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Letters to the Editor
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Supervision
Pharmacies without pharmacists?
From Mr A. C. Gush, MRPharmS
The Government’s proposal, published in the recent Health Bill,
to relax supervision and allow remote supervision comes as no surprise.
The Bill could remove pharmacists from pharmacies, placing them in surgeries,
as doctors’ assistants, depriving the public of the accessible,
highly trained health professional who is so widely valued within the
community. Community pharmacies could be reduced to being distribution
centres, stripped of cost and devoid of professional content.
Patients tell me that they regard community pharmacists as experts on
medicine and public health, whose role in the dispensing process is to
ensure safety and that accessibility to this expert is the most valued
part of the community pharmacy offering. In other words a pharmacy is
not a pharmacy without a pharmacist.
I am no Luddite. I do not spend my time counting, labelling and checking.
I delegate dispensing to technicians, working under standard operating
procedures, which allows me to check clinically any changes to patients’ medicines
or to manage any critical incident. In terms of dispensing, pharmacists
should provide quality assurance not quality control. This effective
delegation matches skills to roles and ensures that the pharmacist can
spend most of the day focused on patients.
Like a captain of a ship, pharmacists have changed from operators in
a system to managers of the systems. They are accountable directly to
the Royal Pharmaceutical Society. Others are responsible to pharmacists
at all times and work under their supervision. Supervision is about delegating
to trained staff with regular monitoring of the process and outcomes.
The primary care role for pharmacists within GP surgeries is, of course,
important. But this role is complementary to, and not a replacement for,
that of the community pharmacist. We must never forget that it is the
combination of accessibility and availability of this expert that makes
community pharmacy uniquely valuable. In my experience, the most serious
and significant interventions often flow from apparently trivial initial
enquiries.
Any suggestion that pharmacists’ clinical roles can be handled
properly by technicians is misplaced and clinically unsafe. This does
not detract from the responsible use of skill mix. A patient in need
of pharmaceutical care may well be identified by a counter assistant.
The patient will be able to receive the required timely intervention
by a pharmacist only if the pharmacist is not tied down in the dispensary
or busy with supplementary prescribing in a surgery.
When independent prescribing was announced by the then Secretary of State
for Health, John Reid, he said: “By allowing fully trained pharmacists
to prescribe independently we can make better use of their considerable
skills in pharmacology and therapeutics and offer people a more accessible
service.” This considerable opportunity can only happen in any
substantive way if the ready accessibility of the pharmacist in the community
pharmacy is not compromised.
Community pharmacy has a bright future: we are firmly part of the health
agenda and are consolidating our role as public health experts in the
high street. Pharmacists are now in a position to move forward professionally
and must grasp new clinical opportunities by the exploiting the responsible
use of skill mix. If elected to the Society’s Council, I pledge
to fight to ensure that the Government realises a pharmacy is not a pharmacy
without a pharmacist.
Andrew Gush
Council election candidate
Royal Pharmaceutical Society
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The
Pharmaceutical Journal