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It is now over 12 years since the NHS (Pharmaceutical Services) Regulations
were last consolidated and the hundreds of changes spread across 20 or
so statutory instruments show that a revision is long overdue. The recent
changes in the GP contract have led to new medical services regulations
and I am led to wonder whether the new contract will spawn revised NHS
pharmaceutical regulations. If so, now is the time when we should be
looking at what we would like to see in them — after all, for the
community pharmacy sector these are the terms under which services are
provided to our biggest and most powerful customer.
Due to the hundreds of amendments the current regulations are practically
impossible for a busy pharmacist (or should I say chemist?) to comprehend.
In addition to this they are out of date and in some ways resemble standard
operating procedures, and certainly do not reflect the professional nature
of the NHS pharmaceutical service. Most worrying in my view, however,
is an inherent acceptance within recent drafting of the regulations of
a movement towards an employee profession — all without any prospect
of a representational body for employee community pharmacists. One part
of the regulations provides an interesting example of this.
The definition of a “chemist” within the regulations has
changed little since the foundation of the NHS. If we cut away the legal
jargon the term is currently defined as a person who is included on a
primary care trust or local health board list (in England and Wales)
as: a registered pharmacist, a person lawfully conducting a retail pharmacy
business or as a supplier of appliances. Put more simply this is a pharmacy
or appliance company owner.
The regulations then define a “pharmacist” as a registered
pharmacist (other than a supplier of appliances only) whose name is included
on a PCT or LHB list or who is employed by someone or a body corporate
who is so included — again, put more simply, this is a pharmacist
owner or employee pharmacist.
It is when these two definitions come together that the regulations appear
muddled. I use the word “appear” out of my genuine respect
for the legal draftsmen who could probably marry all the amendments together
and come up with clarification. I believe, however, that one of the most
important aspects in any changes to the regulations is to separate the
pharmacist who can provide pharmaceutical services to patients from the
pharmacy that can only sell those services.
The definition of the “repeat dispensing chemist” further
illustrates this point. The draftsman cleverly attempts to get around
the difficulty by “construing” rather than defining. The
regulations say that the term shall be “construed in accordance
with Regulation 16B(1)”. ‘Chambers everyday dictionary’ defines
the word “construe” as “to elucidate grammatically
or to translate literally or to interpret” — so that will
certainly open the doors for lawyers of both the barrack room kind and
their more expensive cousins. In this respect we could do worse than
to remember that some of the old health authorities interpreted the current
regulations in such a way as to enable them to attempt to refuse a “professional
allowance” where a pharmacist in charge had not completed the patient
medication records course.
In fact, Regulation 16(B)(1) is not helpful since, in essence, it says
that a chemist may provide repeat dispensing services if he is not a
supplier of appliances only, and (in England) is included in an approved
PCT or LHB list. Of course, that applies to the chemist not to the pharmacist.
The detailed requirements relating to the additional qualifications required
of the pharmacist are contained in the terms of service for chemists
where the chemist must employ a pharmacist with the required qualification.
If the public is to have continuity of service, unless the majority of
pharmacists are “qualified” for all the future roles, there
could be difficulties ahead.
When I registered, more years ago than I like to remember, my qualification
enabled me to provide a full pharmaceutical service. It seems that today,
despite five years’ training to master’s degree level, the
highly qualified pharmacist still needs to obtain additional certification
to keep PMRs, to give advice to owners of nursing homes, to undertake
medicines management, to dispense repeat prescriptions, to prescribe
and probably for every other role that emerges. I suppose that after
20 or so years of continuing professional development a pharmacist might
be able to do what I was permitted to on first registration. There must
be a happy medium somewhere but I am not sure that we all have the will
to find it.
To take a leaf from the CPD manual, what lessons do we learn from this?
· As one of the two principals in the arrangements, pharmacy owners
should take the lead and proactively look at the revision of the NHS
(Pharmaceutical Services) Regulations from the contractor standpoint
rather than just waiting for consolidation by the Department of Health
· Employees should be fully involved in any discussions
· Consultation, when it takes place, should be with the Department of
Health negotiators (pharmacy has had no input into others’ regulations)
· Pharmacists do not need additional training for all the new roles so
the requirements should be revisited
· Opportunities to take additional role qualifications should be provided
in the preregistration year
· There might be merit in splitting the regulations into two parts, one
for the contractor’s obligations, and the other a menu of pharmacist
skills (possibly linking to the new contract)
· Creeping (or piecemeal) change has not improved the position of pharmacists
over the years
· When revision takes place, IT should be used to keep the regulations
up to date
· Community pharmacists should decide whether they wish to be owners
of pharmacies, employees paid on the basis of time, or whether they would
be better selling their skills on a sessional basis
· Avoid being “bounced” by the Department of Health negotiators
into changing the terms of service into little more than standard operating
procedures for pharmacist employees |
The
Pharmaceutical Journal