HIGH street pharmacists are a vital element in the new front line of the public health care system. Along with the growing number of group practice nurses, physiotherapists, and even NHS 24 helplines, they help take the strain of routine queries and minor diagnoses from the shoulders of overworked GPs. The professional chemist can now assess and medicate, deal with repeat prescriptions and remove some of the frustration for patients created by the necessity in most doctors' surgeries of waiting for appointments on crowded schedules. They also play a key role in providing medical cover on public holidays and at weekends. Many are employed by large chains which ensure the maintenance of high professional standards and common working practices. A considerable number of Scotland's 1200 pharmacies are, however, one-man or -woman operations or part of smaller groups. Though equally qualified and experienced, their businesses may depend more on unskilled labour for the routine of day-to-day shop service. Thereby hangs the potential rub.

HIGH street pharmacists are a vital element in the new front line of the public health care system. Along with the growing number of group practice nurses, physiotherapists, and even NHS 24 helplines, they help take the strain of routine queries and minor diagnoses from the shoulders of overworked GPs. The professional chemist can now assess and medicate, deal with repeat prescriptions and remove some of the frustration for patients created by the necessity in most doctors' surgeries of waiting for appointments on crowded schedules. They also play a key role in providing medical cover on public holidays and at weekends. Many are employed by large chains which ensure the maintenance of high professional standards and common working practices. A considerable number of Scotland's 1200 pharmacies are, however, one-man or -woman operations or part of smaller groups. Though equally qualified and experienced, their businesses may depend more on unskilled labour for the routine of day-to-day shop service. Thereby hangs the potential rub.

It makes eminent sense to allow pharmacists to access the NHS patient records they are requesting for many good and valid reasons. The most important is to ensure prescribed drugs do not clash with other forms of medication of which the chemist may be unaware at the time and point of issuing pills or potions to an individual. In this, the pharmacist is the last line of defence against mixing potentially lethal combinations of otherwise beneficial drugs. But patient records also contain a great deal of personal information which might, if leaked, be useful in a commercial sense to drug manufacturers assessing new product lines or marketing strategies. It would also prove a money-saving bonanza for life insurance companies if they could obtain a discreet but detailed medical background on clients applying for cover, or to financial institutions assessing clients for the security of loans. On a simpler but no less important stage, allowing potentially unfettered access to the medical history of individuals within small communities might prove embarrassing and psychologically damaging if it then became the subject of gossip.

The key to all of it would be guaranteeing the security of the records and effectively restricting access to them. At the moment, the patient has the right to insist on seeing his or her own records. Doctors and practice nurses and medical staff in hospitals to which the individual might be referred are obviously also on the list. While no system is perfect, the existing caveats on viewing personal details seem to work reasonably well. Expanding the list of those eligible on computer networks, which are by their very nature insecure, takes confidentiality into a whole new sphere. Some rural communities have already expressed concern. It is the legitimate worry of people living in small towns or villages that their most intimate medical secrets might be exposed inadvertently or viewed by junior pharmacy staff who know them but are not directly involved in their treatment.

Widening access to a database containing information as personal as medical records makes absolute sense in purely logical terms. The argument hinges now on whether averting a few preventable deaths justifies what might result in larger breaches of personal confidentiality.