The Pharmaceutical Journal Vol 267 No 7172 643-649
3 November 2001

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Letters to the Editor

Supervision (4 letters)

Access to the pharmacist must not be compromised

From Mr D. L. Coleman, FRPharmS

I welcome the reopening of the debate on supervision. I find it hard to believe that the "bell and buzzer" still exist. I would have thought that the mandatory training of medicines counter assistants would have ended that archaic practice. But I do wonder at times whether regular checks are made to see that adequate training is carried out. I seem to hear too often that "there is no time".

The question being asked is on supervision, but is that the right question? Should we decide that supervision could be "remote", there would still remain the need for a pharmacist to be present at the pharmacy, partly for legal reasons. Controlled Drugs, for example, could neither be issued nor received in the pharmacist's absence. But more importantly, the pharmacist needs to be present to meet the reasonable expectations of the public.

In her paper, Helen Darracott says that the public want to be assured "that procedures for assessing and managing risk are in place and are followed" (PJ, October 20, p577). I think that most members of the public would prefer to have a pharmacist present when they enter a pharmacy, whether it be to ask someone to look at a nasty insect bite or for an urgent "morning after pill", or even to seek reassurance that the symptoms they are experiencing are not side effects of medicines or an incipient heart attack. These are all real people with real concerns who want face-to-face help at once from their pharmacist. Remote links via a third person and a telephone are not what they need. Other professionals, too, need to contact a pharmacist when a problem arises and easy access is important not just to the pharmacist but also to pharmacy records.

There is a need to have a pharmacist available to visit people at home and to undertake other activities away from the pharmacy. This need could surely be best met by a pharmacist working a set number of hours a day based at a local pharmacy to provide these services.

For a long time we have claimed that the pharmacist is the one health professional readily available to the public. That is a strength, and a fact appreciated by the public (often faced with growing waiting times to see a general practitioner). It is not something that should be compromised, whatever we decide on supervision.

David Coleman
North Walsham, Norfolk

Fundamentals are simple

From Mr R. B. A. Johns, MRPharmS

It may be that my age dictates the desire for simplicity in all aspects of life but, having attended the last special general meeting on supervision, I believe the fundamentals of the situation are unchanged since then, and are indeed simple.

Whoever bears ultimate responsibility for the outcome of the supply of a medicine, be it by dispensing or by over-the-counter sale, would be unwise not to assure himself or herself that the procedure has been carried out correctly in every particular; acceptance of that responsibility should be appropriately remunerated. Sadly, since that last SGM the lot of the community pharmacist seems to me to have been one of ever-increasing demands on his time (partly by the extension of supervision to include OTC supply) and ever-diminishing reward.

The ludicrous reality of OTC supervision is perfectly depicted in your cover picture on 20 October. It is clear that the assistant is showing to the pharmacist a medicine about to be sold, but what is the "off stage" pharmacist doing? Is he peering from a distance in order to read the name on the package, and then studying closely the prospective purchaser to assess whether that person can properly be supplied? Or is he, as I suspect, merely nodding his approval and getting on with his VAT return?

The essential point — and I realise this is a Utopian dream — is that if a medicine is thought suitable for OTC supply it should be totally free of potentially injurious characteristics that necessitate a pharmacist's advice. Conversely, if such characteristics are present, then the supply should be conducted under exactly the same conditions as those applicable to a dispensed medicine. And the logical conclusion of that is that all supplies of oral medicines, regardless of quantity, should be under the supervision of a pharmacist or medical practitioner. Yet it is still possible to obtain small packs (with little control over the number of them) from a newsagent or petrol-attendant. Need any more be said?

Richard Johns
Boston, Lincolnshire

Why a second pharmacist is needed

From Mr A. J. Hadfield, MRPharmS

I write in response to the article on supervision (PJ, 20 October, p577). I cannot believe the profession is still wrapped up in the ludicrous idea that a pharmacist can supervise or be in control of a pharmacy when he or she is not there. Pharmacists who do the job (and I mean properly) will know that running a pharmacy is a demanding job while on the premises, let alone on the end of a mobile telephone. How can one possibly counsel a patient without seeing them or assess a prescription without recourse to records?

I am often called by the surgery to speak to patients because "the doctor has gone home" or "the practice nurse is on her visits" or the whole place is shut for training. I am there, all the time, when the doctors ring, when district nurses call in for help, when the patients are stuck or ill. What is more, I am seen to be there: I am visible and available.

Some of my colleagues tell me I am a stick-in-the-mud, that I will stifle the growth of the profession, yet I still manage to work for one of the local surgeries half a day a week, I still visit my care homes and I still visit patients in their homes if they are struggling to cope with medication. How? I have a locum or part-time second pharmacist.

So there is a way forward: those roles to be undertaken in the pharmacy — medicines management, repeat prescribing, pharmacist prescribing — will be done by the pharmacist on site. The roles that require absence for more than a few minutes will be undertaken by a second pharmacist who will doubtless become more skilled in these activities with time and will not have his or her mobile telephone ringing every other minute asking the impossible.

It will take time and money and more well trained pharmacists to fulfil this scenario but it will work, it does work and it will not wreck or undermine the most valuable thing we have — the trust of the public.

Andrew J. Hadfield
Mottram-in-Longdendale, Cheshire

Now the genie is out of the bottle

From Mrs L. M. Godfrey, MRPharmS

The argument for the supervision of sales of medicines was lost when the Royal Pharmaceutical Society failed to prevent potent medicines from going on sale in every garage and corner shop in Britain. It is too late now to put the genie back in the bottle.

In the coming debate on supervision, the paramount issue must be the safety and protection of the patient.

Lois Godfrey
London W8

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