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· Which? report
· Community pharmacy
· Branded generics
· Open-plan dispensing
· Value added tax
· CPD
· The Society
· The Journal
Letters to the Editor
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Which? report
We cannot shift responsibility away from the pharmacist
From Ms G. Ames, MRPharmS
I was surprised to read your leading
article “Which? hunt” (PJ,
7 February, p142). The suggestion that if the patient is known to his
or her local pharmacist, the quality of service provided would be higher
is rubbish. That statement is a weak excuse for incompetence. The whole
concept of community pharmacy is our easy availability to the public.
Anyone should be able to walk into our pharmacies and obtain good advice.
Our pharmacy assistants are supposed to be trained to ask patients the
initial, relevant questions and to refer them to the pharmacist when
necessary. However, your article would have us believe that the onus
of responsibility for imparting that information lies with the patient,
not with the pharmacy staff. Are we to understand that the general public
have somehow educated themselves to a degree that they can now comprehend
their condition sufficiently well as to apprise the medical profession
without being prompted? My training and that of the counter assistants
has always been that we are to be proactive and thorough in our questions
to the patient in order to understand the condition described. On numerous
occasions I have questioned patients who, for example, emphatically deny
taking any other medicines. However, after the third or fourth time of
asking (in different ways), a realisation dawns and the patient states: “Oh
yes, I am taking some of those. Is that what you mean?”
Yes, patients do have a degree of responsibility to impart the information
sought but we cannot shift the onus of responsibility away from the professional,
who knows what questions to ask and appreciates the significance of the answers.
It is clear from the Which? report that the pharmaceutical profession is not
ready to embark on all the new initiatives that the Royal Pharmaceutical Society
and the Government are keen we should. High dispensing levels and often cramped
conditions in our retail premises has put enormous pressure on pharmacists.
I accept that the profession must move ahead into new areas, but it should
not be at the expense of essential services currently available.
Geraldine Ames
Stroud,
Gloucestershire
Let us move away from the blame culture
From Dr M. C. Watson, MRPharmS
The Royal Pharmaceutical Society has asked Which? to identify the pharmacies
that were visited for their recent report “Can your pharmacist
cope?”, their purpose being to “help the pharmacies visited” not
for “punitive” reasons (PJ, 14 February, p198). Although
it makes uncomfortable reading to learn about the inappropriate outcomes
of the covert visits made during the study, the Society’s reaction
in wishing to seek out these pharmacies is cause for even greater discomfort
and suggests that it is missing the point. The problem will not be resolved
at a pharmacy-level: organisational changes are required.
Currently, within the NHS there is an increasing focus on risk management
and improved patient safety. A key theme of enhancing safety and minimising
risk in high risk activities such as the provision of health care in
general, and the supply of non-prescription medicines in particular is
the emphasis on the process that generates the risk or error, not the
individual.1 In this case, it is the process of supplying non-prescription
medicines in general and not the individual pharmacy or member of staff
with whom the Which? “patient” consulted.
In order to progress, we need to move away from blame culture and to
start looking at the bigger picture. If the public is to have confidence
in the supply of non-prescription medicines and advice from pharmacies
we need to think about radical changes in the activities of community
pharmacists and their staff. Time and again we hear of pharmacists remaining
in the dispensary while the least-trained members of staff are involved
in the riskiest activity, ie, supplying the medicines. Either pharmacists
need to move out to the counter or the people behind the counter need
further training to equip them with the skills and knowledge necessary
to ensure the safe and effective supply of non-prescription medicines.
Organisational changes are required to provide pharmacy support staff
with regular ongoing training to ensure that they are equipped to deal
with customer requests and needs.
Training solely to enhance knowledge is not enough.2,3 There are many
barriers, other than lack of knowledge, to the supply of non-prescription
medicines from pharmacies: inadequate communication skills, lack of protocols
(eg, which patients, products and symptoms to refer to the pharmacist
or GP), and adverse customer/patient response all reduce the likelihood
of achieving ideal outcomes with consultations.
The Society’s time would be better spent addressing these issues
rather than trying to identify the pharmacies that generated the less
than favourable outcomes.
I am currently investigating these issues as part of an MRC fellowship: “Identifying
optimal strategies to promote the evidence-based supply of non-prescription
medicines from community pharmacy”. I would welcome comments or
suggestions from community pharmacists and their staff or, indeed, the
Society on possible solutions to the problems discussed above.
Margaret Watson
Department of General Practice and Primary Care,
University of Aberdeen
(e-mail m.c.watson@abdn.ac.uk)
References
1. Reason J. Human error: models and management. BMJ 2000;320:768–70.
2. Watson MC, Blenkinsopp A. Pharmacy support staff need ongoing training
if goals are to be realised. The Pharmaceutical Journal 2003;271:738.
3. Watson MC, Bond CM, Grimshaw JM, Mollison J, Ludbrook A, Walker A.
Educational strategies to promote evidence-based community pharmacy practice:
a cluster randomised controlled trial. Family Practice 2002;19:529–36.
Society should have called for Government investment
From Mr J. Andrews
As a preregistration trainee I am disappointed with the Royal Pharmaceutical
Society over its inadequate reaction to the Which? report, the findings
of which are a blow at a time when the profession should be seen as a
source of excellent service and reliable advice concerning all aspects
of health care.
Calling for proper support and investment from the the Government, and
stressing that the results were not a clear representation of the profession
as a whole would have been a good start for the Society. Now the opportunity
has gone.
James Andrews
Guildford, Surrey
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