament or otherwise; To establish a club for the relief of decayed or distressed members. 12

Registration of pharmacists Pharmacy Act 1852: – Registration of pharmaceutical chemists; – Register kept by Pharmaceutical Society (not Pharmacy Board); Pharmacy and Poisons Act 1868: – Additional register of Chemists and Druggists; Separate Registers continue to 1954; Registration of pharmacy technicians; Separate Pharmacy Board (GPhC) in

Pharmaceutical Society v. The London and Provincial Supply Association 1880 The origin of chain pharmacy or multiples Pharmacy and Poisons Act 1868; Act referred to ‘a person’; case tested whether restrictions applied also to a company; 1878 sale of Oxalic Acid - £5 fine; Business converted to a limited company; Challenged – unlawful sale of poisons; House of Lords: A company can carry on a pharmacy business provided a ‘qualified person’ is employed for the sale of poisons. 14

Multiples in Community Pharmacy 15

16 Jesse Boot (Lord Trent)

17 William Glyn-Jones

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The Growth of the Welfare State: National Health Insurance Act th Century – Friendly Societies; Poor Law institutions; National Health Insurance applied to workers aged over 16; Less than £160 pa; Dependants not covered, but received support payments; Included costs of medicines. 19

Pharmacy’s Seven Principles 1. No agreement for supply of medicines should be made except with a person, firm or corporate body entitled to carry on the business of a pharmaceutical chemist or chemist & druggist; 2. Dispensing under the Act should be done under the direct supervision of a pharmacist; 3. The control of medical and pharmaceutical services to insured persons should be in the hands of the county insurance committees, NOT under the control of Friendly Societies; 20

Pharmacy’s Seven Principles (con’t) 4. A panel of all qualified pharmacists in a particular district willing to supply medicines under the scheme should be set up; (no registration); 5. Remuneration for pharmacists should be on a scale system, and not on a per capita basis; 6. Pharmacy should be represented on the county health committees, the advisory committees, and the Insurance Commission; and 7. Medical benefit should not be extended to persons earning more than £160 per annum. 21

Impact of National Health Insurance on Community Pharmacy 1913 Distinction made between prescribing and dispensing for first time; Salaried service for dispensing National Insurance prescriptions rejected; Companies as well as proprietors able to contract to provide dispensing services; Within one year number of prescriptions presented at pharmacies had tripled. 22

Pharmaceutical Society v. Jenkin 1920 Proposed Joint Industrial Council to regulate wage rates and other conditions of service; Opposed by Boot and Scottish pharmacists; Arthur Henry Jenkin – injunction; Judgement: ‘the Society does not have powers to regulate wages, hours of business, prices, or provide insurance or legal services’; Retail Pharmacists Union; 1923 – Guild of Public Pharmacists. 23

‘Redefining Purpose’ 1920 to 1948 The Pharmacy and Poisons Act 1933: – Membership of Pharmaceutical Society compulsory; – Inspection of premises; – Statutory Committee; – Statement upon Matters of Professional Conduct ‘the triumph of professional regulation over protection and trade unionism.’ 24

National Health Service Act 1946 Implemented 5 July 1948; Services available to all; - Unemployed men, women and children. Free at time of need; - National Insurance contributions + taxation. Free medicines; - prescription charges introduced

Impact of National Health Service on Community Pharmacy 1948 Prescription numbers virtually quadrupled from 70 million to 250 million per year; Existing shop floor space used to enlarge dispensaries; Dispensing of prescriptions becomes principal source of income & main business; Most pharmacists undertake dispensing themselves. 26

Pharmaceutical Society v. Dickson 1965 Attempt to control ‘non-professional’ business; Society proposes that new pharmacies: – be situated in physically distinct premises; – confine their trading activity to the sale of pharmaceuticals, professional and ‘traditional’ chemist’s goods (toiletries, cosmetics and photographic items). 27

The Dickson Judgement 1965 ‘it is not within the powers of the Society to enforce the provisions of the motion; the said provisions are in restraint of trade;’ 1965 Court of Appeal confirmed decision; 1968 House of Lords: ‘not within the Society’s main object of ‘maintaining the honour and safeguarding and promoting the professional interests of members;’ Society did not have power to control commercial aspects of pharmacy. 28

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‘Disappearing Pharmacist’ Pharmacist ‘hidden’ in dispensary at back of shop dispensing prescriptions; Only emerges when asked to do so; Becomes ‘normalised’: new entrants see role of pharmacist as ‘backroom’ person; Nature of dispensing changes: reduced need of extemporaneously prepared medicines. 30

British Pharmaceutical Conference 1981 ‘one knew there was a future for hospital pharmacists, one knew there was a future for industrial pharmacists, but one was not sure that one knew the future for the general practice pharmacist.’ Dr Gerard Vaughan, Minister of Health 31

The New Pharmacy 1986 to to the emergence of the ‘new pharmacy’; – Creation of General Pharmaceutical Council; Royal Pharmaceutical Society becomes Professional Leadership Body; RPS establishes Faculty; 5.Beyond 2013–transition or transformation? 32

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The Nuffield Report 1986: Terms of reference ‘to consider the present and future structure of the practice of pharmacy in its several branches and its potential contribution to health care and to review the education and training of pharmacists accordingly’ 34

The Nuffield Report 1986: Recommendation ‘we believe that the pharmacy profession has a distinctive and indispensable contribution to make to health care that is capable of still further development’ 35

Department of Health and pharmaceutical profession Joint Working Party 1990 Terms of reference ‘to consider ways in which the National Health Service community pharmaceutical services might be developed to increase their contribution to health care; and to make recommendations’. 36

‘Pharmaceutical Care: the Future for Community Pharmacy’ 1992 increasing the range of medicines available for sale by pharmacists; the maintenance of patient medication records by pharmacists; the extension of needle and syringe exchange schemes; participation in health promotion campaigns; having separate areas for providing advice and counselling. 37

Pharmacy post-2010 Regulatory and representative functions of Pharmaceutical Society separated; General Pharmaceutical Council established 2010; Professional Leadership Body set up; ‘akin to a Royal College?’ Voluntary Membership; Role of other pharmacy organisations; Transition or transformation? 38

Conclusions: Change Shift to be more accessible to public; First port of call; Extended role as skill substitution; Taking on roles previously undertaken by doctors; De-regulation of medicines; Move towards pharmacist prescribing. 39

Conclusions: Continuity Ready accessibility throughout community; Available during normal shop hours; Accessible without appointment; No charge for advice; Supply of low cost medicines. 40

Themes in Pharmacy’s History Conflict over professional boundaries; Changes in how society defines harmful substances; Tension between pharmacy as trade and pharmacy as profession; Shifts in remuneration arrangements; Shift from product focus to patient focus. 41

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