The Pharmaceutical Journal
Vol 268 No 7194 p543
20 April 2002

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  Supervision
  Checking technicians
  Drug-herb interactions
  NHS
  Community pharmacy
  Hospital pharmacy
  Prison pharmacy
  The Profession
  Wholesaling
  CPD
  Pharmacy practice
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  The Society

Letters to the Editor

Supervision

Practice must go beyond supervision

From Mrs H. St C. Remington, FRPharmS

Graham Phillips writes in Broad Spectrum (PJ, 30 March, p430) on supervision and skill mix and on the adjacent page in the same issue Sittal Patel writes a letter about the contrasting role of nurses and pharmacists in provision of necessary medicines. She wants role development and the facility to deliver best care to patients. Mr Phillips describes doing the same. I believe the message from Lambeth is in support of both their wishes.

The Royal Pharmaceutical Society supports the pharmacist in the community in the delivery of medicines management services. This is not some magical divide between prescription products and over-the-counter medicines. The law does, however, do that to us and so we are striving to achieve the public, Government and professional agenda in a new way of working, with new rules, and potentially new remuneration models.

As a secondary care pharmacist, I agree with the differential Mr Phillips poses, that we have little to do in the way of self care advice for the inpatient stay. Medicines management takes many forms and we all work clinically when we ensure that the patient gets the optimum treatment. The difficulty identified by Mr Phillips is how do we retain the best of the past and yet move on. There are doubtless many models that could work. Skill mixing work is one of them.

In the hospital service we employ one or two pharmacists within a whole team approach in the dispensary. The economies and efficiencies of scale clearly have a place. One way of working may well be to address this in the community, too. Where newly qualified staff team up with experienced pharmacists perhaps Mr Phillips and Ms Patel could both achieve the best solution. Time out of the premises would allow some of the new roles to be achieved or indeed practised in the community pharmacy, with clinics and chronic medication review, and, soon, supplementary prescribing. Staying alone, practising in the traditional manner will carry on in many places, too.

I disagree that Lambeth is divorced from practice. How-ever, it has a responsibility to offer leadership and vision of how pharmacy may achieve its core purpose of medicines management within the new National Health Service. The debate needs to be about how local pharmaceutical services can be moulded to deliver for the patient and for all the highly clinically qualified pharmacists coming out of preregistration training and becoming disaffected with "licking, sticking and pouring".

Ms Patel wants to have the facility and framework to do even more than the scenarios described by Mr Phillips, not less or even the same. In Lambeth, we have a responsibility to forge the means of meeting the old and the new. Both are still medicines management. I understand some, but I agree not all, of the pressures of immediacy, and limited released time from employing a skill mixed workforce. I suspect that mergers and changed service models must be embraced to move on. The Pharmaceutical Services Negotiating Committee has the responsibility for negotiating new ways of remunerating for changed models of working, and we need to learn how to make LPS work for everyone. Local PCTs have the opportunity to address these agendas and if we do not meet these challenges and find solutions then there is a risk that "supply" rather than "pharmaceutical care" will emerge, with real damage to patients' safe and increased access to medicines.

Pharmacy technicians have developed clinical work models in the hospital sector. Their role goes far beyond the supply role, too. Dispensing assistants, trained to the equivalent of NVQ 2 are now employed for assembly and associated supply duties. Many clinical technicians are employed in the primary care trusts, too. A team approach needs developing in all settings.

The Council of the Society recognises the accountability of the pharmacist in the process of medicines management. Supervision as a concept is only part of this, and today we must go beyond it if we are to achieve clinical governance in a real sense for patients.

Helen Remington
Chief Pharmacist, Addenbrooke's Hospital, Cambridge, and
Member of Council, Royal Pharmaceutical Society

Members' skills must not be eroded

From Mr I. C. Strachan, MRPharmS

The recent Broad Spectrum article by Graham Phillips (PJ, 30 March, p430) questioned the Royal Pharmaceutical Society's position on skill mix at the expense of our traditional roles. To propose change is simple; to sustain it, however, demands commitment and a following from others. But is our leadership in danger of playing fast and loose with a network that has earned public confidence for decades? Extending our roles is, of course, a sensible and natural aspiration, but not through eroding our status. It seems we are endeavouring to redefine our role in order to release time for medicines management, local pharmaceutical services and other collaborative initiatives. Why is the job I have undertaken for 15 years suddenly open to such condemnation?

I strongly oppose the protagonists who feel it appropriate to relax supervision as a currency for more corroborative integration with other health professionals. I acknowledge pharmacists are demoralised and demotivated, yet the only latitude we should exercise is to encourage delegation and refraining from the mechanics of dispensing. When additional roles are undertaken then the funding should be sought for locum cover.

For the record, I wish to remain in my pharmacy, offering advice to my patients, supplying medicines more effectively by means of positive steps to move POM to P. It is a role I relish, enjoy and, contrary to the view, find intellectually fulfilling. More importantly however, it offers a job description my customers respect and appreciate. Any future strategy for change must not commence by eroding the skills of its members, but through building strengths the community network has delivered.

Ian Strachan
Bury, Lancashire

Is the pharmacist legally responsible?

From Mr D. P. Phillips, MRPharmS

Has Andy Murdock hit the nail on the head (PJ, 6 April, p468)? Are there accountability differences between a superintendent pharmacist and a pharmacist? He obviously thinks not, but clearly in a court of law there is a difference. The tragic "peppermint water" case (PJ, 16 February, p228) highlighted this difference by the fact that the focus of attention was on the pharmacist and preregistration trainee rather than on the superintendent pharmacist. The superintendent, I presume, was not judged responsible because he was miles away at a different location and therefore not directly involved.

What if a similar fatal error occurred with a checking technician? The Royal Pharmaceutical Society says that the pharmacist is legally responsible. This may be so, but could not the pharmacist have a strong case in mitigation? The error would have occurred regardless of whether the pharmacist was present or not. Indeed he might just as well have been playing golf 50 miles away with the superintendent. Could not the pharmacist in defence question whether he is any more to blame than the superintendent? If this in anyway holds true, would not the focus of attention play heavily on the checking technician? A precedent has been set for this possibility in the "peppermint water" case.

Community pharmacists know they live in a blame culture and are keenly aware of litigation with regard to practice. I am not a legal expert but the issue of accountability and responsibility may not be clear cut. It is in the interests of both checking technicians and pharmacists to know where they stand. The letter from Mr Murdock, in my opinion, has done little to clarify the situation.

David Phillips
Market Drayton, Shropshire

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