As I put the new boxes of escitalopram on my shelves I started to fume. The outer cartons were literally three times the volume of the old boxes. If ever something was calculated to incense me, they had succeeded. The same crowd had done the same thing with aspirin 75mg a few years ago. Pharmacists do not want large boxes taking up huge real estate in their pharmacies — size is money. It costs more to store big boxes of increasingly inexpensive medicines. Additionally, they hide more modest packages, adding incrementally to the daily cognitive burden. It also brings the greater question to the forefront; waste generation is already an issue about which we are extremely conscious. Aside from the cardboard outer, almost all the packaging in the pharmacy goes into landfill. It is simply unacceptable. There seems to be no environmental impact assessment in relation to placing medicinal products on the market. Other than Repak demanding their pound of flesh, nobody appears to give any thought to the amount of waste generated by a typical pharmacy. If you were to do some loose calculations it is obvious that the typical pharmacy is placing many tonnes of non-recyclable waste into the community every year. Again, this is very much a problem of the modern age. Up to maybe 30 years ago, the vast majority of medication was supplied in large wholesale packs. It is clear that the tablet counters are slowly being relegated into the dustbin of history. The clitter clatter of the tablets pinging their way down the chute has become less of a pharmacy background noise. There has to be a better solution for the environment.

Recently we were told that the PCRS has finally agreed that pharmacies can produce a unified claim form on an A4 sheet of paper. This has solved one pressing issue. The clickety clack of the receipt printer has been jarring our ears for the last 30 years. It is mind boggling that this receipt printer was ‘an interim solution’ until a proper electronic solution for patient verification was found. At the time it was envisaged that the new solution would be based on smart cards. Many of you may not realise that, at the time of the new pharmacy contract, there was a sum of half a million pounds allocated to improve pharmacy practice, which was all spent on these printers. And then some. It was interesting at the time to see how such a sum of money could be easily swallowed up. From memory, the printers themselves cost less than £200,000. The rest was swallowed up in consultancy fees for project managers, as well as customisation and delivery charges for the vendors. It was a great example of a cost expanding to fill the budget available.

Now we find ourselves in a situation where we have to bear the full cost of producing unified claim forms. Toner, ink and paper is not cheap. At a minimum, electronic receipts, avoiding waste, must become the norm.

The Budget 2025 announcement on HRT must surely go down in history as one of the great political stunts. A blatant appeal to a known voting demographic sector. While nominally a women’s health initiative, it is a bit of a head scratcher to see where the pressure points came to bear. My personal experience has never shown cost to be a barrier to access. While I am only one pharmacist, it is hard not to think that this would be most people’s view. So, you have to think that this is an initiative of the chattering dinner classes. It appears to be really something that hasn’t been thought through to any great extent, and it is hard to see how it is going to be implemented. One of the unfortunate lessons we took from the free contraception scheme was that bureaucracy triumphs intent every time. So, as doctors finally grappled with modern contraceptive regimes, the PCRS initially would not pay for prescribed doses, where they varied from the SPC. This negative, and costly, experience got me thinking of the edge cases for HRT.