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I fully support a relaxation in the pharmacy supervision
requirements. However, before that occurs I would suggest there is need
for the Society to conclude its discussions on ensuring the competence
of pharmacy support staff upon which Council consulted members in August
2000.
As part of that competence issue I firmly believe that pharmacy technicians
should be registered by an appropriate body (preferably the Society) and
should be subject to a code of ethics and a continuing professional development
requirement.
Given such registration and regulation of pharmacy technicians it will
be possible to relax the current, strict, definition and interpretation
of supervision so as to allow pharmacists to provide a wider range of
pharmaceutical services within pharmacy premises and to be absent from
the pharmacy for brief periods of time provided they can be immediately
contacted by pharmacy staff when the need arises.
These changes will enable a pharmacy to establish new services in which,
for example, the pharmacist is on the premises but fully engaged in the
delivery of pharmaceutical care in a separate consultation area or the
pharmacist is off the premises providing a professional service to, for
example, a GP practice or rest home.
As and when a relaxation in the supervision requirements
occurs operating systems and procedures will need to be drawn up in respect
of
- professional/clinical checking of all prescriptions
by a pharmacist (preferably as the first step in the dispensing process)
- final accuracy checking by a pharmacist or accredited
checking technician (preferably one who has not been involved in the
assembly, preparation or labelling of the dispensed items)
- handing out of dispensed items, together with relevant
advice, by a pharmacist or pharmacy technician
- the sale of medicines by trained pharmacy staff —
with guidelines for referral to a pharmacist or pharmacy technician
when appropriate
- a means of contacting a pharmacist who is away from
the pharmacy
The Society's Code of Ethics rightly requires accountability
and this must surely operate at three levels. The proprietor/superintendent
community pharmacist, and the hospital chief pharmacist/senior pharmacy
manager, must be accountable for the establishment and maintenance of
the pharmacy's operating systems and procedures. The pharmacist-in-charge
at any one time must be accountable for the effective operation of the
established systems at that time while individual pharmacists, and pharmacy
technicians must remain accountable for their own actions.
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There is no doubt that changes are required in order
to modernise community pharmacy and I support some relaxation in supervision
requirements. However, no change must be allowed to compromise any aspect
of current practice which is of great value to consumers.
As guardians of public safety in medicines-related issues and by virtue
of public accessibility to a conveniently located open-access service,
community pharmacy provides what the consumer wants and needs: immediate
access to a network of pharmacies staffed by knowledgeable health professionals,
supported by trained and competent staff.
The question is how can pharmacy meet Government objectives, while still
satisfying public demand and undertake professional re-engineering at
the same time without creating additional problems along the way? The
answer lies in a hybrid.
More pharmacists are needed. If convenience of location and access is
to be preserved then the formation of group practices of two or more neighbouring
pharmacies will only be a practical solution in a very limited number
of situations. For most of the country there is little scope for reduction
in pharmacy numbers without at the same time compromising access. Similarly,
e-pharmacy, walk-in centres or NHS Direct will not reduce the need for
maintaining the network of pharmacies; instead they will serve to increase
demands on primary care.
Pharmacists need to let go of the technical aspects of dispensing and
medicines sales, allowing trained, and possibly regulated and registered
staff, to work under protocols. Training and certification of medicines
counter assistants is now well established but more rigour is needed in
the system. Methods should be introduced to continually refresh and update
the knowledge and competencies of these important front-line staff and
dispensing assistants.
Standard operating systems and protocols must be introduced to allow competent
staff to work in the absence of a pharmacist, provided the pharmacist
can be consulted immediately problems arise and can quickly be present
to advise patients when required. Web-cam links between the pharmacy and
a pharmacist working remotely, perhaps along the road at a GP practice,
sound attractive but it is impossible to pick up accurately on body language
with this type of technology. Pharmacist interventions in the future could
be limited to situations only where there is significant concern, for
example, over appropriateness of treatment, safety or concordance issues.
Under these circumstances, there is no substitute for face-to-face interviews
with patients.
I am not yet ready to accept a situation where a pharmacist can be absent
from the pharmacy premises for more than a few minutes at a time while
the work of that pharmacy continues. I am happy, however, to contemplate
a situation in which the pharmacist is, for example, conducting some type
of clinic within the same building but away from the immediate area where
dispensing and medicines sales are occurring. Providing competent staff
are working to set procedures then patient safety and access should remain
uncompromised.
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