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Letters to the Editor
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Skill mix
Risk to public of pharmacist’s absence
From Mr B. Nathwani, MRPharmS
I was concerned to read the paper presented to the English National
Board by the Royal Pharmaceutical Society regarding skill mix. This paper
(PDF 90K)
is probably reason number 101 why the Society’s dual role is untenable and
the Government quite rightly has lost confidence in the Society’s
ability to protect the public. Society staff and English board members
will be going to
roadshows to promote absent pharmacists and thereby restricting instant
access to a pharmacist. This from a regulatory body charged with protecting
the public.
This paper blindly follows a predetermined dogmatic Society “policy” irrespective
of evidence that this “policy” will compromise public safety.
We can see what a hollow boast it was for the Society to state proudly
and boldly in its response to the Foster report that it follows best
evidence-based practice.
Without even going into detail about the exact tasks, extent, competencies
or quality of technician training and other such minutiae we shall see
below that the Society’s skill mix position goes against the published
evidence base.
Two pieces of research1,2 clearly show the risk the public will be exposed
to if the English Pharmacy Board, the Society and the DoH have their
way.
The skill mix debate, essentially about what tasks can be safely delegated
to other members of the “pharmacy team”, is based on two
fundamental premises.
The first premise is that standard operating procedures (SOPs) are always
followed. Evidence shows that in practice this does not happen. For this
we can learn from the Netherlands,3 where pharmacists can be away from
the pharmacy and highly trained “pharmaconomists” — Dutch
technicians — can issue repeat prescriptions in the absence of
a pharmacist. In the Netherlands the SOPs which defined when a pharmacist
could be absent were not followed over 40 per cent of the time. There
is no reason to believe that the situation will be better in England.
In fact anecdotal indications in England point to a far worse picture
in context of SOPs not being followed.
Even more worryingly the Netherlands research found that for what is
described as “pre-conditions for clinical care”, SOPs were
not followed for a staggering 66 per cent of the time. Simply put, even
the simplest SOPs relating to basic tasks before a repeat prescription
was issued by a highly trained Dutch technician in the absence of a pharmacist
were not followed.
The second premise is that most pharmacy staff would welcome the pharmacist
being absent. But the DoH-commissioned skill mix survey in 2002 found
that this was not the case. This paper even had difficulty in defining
what “skills” or “skill-mix” meant in context
of community pharmacy.
In relation to freeing pharmacists’ time, the consensus of the
technicians interviewed in this DoH-commissioned study was that the pharmacist
should stay on the premises. These technicians wanted the freed time
to be used by the pharmacist to stay on the premises to provide more
on-site services and better access for patients. So there we have it.
Even the majority of technicians do not want pharmacists to be off-site.
Given that published research clearly shows that the two fundamental
assumptions on which the Health Bill seeks to allow pharmacist absence
go against the evidence base we can legitimately ask on what evidence
the Society’s policy position is based.
Bharat Nathwani
Pinner,
Middlesex
References
1. Hassell K, Shann P, Noyce P. Pharmacists in the new NHS — a
review of roles, responsibilities, development and innovative schemes
in sill mix. Manchester: University of Manchester; 2002.
2. Mullen R. Skill mix in community pharmacy: exploring and defining
the roles of dispensary support staff. Manchester: University of Manchester;
2004.
3. Boyson M. Delivering pharmaceutical care in the Netherlands: practice
and challenges. Pharmaceutical Journal 2004;273:757–9 (PDF 130K)
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PRIYA SEJPAL, professional ethics pharmacist, Royal Pharmaceutical
Society, replies:
The Society’s policy states that the responsible
pharmacist should be able to be absent for short periods provided certain
specified
conditions are met. There is a clear need to balance the provisions
to allow absence from the pharmacy with the need to ensure that patient
and
public safety is not compromised. The Health Act is enabling legislation
and where members of staff do not consider themselves to be competent
or comfortable for the pharmacist to be absent for a short period, this
would need to be considered.
Standard operating procedures should be drafted with the assistance
of the pharmacy team to ensure they are relevant and workable in practice.
Involving the pharmacy
team will not only ensure that individuals’ skills are employed but will
also ensure that specified procedures are followed.
The Society is keen to embrace the positive aspects that the Health Act brings
to pharmacy while also ensuring that patients and the public continue to
receive a good level of pharmaceutical care. The comments received within
this letter
will be passed to the working group for their consideration. |
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The
Pharmaceutical Journal