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Malcolm Almond is a community pharmacy locum from
Brighouse, West Yorkshire
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A presentation of workforce statistics to the October 2004 meeting of
the Royal Pharmaceutical Society’s Council has raised questions
about the position of freelance locums as proposed changes to practice
evolve.
In 2003 there were 8,500 locums on the Society’s Register, 5,000
of whom were part-time. With 2,200 of these over retirement age and 400
aged between 50 and 64 years this leaves the community pharmacy workforce
vulnerable in the short term. With the introduction of continuing professional
development and the abolition of the part-time registration fee, many
might leave the Register over the next few years.
Some will remain registered for one more years in the hope that they
can influence events at Council elections. They will have been encouraged
by what has happened with the new Royal Charter and the influence of
the voter upon it.
Others will continue to work as before until they see what the impact
of CPD is going to be. They may well decide that remaining on the Register
is not worth the hassle.
It is easy to see how thousands of locum pharmacists might be lost over
the next five years.
However, it is not just changes to the Register that are going to have
an influence on locums. The launch of the new community
pharmacy contract in England and Wales this month (and in Scotland next April) will have
a greater impact because some compulsory changes in practice are likely
to make the community pharmacy locum feel uncomfortable with the systems
put in place.
Standard operating procedures
As part of the audit and clinical governance process, pharmacies have
to put in place standard
operating procedures which will be put under
close scrutiny now that the new contract has gone live. What will happen,
however, if a locum arrives for work and is not happy about the procedures
that have been adopted?
More experienced pharmacists have spent many years in practice and
are comfortable with the final checking system. It is a system that
has been
tried and tested over many years by thousands of pharmacists and has
a good record as regards the low level of errors and complaints.
In future, standing operating procedures may well be in place which give
more responsibility to technicians. There is no doubt that the use of
checking technicians is going to escalate over the next few years and
their standards will improve with the required training and experience.
However, at the present time I find too many errors in the work of technicians
to accept them as a replacement for the pharmacist.
When we do move to checking technicians, who will take responsibility
for any errors made during the dispensing process? The locum will be
the person on the spot supervising dispensing activities but the system
will have been put in place by a proprietor or superintendent who will
not be present in the pharmacy. If something goes wrong and there is
a claim from a member of the public it may make a difference from the
insurance point of view — and it certainly will from the disciplinary
aspect. Disputes?
There could be disputes between insurers should the locum and the pharmacy
have different insurance companies for their professional indemnity
insurance. Knowing how insurance companies hate to pay out, I can
see arguments ahead about liability.
On the disciplinary front it may take a ruling from the Statutory
Committee to decide blame although both parties could be at fault.
There will be
a responsibility on the proprietor or superintendent pharmacist to
ensure that checking technicians are of a sufficiently high standard
to undertake
their duties. There will probably be no opportunity for a locum to
change operating procedures. It could be that locums will not continue
to take
bookings from pharmacies where they consider practices to be not to
their satisfaction.
Then there is the question of continuing professional development.
It is an area where the community pharmacy locum does not fit the profile
of the average community pharmacist. It will be interesting to see
how
the portfolio of different locums will be assessed.
Some locums work for only 10 hours a week and do not come into contact
with the public as often as a proprietor or manager does. Their working
time may be spent on a production line which churns out hundreds of
dispensed medicines per day or they may spend all their time checking
monitored
dosage systems to back up a domiciliary service. They have little time
to assess, plan and reflect on what they are doing and they have little
variation in their work. In fact they are doing what they have spent
a lifetime doing and do not fit neatly into practice pigeon holes.
At the October 2004 meeting of Council, one Council member called for
the Society to support locums. As the profession changes, little training
is currently offered to freelance locums to cope with new roles. Local
services such as supervised methadone consumption and head lice treatment
have been introduced and community pharmacists have been offered appropriate
training. However, the freelance locum is thrown in at the deep end
to sink or swim; there is rarely an offer of training. It is a case
of pulling
out a file, filling in the relevant paperwork, counselling the patient
and muddling though. This situation will only get worse as more new
roles are undertaken.
Primary care trusts are already working towards such things as minor
ailments schemes and nicotine replacement therapy but few will have
a comprehensive list of locums, and their contact details, working
in their
contracted pharmacies (although that will be a requirement). Difficulties
particularly arise where a locum works in areas covered by numerous
primary care trusts because procedures may vary for any given initiative.
A locum
working 40 hours per week may well work in 40 or 50 different pharmacies
in a year; these pharmacies may be covered by more than a dozen primary
care trusts which have all developed different enhanced services with
different protocols. Unless moves are made to include the locum the
NHS could be replaced by a fragmented health service. Lack of courses
Another cause for concern is the reduction in the number of distance
learning courses offered by the Centre for Pharmacy Postgraduate Education.
Two years ago the CPPE offered 60 distance learning courses but this
has been reduced to fewer than 40, with topics such as stoma care now
excluded. It is unfortunate that as demand for education increases
the number of courses available has decreased. A pharmacist who has
already built up a substantial continuing education portfolio will
find insufficient courses of interest remaining to put in the number
of hours as still required by ‘Medicines, ethics and practice’.
New services will be introduced over the next few years whether they
are essential, advanced or enhanced services. Training will be needed
and no doubt provided but will the locum be included? If services are
to be seamless, locums must be offered adequate training for all the
tasks they are likely to undertake. |
The
Pharmaceutical Journal