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Membership to be consulted on self-checking by technicians
The Council of the Royal Pharmaceutical Society is to consult the Society's
membership on whether it should relax its current recommendation that
non-pharmacists should not carry out self-checking of the accuracy of
their dispensing.
The Council had been asked to review its policy
by the Practice Committee, which, at its meeting in March, had considered
a draft document setting out guidance on developing and implementing standard
operating procedures (SOPs) for dispensing activities (PJ, March
24, p389). In a section on checking procedures, the guidance stated that:
(1) the SOP should be clear about which persons were authorised and competent
to check; (2) the procedure should include an accuracy check that should
wherever possible be undertaken by a second person; and (3) self-checking
by a non-pharmacist was not recommended. However, the committee had felt
that, so long as a professional check was always undertaken by a pharmacist,
the SOP should not preclude accuracy self-checking by technicians who
had been trained to carry out such checking and were competent to do so.
Considering the committee's request at its meeting
in London on April 3 and 4, the Council was reminded that, on the recommendation
of the February, 1999, “skill mix” report, it had previously agreed that
pharmacists should be required to have written SOPs for dispensing activities
in place by January 1, 2005, as part of the process to support clinical
governance in the pharmacy setting. Because of the need to involve other
pharmacy bodies, work towards this goal was being carried out through
the pharmacy sector committee of the Science, Technology and Mathematics
National Training Organisation, on which the major employers of pharmacists
and support staff were represented.
In consultation with the Practice Committee, the
sector committee had prepared a document giving guidance to pharmacists
on developing and implementing SOPs. This included a statement that self-checking
by non-pharmacists should not be recommended, which was in line with a
recommendation in the Society's skill mix report. However, because of
comments that there might be suitably trained technicians within the hospital
sector for whom self-checking might be appropriate, the sector committee
had specifically asked the Practice Committee to examine this matter before
approving a final draft of the guidance for wider consultation.
Mr CURPHEY (chairman, Practice Committee) stressed
that the matter was not about supervision. It was only concerned with
accuracy checking. Although it might seem clear that the current policy
should stand so far as community pharmacy was concerned, procedures in
the hospital service meant that the issue was not cut and dried. When
the consultation document went out to the profession, attention should
be drawn to the issue of self-checking so that the Society would gain
a genuine understanding of what the profession felt about the issue.
Mrs REMINGTON said that pharmacist self-checking
was a necessary way of working when working single-handedly. If checking,
as a task — a part of the overall dispensing activity — could be done
by trained technical staff, then there was no reason to prevent it being
done by them too in a self-checking process.
The pharmacist's underpinning knowledge base was
essential in confirming the safety and appropriateness of the prescription
for the individual patient. But label generation, product assembly and
labelling were separate and distinct parts of the dispensing activity
and, with training, all could be done by technical staff. If they were
competent at those tasks, then why draw a distinction between pharmacists
and technicians?
In the hospital sector, second checking of all staff
was the normal approach. In circumstances where double checking was not
feasible, as with on-call lone working or ward work, then self-checking
was required. Technicians were increasingly working at ward level, where
part of their role was to relabel patients' own drugs on admission or
stock medicines from the nurses' cupboard. Modernising the way they worked
within a risk assessment and competency based approach that took account
of necessary skills and knowledge required for any task, was exactly what
was needed to enable new systems of supply and care to be put in place.
Miss EWING supported Mrs Remington's remarks. Implementing
“Pharmacy in the future” and re-engineering the hospital service was impossible
without using technicians as self-checkers at patients' bedsides, particularly
to speed the process of discharge and to help the patient journey.
Mrs STONE said that, while Mrs Remington and Miss
Ewing could exercise a greater professional discretion and control over
their working environment, most pharmacists who dispensed for patients
were in the community setting, where trained support staff were sadly
still lacking. It was those pharmacists who would have to make the greater
attitude shift to adopt standard operating procedures.
Mr BURR said that real challenge was where the Council
saw the profession in the future. He saw the future of pharmacy as the
pharmacist being the person responsible for the appropriateness of the
medication. The profession did not have a future if it held on to the
idea that non-pharmacists would not do dispensing checking in the very
near future in community pharmacy. That held the key to how they were
going to deliver medicines management services and how they were going
to get pharmacists talking more to patients.
Mr Burr was keen to see standard operating procedures
putting the focus on key roles for the future. That meant that pharmacists
would have to let go of some of the things they had traditionally dealt
with.
Professor DAWSON felt it was important to differentiate
two problems: the first was to get the SOP document out; the second was
to review the question of checking. If the document made it clear that
the recommendation on self-checking was current policy but that it was
in need of review, then that might isolate the decision and generate sensible
discussion on the problem
Mr CURPHEY said that the Council's current policy
was that self-checking by non-pharmacists was not recommended, but several
had expressed the view that that was unsustainable. Therefore the Council
was being asked to change policy. Standard operating procedures were about
the future of pharmacy, not how it was at present. Mr Curphey thought
Professor Dawson's suggestion was a good way of tackling it.
The PRESIDENT felt that that was a way forward.
The notion of consultation was important.
Mr EMSON said that he had a great deal of sympathy
with what Mrs Remington had said, but there was a patient safety dimension.
He felt that an SOP with a check in the process was safer than one without
a check in the process. Therefore he was cautious about recommending anything
that encouraged the removal of a check in the process. He favoured the
proposal of Professor Dawson to maintain the status quo for the time being,
particularly in community pharmacy, because of the patient safety dimension.
If there was an opportunity for a check, Mr Emson said he would wish to
see that in an SOP rather than not. He would look for a way in which the
differences in hospital pharmacy could be incorporated without locking
them into a policy.
Mr DARLING said that the final responsibility was
important in any consultation document that went to the membership. As
Mr Burr had said, practice was changing and developing, and perhaps there
would be quicker changes in the future, but the final responsibility did
not move from the pharmacist. It had to be clear that the responsibility
for the patient's safety and well being in relation to medicines was that
of the pharmacist. Incorporating that sentiment into the explanatory documents
would be extremely important in helping the membership to move forward.
The PRESIDENT replied that the Council had had a
very useful debate. The feeling was that they would progress down Professor
Dawson's suggestion, picking up what Mr Darling and Mr Emson had said.
Future of Lambeth property
On the motion of Mrs Hoare, the Council agreed that
it would proceed to consider making policy on the future of its property
at Lambeth with regard to the public and membership areas.
Mrs Hoare said that her motion sought information
and assurances about changes that were taking place on several floors
of the headquarters building. The aim was to rekindle debate that would
lead to a policy on the future of the property at Lambeth. She would like
the Council to look again at the two development schemes it had received
in April 2000. One was an ambitious scheme that would not only maintain
the asset value of the property but also increase it. Both schemes included
elements that would generate revenue. But at the moment everything was
on hold while the Society recouped the expenditure it had made on other
initiatives.
The Council had also looked at alternative strategies
to raise funds to develop the museum. The museum needed to conserve and
display more of its artefacts — ideally in one place rather than spread
around the building.
There had also been a plan, once the President moved
into the new flat, to make the fifth floor area into a more useable and
convertible conference space that would generate revenue.
On the ground floor, several things needed to be
done in connection with security and reception. Most importantly the Society
needed to comply with legislation regarding access for disabled people,
who currently had no adequate means of reaching the basement or the library.
Mrs Hoare hoped the Council would now proceed to
make a policy so that it could identify areas for future income generation,
conferences and the role of the museum.
Mr ARGOMANDKHAH seconded Mrs Hoare's motion.
The SECRETARY AND REGISTRAR agreed that a plan was
needed for the future. However, because of demands from other priorities,
it had been essential to put the development project on hold. Nevertheless,
a great deal of information was available from which to plan for the future.
Current plans addressed the priorities outlined
by Mrs Hoare, including reception facilities, security and satisfying
the health and safety measures. There were plans to refurbish within budget
bearing in mind the vision for the future. Nothing was being done that
was inconsistent with that. The Council needed to develop an overall plan,
but it had to prioritise and should not be distracted into other projects.
Mr CURPHEY thanked Mrs Hoare for drawing attention
to the matter. The policy of 12 months ago had appeared to have disappeared
into a black hole. But the Secretary and Registrar had now reassured the
Council that all that was being done in the building was in accordance
with the plan. He felt that it would be useful if the Secretary and Registrar
could let the Council know what was going on on a more regular basis.
The TREASURER said that at the moment the Society
could not afford development on a grand scale but it would continue with
the ongoing refurbishment that had been built into the budget for 2001.
The PRESIDENT suggested that a quarterly report
on developments would help to progress Mrs Hoare's intention.
Mr DARLING expressed a belief that the work that
had gone on in the past 12 months had not just maintained the building's
asset base but had increased it. Continuing refurbishment was essential,
as was regular information. The next crucial step was to consider whether
the space occupied by the current President's flat could be incorporated
into the fifth floor to increase the letting potential of the building.
Mrs HOARE said that she was anxious that the Society
should not spend money that would be wasted in the future. The Council
should look towards a final vision with regard to the museum and at the
same time look at more innovative ways of raising money so that when it
was able to develop the building there were funds to fit out the museum
in the way that was wished.
Mrs Hoare's motion was then put to the Council and
was carried.
Concordance task force
The Council welcomed the Government's decision to
establish a task force to look at concordance in medicine-taking. In particular,
the Council welcomed the announcement of funding to support a project
team working under the direction of the task force from a base at the
Society's headquarters. The Council congratulated the Society's head of
pharmacy practice research, Dr Sue Ambler, for the work she had done in
promoting patient concordance.
The VICE-PRESIDENT said that the Society's involvement
in concordance went back to 1995 when, along with another partner in the
work, it had established a concordance steering group under the chairmanship
of Professor Marshall Marinker. The steering group, which included eminent
people from a wide variety of backgrounds and specialisms, had the aim
of inquiring into why half the people with serious illness did not use
medicines to the best effect.
A report published by the steering group in 1997
had had an immediate effect and had brought a fruitful partnership with
the Department of Health, which had resulted in the decision to set up
the task force specifically to look at how patients could be empowered
to take an active role in their own care. The Government was supporting
it by funding to the tune of £1.3m.
Special general meeting
The Council agreed that a requested special general
meeting of the Society should not take place until after the close of
voting in the Council election. A suitable date would be chosen and the
membership would be given at least two week's notice of the date.
The SECRETARY AND REGISTRAR reported that requests
for a special general meeting had been received from two members, Ashwin
Tanna and Philip Walton. Because of Mr Tanna's holiday arrangements, it
had not been possible to arrange the meeting early, and because Mr Tanna
was a candidate in the Council election, the Officers felt that it was
inappropriate to hold the meeting until after the election was completed.
It was felt that, as with previous special general
meetings, the meeting should be on a Sunday to enable those who wished
to attend to do so. It would be held at the Society's headquarters building,
which Mr Tanna had suggested would be able to accommodate the number of
people that he foresaw would attend. If necessary, the meeting would have
to be reconvened at a larger site subsequently.
PJ editorial advisory board
The editor of The Pharmaceutical Journal,
Olivia Timbs, informed the Council that she was close to appointing The
Journal's editorial advisory board. She had already approached a number
of people informally and would make formal approaches after the meeting.
Everyone on her list had been recommended by at least two separate people.
The recommendations had mainly come from the editorial staff but she had
also canvassed opinions elsewhere. It was not possible for the list to
be comprehensive because the team had to be small to be manageable, but
gaps could be filled by informal contacts.
Academy of Pharmaceutical Sciences
The Council approved proposed changes to the constitutional,
financial and management arrangements of the Academy of Pharmaceutical
Sciences that were intended to move the academy towards becoming financially
free-standing while retaining mutually beneficial links with the Society.
Professor DAWSON (chairman of the academy) said
that there were a number of key elements within the academy's proposal.
The primary one was to endeavour to run as a cost centre and take responsibility
for its own future. That was commendable. It would seek sponsorship to
manage some of its processes. It would seek to have a service contract
with the Society so that the services it took from the headquarters building
were accounted for and paid for, and the services that the Society asked
from the academy would be equally accounted for and paid for. There was
a synergy between the needs of the academy and the needs of the Society.
The proposals before Council were to support the
academy's plans, to ask the Director of Resources to negotiate the new
financial relationship with the academy, and to approve the changes to
the academy's constitution. The academy would seek a membership fee within
that; it would seek sponsorship; it would seek perhaps to take over some
of the residential courses that the Society currently ran from the scientific
and technical service unit. It was anticipated that, as it gained strength
and went forward, a revenue stream should come back from its operations
into the Society.
The academy would facilitate the Society meeting
its charter objectives in science. It had formally embedded that crucial
point in its proposed revised constitution. It had also incorporated the
provision of planning for the scientific half of the British Pharmaceutical
Conference, in conjunction with the Conference Science Chairman. The Conference
Committee needed the help of the academy. All who had attended the conference
over the past few years had seen a dramatic change in the quality and
the numbers of presentations — not just in science but also in practice.
That could and would be maintained.
The academy needed to stand on its own feet. It
had an annual general meeting later in the year to get approval from its
wider membership for the proposals put forward. The academy was keen to
progress, and Professor Dawson commended the proposals.
Asked what formal relationship there would be between
the academy and the Society, Professor Dawson said that two Council members
sat by right on the board of the academy. The Science Committee, by right,
had the chairman of the academy sitting on it plus the Conference Science
Chairmen for the current and following year [both of whom were selected
by the academy board].
In reply to a question about the academy's future
financial arrangements, Professor Dawson said that advice had been received
that the academy would be most appropriately constituted as a separate
legal entity. This meant that no residual risks would be associated with
the Society should the academy not achieve the success it expected. The
academy's financial support from the Society at the moment was in the
region of £25,000 a year. It was agreed that that would not increase without
just cause, and the academy would have to justify that, as any other budget
holder would. There would be ongoing dialogue to make sure that there
was no downside to the Society but that there was an upside of benefit
to both organisations.
Asked whether other Society groups could be treated
in the same way, Professor DAWSON said that the academy was a mix of pharmacists
and non-pharmacists, which had particular connotations. But the principles
of the proposals were sound and had the potential to be applied to other
membership groups, perhaps in whole or in part, as those organisations
developed.
Infringements committee
Practising while not registered The
Council agreed to refer to the Statutory Committee the case of a pharmacist
who allegedly had continued to practise after his name had been removed
from the register for non-payment of fees.
The Infringements Committee heard that the pharmacist
had been removed from the register on June 2, 1999, for not paying his
retention fee. In January, 2000, the Society had received information
that he had worked for a total of 74 days as a pharmacist after having
been struck off. A letter sent to him at his last known address had been
returned marked “Not called for” by the Royal Mail. In the absence of
any means of contacting him, no further action had been possible.
On December 22, 2000, he had contacted the Society
by e-mail, claiming that he had not practised since discovering that he
had been struck off but that he might wish to practise in the future.
During a follow-up telephone call, he had been told that he needed to
supply an address if he was to re-register.
On March 1, the registration section had received
a letter from him enclosing his retention fee and restoration fee. He
had duly been restored to the register, but a letter sent by recorded
delivery to the address he had given had been returned by the Royal Mail,
marked “Refused”.
Supply of EHC The Council accepted
a recommendation of the Infringements Committee that a warning letter
should be sent to a pharmacist who had allegedly failed to acquaint himself
with adequate information about non-prescription emergency hormonal contraception
before making a supply of a levonorgestrel product to an apparently distressed
customer.
The case had arisen from a newspaper report claiming
that the pharmacist had sold Levonelle-2, the prescription-only version
of the EHC product, to a girl who was aged under 16 years.
Committee members considered a letter from the pharmacist
from which they gained the impression that he had made a genuine attempt
to help someone who seemed to be in real need, who appeared to be aged
at least 18 years, and who claimed to have used EHC on a previous occasion.
The committee also noted evidence that the pharmacy's wholesaler had wrongly
supplied Levonelle-2 against an order for non-prescription Levonelle.
The committee was, however, concerned at the pharmacist's
admission that he had failed to study the Society's EHC guidelines (PJ,
December 16, 2000, p890). Despite that failure, he had gone on to supply
the medicine when there were other avenues of supply open to the “patient”.
Theft of pharmacy stock The Council
agreed to refer to the Statutory Committee the case of a pharmacist who
had stolen stock worth more than £60 from a pharmacy at which he was employed
as a locum. The Infringements Committee heard that Ginkgo biloba
tablets, Pharmaton capsules and Duracell batteries had been found concealed
upon his person during a search as he left the pharmacy premises after
his third day there. During a police interview he had admitted the theft.
He had subsequently received an adult caution.
Locum's errors The Council agreed
to make a complaint to the Statutory Committee about a pharmacist who,
while working as a locum, had allegedly made a number of dispensing and
labelling errors. It was further alleged that he had shown no concern
for patients' welfare, had sought to apportion blame to others and had
demonstrated no sense of professional responsibility. On the recommendation
of the Infringements Committee, the Council agreed that the Statutory
Committee should be asked to deal with the matter expeditiously and that
the pharmacist should be advised to cease practice.
Health Act Order
The Council approved a revised consultation document
on the reform of the Society's disciplinary machinery and the introduction
of competence-based practising rights.
Mr DARLING (chairman of the Health Act working party)
told the Council that responses to the consultation document (circulated
with The Journal of February 17), although few, had been extremely
good and constructive, and changes arising from the consultation were
in the revised document before the Council.
One change was intended to clarify the fact that
the proposals covered matters of professional conduct as well as competence.
Another change clarified the functions of the appointments committee.
A major item of comment had been the input of Council
membership to the various committees. However, it had been decided that
the document should not specify in detail the composition of the different
committees. Such details were more appropriate for inclusion in implementing
regulations, which could be amended in the light of experience, rather
than in provisions contained in the enabling Order.
Mr Darling hoped that the Council would approve
the document for submission to the Health Ministers, who would themselves
then issue a consultation document as they had done for the nurses and
the Health Professions Council.
Mrs REMINGTON said that she understood the rationale
for not specifying how many Council members would sit on different committees,
but her worry was that there might be no Council members at all. She suggested
adding a sentence to the effect that the investigating committee, appointments
committee and professional competence audit committee would include members
of the Council.
The Council agreed that the revised consultation
document, amended as suggested by Mrs Remington, should be submitted to
the Department of Health.
Revised Code of Ethics
The Council approved an amended version of the draft
revised Code of Ethics (PJ, March 10, pp325–332), taking into account
the response to the consultation exercise and the outcome of discussions
with the Office of Fair Trading. A final version would be published in
good time for it to be considered for approval by the annual general meeting
in May.
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