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Which? report
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Which? report
Scenario devisers are to be congratulated
From Mr B. Shooter, MRPharmS
In my opinion the Which? report into pharmacies was a robust test of
community pharmacists and their medicines counter assistants.
The pharmacists, and I assume that they were pharmacists, who devised
the scenarios are to be congratulated because one each focused on a current
problem associated with over-the-counter medicines:
• The “Malaysian diarrhoea” scenario illustrated the need,
hitherto unknown by me, for the 2WHAM questions to be 3WHAM for diarrhoea,
with the addition of “Where have you been?”.
• Should 75mg aspirin be taken prophylactically by healthy people? As
I see it the jury is still out on that, so “correct” advice
will be difficult to offer.
• Because of its interaction profile, we should treat St John’s
wort as a pharmacy medicine in spite of its widespread availability.
We have not up to now.
• Pharmacists should, and I am sure usually do, adapt their questioning
and advice to patients wanting to buy emergency hormonal contraception
according to the age and status of the woman concerned. Most married
women would object strongly to being counselled about sexually transmitted
diseases.
I am not sure that even my excellent staff would have passed in every
one of these four scenarios.
The use of mystery shoppers is now a common and useful monitoring and
training tool. It is used routinely by the multiples and we, as a profession,
should take full advantage of the strengths and weaknesses that our responses
have highlighted in the Which? report.
I use a firm with which I devise different scenarios every two months
and then it covertly makes test purchases from my staff and some of the
neighbouring pharmacies as a comparison.
The staff are aware of and have no objection to the process. The results
are used on a no-blame basis as the subject of either a one-to-one discussion
in the pharmacy or for a staff training evening at a local restaurant.
There are firms recommended by the National Pharmaceutical Association
that independent pharmacies can use. However it would be difficult to
test the pharmacist owner.
If there was a demand, perhaps the NPA could set up a pharmacist testing
service for those that require it, with the results coming back only
to the pharmacist.
Barry Shooter
Romford, Essex
Forty per cent of 84 pharmacies is disproportionate
Mr L. A. O. Lewis, MRPharmS
Let us put the Which? report into perspective and weigh the lessons
that can be learnt against damage to public confidence. There are six
million daily visits to 12,000 pharmacies. Does this not strike you as
a report with gross statistical disproportionality balanced against the
prominence that it was given in the news media?
I evaluated the report as published in the online magazine and, to my
dismay, there was more serious reprehension for the profession. In my
judgement there was a scanty attempt to patronise the Royal Pharmaceutical
Society’s measured response to the report. Which? suggested: “The
government must sit-up likewise and take notice, by investing more into
training and evaluation before putting more pressure on pharmacists,
by extending their role.” The report stated: “The role of
pharmacists is being extended. Our research shows they’re not up
to the job.” It added: “For a start, we found more than 40
per cent of pharmacies gave unsatisfactory advice, and often failed to
ask the right questions.” Are we to return to medieval times when
witches were burnt at the stake and apothecaries were the norm?
Should we not progress pragmatically to extend our professional roles
in order to make use of the scarce resources of the nation’s health
to benefit us all? Surely 40 per cent of 84 chemist visits is a disproportionate
figure, actually less than half of 0.0014 per cent ([84/6,000,000] x
100 per cent) of daily visits to pharmacies. Should we sit back and allow
such vituperation of our profession or speak out for the overwhelming
majority of pharmacists doing their best for the public daily?
Arthur Lewis
Bristol
The profession must embrace the findings
From Mr R. S. Patel, MRPharmS
I found the Which? report on pharmacies made for interesting reading.
Rather than slate such reports, the profession should embrace the findings
and formulate a strategic response to make sure that this type of disreputable
statistic does not lend itself to sceptics of pharmacy.
Whichever organisation a pharmacist works in, whether large or small,
the pharmacist is ethically obliged to serve the best interests of the
patient.
Clinical governance is “a framework through which NHS organisations
and service providers are accountable for continuously improving the
quality of their services and safeguarding high standards of care by
creating an environment in which excellence in clinical care can flourish”.1 It is about to become an essential part of the new pharmaceutical services
contract.
Clinical governance strategies incorporate personal development plans,
standard operating procedures, risk management, clinical guidelines and
clinical audit. In my view, had any of those pharmacies visited by the
Which? survey formulated and implemented a clinical governance strategy,
then the outcome would have been somewhat different.
The blame lies with our profession and that includes the Royal Pharmaceutical
Society, local pharmaceutical committees, individual pharmacists, pharmacy
proprietors and organisations. LPCs should be forced to push primary
care trusts into distributing funding available for clinical governance
implementation within pharmacies. In fact, the Government has earmarked
in excess of £2m specifically to implement clinical governance
in community pharmacy.2
I was surprosed at the Society’s response to the Which? report: “The
Society would welcome the opportunity to investigate these incidents
in order that we can offer the pharmacies involved the right help and
support to improve their levels of service.”
We do not want to see the Society giving a response of investigating
and helping only the pharmacies mentioned in the survey. It should look
beyond and plan a profession-wide response to address this issue. The
membership should demand money is reinvested in important areas, such
as clinical governance implementation rather than wasting money on bureaucratic
consultation documents. We should question the Society’s role as
a regulator (to which it attaches so much importance) since it should
be taking the initiative on performing such surveys instead of waiting
for outside consumer associations to criticise our shortcomings.
We all have a responsibility to deliver a first-class, patient-centred
service, regardless of for whom we work. Indeed this is the focus of
our code of ethics. If we fail as Which? has shown, then we do not deserve
to be given extended roles.
Rajive Patel
Superintendent Pharmacist and Director,
infoHealth Pharmacy Group
References
1. Clinical governance: quality in the new NHS (HSC 1999/065). London:
Department of Health; 1999.
2. Pharmacy in the future — implementing the NHS plan. London:
Department of Health; 2000.
Practice support may be a way forward
From Professor C. W. Anderson, MRPharmS
When considering our response to the Which? report, perhaps we should
look to the Pharmaceutical Society of Australia, which has changed from
providing traditional continuing education programmes to providing individualised
support consisting of workshops,
in-pharmacy support, peer networking, mentoring and pseudo-patron (mystery
shopping) visits.
Practice support is about colleagues assisting colleagues to embrace
change and develop professional services. The practice support programmes
assist pharmacists in a number of areas, including the “Pharmacist
only and pharmacy medicines programme”. This approach focuses not
only on patient data collection and drug therapy assessment, but also
on practical strategies for dealing with people at different levels of
readiness to interact with the pharmacist or assistant.
Research has indicated that when workshop training is followed by onsite
training through the use of pseudo-patron visits with immediate feedback
and coaching, educators can shape the practice behaviour. This forms
part of the quality improvement accreditation programmes provided by
the society. The response to this programme, which is not free of cost,
has apparently been good and nearly all pharmacists want to take part.
Claire Anderson
Director, Centre for Pharmacy, Health and Society,
University of Nottingham
The Society must be involved in future investigations
From Mr P. R. Scott, MRPharmS
Congratulations to Which?! Once again a bunch of journalists, whose
professional standing in surveys of the general public regularly comes
on a par with politicians and second-hand car salesmen, have proved to
their own satisfaction that visiting a pharmacy can “seriously
damage your health” and had their report publicised by more headline-seeking
journalists on national television and, no doubt, in national papers.
What I would like to know is whether or not Which? approached the Royal
Pharmaceutical Society to seek its co-operation in ensuring these checks
were carried out in an appropriate manner, which would, therefore, result
in any criticisms being valid.
The Society, and the overwhelming majority of the membership, have a
vested interest in ensuring that our collective standing with the public
is both well-deserved and not prejudiced by inaccurate reporting.
If the Society was not involved I hope it will mount a concerted media
campaign to make it known that it wishes to be involved from the outset
in any future “investigations” to ensure they are fair to
both the public and to the countless pharmacists who practise to the
highest standards.
I note 35 checks out of 84 “failed” to satisfy Which?. The
only two which were mentioned specifically referred to a supply of Levonelle,
where there did appear to be a prima facie case made that the standard
protocol of checks was not carried out properly. I hope the Society will
insist on being given details of all 35 examples with a view to “naming
and shaming”, if it is appropropriate. If the 35 conclusions were
flawed this should also be publicised as widely as possible.
Peter Scott
Broadstone, Dorset
The Society must help to combat the problem
From Mr S. R. Whelan, MRPharmS
I have just seen, with dismay yet again, the findings of the latest
Which? report into advice given by pharmacists. Although I am aware of
the faults in this type of research, I am saddened to see that yet again,
advice given by an albeit small number of our colleagues does not meet
the standard that the majority of us expect.
I would like to know what the Royal Pharmaceutical Society is doing to
combat this problem. There needs to be a better way of dealing with pharmacists
who are allowed to practise in this way, now.
Having seen all of the energy put in over the past six months in the
drafting and debating of the new Charter, I wish that the energy was
better spent getting the basics of pharmacy practice right at the patient
level. If we do not, then we can resign ourselves to the fact that we
deserve the MORI classification of “non-manual workers”.
Sean Whelan
Skipton, North Yorkshire
An unbelievable Society response
From Mr I. Abrahams, MRPharmS, and others
Naturally we are,together with all our colleagues, upset
to learn of the latest report by Which?, which appears to reflect badly
on a large
minority of our profession.
However, our sense of sadness and perhaps guilt (for it could be anyone
of us who stands accused) is dwarfed by the anger which we now direct
at David Pruce, a spokesman for the Royal Pharmaceutical Society.
He meekly accepts a guilty verdict for his members in a statement, which,
far more than the Consumers’ Association report, will cause the
public to view pharmacists with disdain. Why did he not challenge the
authors of the report on their methodology or accuracy of their clearly
subjective findings?
Everybody knows that the publishers of Which? would not be now licking
their lips if they had “found” only one or two failing pharmacists.
Any reasonable professional also knows that an actor arriving in a pharmacy
with “symptoms” will not give out the same signals as a genuine
patient and the examples quoted in the press leave many questions unanswered.
It is likely that there are some poor pharmacists out there, just as
there are some poor GPs and poor performers in every discipline, but
for the our own spokesman to have us all hung, drawn and quartered is
just unbelievable.
Ian Abrahams
Pinner, Middlesex
Derek Cane
Bushey, Hertfordshire
Howard Cohen
Edgware, Middlesex
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DAVID PRUCE, director of practice and quality improvement, Royal
Pharmaceutical Society, replies:
Which? is published by the Consumers’ Association,
an independent organisation that supports its work through the
sale of publications. The Society was not invited to have any part
in planning or advising on the research undertaken in pharmacies
although we were told about the headline findings in advance.
The sample of pharmacies surveyed may have been small but the fact
that poor advice was identified in nearly 40 per cent of scenarios
was clearly not something
that could be ignored. The public has a right to expect good service in a pharmacy
and our response emphasised the excellent service and first-rate advice that
the great majority of community pharmacies provide. We also pointed to the
evidence for the public’s satisfaction with and trust in their pharmacist’s
advice. We took issue with Which?’s claim that the survey provided evidence
to question the advice of pharmacists generally.
Throughout the life of this story, we were active in ensuring that the profession’s
view was aired across the national and local media. Our spokespeople — including
the President, senior staff and our branch public relations officers — appeared
on many television and radio programmes as well as featuring in press coverage.
Interestingly, the emphasis in several of the reports was more on the positive
rather than negative aspects of pharmacists’ services. Several broadcasts
used interviews with members of the public who generally had good things to
say about their pharmacist. We used the opportunity to promote the expertise
of pharmacists right across the media and several of the reports came over
as supportive of our position. Health Minister Rosie Winterton issued a statement
reaffirming the Government’s commitment to developing the role of pharmacists.
The Society now seeks to follow up this survey and investigate the circumstances
in which Which? says that poor advice was given to its researchers. We want
to review the scenarios Which? acted out, the criteria against which performance
was judged and the sampling methods used. We would like to work with the pharmacists
concerned to identify what may have gone wrong, support them in the improvement
of their practice and then share any learning points that arise more widely.
We have asked Which? to share its data with us so that we can proceed but have,
at this point in time, had no response to this request. We very much hope that
Which? will co-operate with us as is it is in everyone’s interest that
we should be able to support pharmacists in their practice. |
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