PRESS RELEASE from the national Pharmacy Association (with comments by The Editor)

NPA URGES CAUTIOUS APPROACH TO CHANGES IN “PERSONAL CONTROL” AND “SUPERVISION” IN PHARMACIES

The NPA has been considering the proposed changes to the definitions of “personal control” and “supervision” as outlined in the recent Health Bill and in the DH’s information paper which provides additional detail on what may be included in Regulations pursuant to the Bill.

In forming its position, the Board took into account the following issues:

• Of paramount importance is the maintenance of public safety and the quality of pharmacy services.

(If safety were of paramount importance then no professional person, such as pharmacists claim to be, would act outside his area of competence and training and chemists are not trained to diagnose.  That takes upwards of six years at medical school, not a 2 week night school course supervised by their colleagues.   It is far too late to consider the safety of the patient after he has been harmed))

(The quality of true pharmacy services will inevitably deteriorate as the chemists dabbles in matters for which he is not trained)

• Any changes in definitions of "personal control” and “supervision” must be unambiguous and clearly understood by pharmacy owners, pharmacists, the disciplinary body and the public.

(And by the general public who, were they to understand what the High Street chemist is intending to do, namely diagnose without examination or taking a comprehensive history from the patient, before finally prescribing medications very likely without the knowledge of the patient's physician)

(The main purpose of the High Street chemist is to safely supervise the dispensing of medications to the patient who puts his trust in him.   For reasons possibly more related to arrogance the chemist now feels that that task is beneath him and can be safely delegated to a trained dispenser.   As the chemist is not trained for any other task, what is his purpose?)

• The changes must enable pharmacists to free themselves from tasks which can be safely and effectively performed by appropriately trained support staff and give pharmacists greater flexibility to provide clinical services.

(It is interesting that chemists now believe that they can "free themselves" from demeaning tasks such as dispensing so as to carry out professional duties for which they will have little or no, but certainly inadequate training.  It is even more interesting that the main objection of the NPA and other chemist groups against doctor dispensing was that, in their opinion, doctors do not supervise.   It is wonderful how opportunity so often demonstrates hypocrisy and lack of character)

• Ready access to a pharmacist is a major strength of the pharmacy service and a significant factor underpinning government policy on improving pharmacy services. Therefore the changes should not result in a significant decrease in the public’s access to a pharmacist.

(If the chemist is going to be swanning around the neighbourhood, out of the shop how will this equate with his ready access by patients?)

The key aspects of the NPA’s position are as follows:

• The Responsible Pharmacist should be responsible for the safe and effective running of the pharmacy and be in charge of the business of the retail sale or supply of medicines and – subject to the directions of the Superintendent Pharmacist (if applicable).

(We cannot argue with that. It is, after all, what the chemist is trained to do)

• The Superintendent Pharmacist’s role should be to assume overall responsibility for company policies and procedures set at Board level to address clinical/corporate governance and compliance with legal and ethical obligations.

(Again, unarguable)

• Legislation should not specify (as is suggested in the Department of Health’s document) that pharmacists need extra qualifications and a certain length of experience working in a registered pharmacy before becoming eligible to be a Responsible Pharmacist. The current Code of Ethics states that a pharmacist should work within their area of competence and should not undertake any work outside of their competence. Provided this requirement is incorporated into the new Code of Ethics there is no need for legislation to control the circumstances under which a pharmacist can take the position of Responsible Pharmacist.

• A pharmacist cannot be responsible for more than one pharmacy at any one time.

• The Responsible Pharmacist should be present on the pharmacy premises for the vast majority of the time.

(A responsible pharmacist should be present all of the time that dispensing is going on)

• The Responsible Pharmacist should be allowed to leave the pharmacy premises but no specific time limit should be set. The Responsible Pharmacist should use his discretion about the length of time he is off the premises and for which reasons – bearing in mind that he should be present in the pharmacy for the vast majority of the time.

(Does "vast majority of the time" mean most of the day, week or year?   An important point if the chemist is going to be able to get in a round of golf whilst being "responsible")

• If the Responsible Pharmacist leaves the premises he must ensure that procedures are in place to protect the public – including ensuring adequate supervision of the sale and supply of medicines.

(Presumably the identical supervision which occurs in general practice dispensing?    Doctors, too, have safety protocols.  See The Complete Dispenser by David Roberts)

• Options for adequate supervision of the sale and supply of medicines during the Responsible Pharmacist’s absence are:

- Engaging another pharmacist to be on the premises to cover the periods of absence.

- Remote supervision by the Responsible Pharmacist – if possible (depending on the reason for his absence from the pharmacy).

- Engaging another pharmacist to supervise remotely.

(At present the shop assistant puts her hand in the air and gesticulates towards the distant chemist to obtain permission to sell pharmacy-only products.    She will need very long arms in the future, to reach her golfing boss on the fourth tee and will she dare to disturb him for every sale in the busy shop?   The law presently says she should.   Is this law to be changed to maintain the chemist's profit?   And what do patyients think about this?  Have they been asked?)

• A pharmacist who is supervising remotely must remain accessible and make use of technology so that he is able to supervise to the same extent as he would be able to if he was on the premises. For example, he must be able to see either the paper or electronic versions of a new prescription and the patient medication record, and be able to answer staff queries or speak to the patient if necessary.

(Impossible)

• While a Responsible Pharmacist can only be responsible for one pharmacy at a time, it should be possible for a pharmacist (who is not a Responsible Pharmacist) to supervise more than one pharmacy at a time during the absence of the Responsible Pharmacist.

(So Tesco's will have one pharmacist, perhaps in India, to supervise a Region of shops)

• The Responsible Pharmacist may delegate tasks to appropriately trained and competent staff but regulations should specify that supervision (remotely or from the premises) can only be delegated to another pharmacist. Other than that, regulations should not specify to whom pharmacists can delegate specific tasks. This should be left to the professional discretion of the pharmacist.

(Does this mean that all the above is nonesense and that there must be a chemist on the premises?   No, it means that the absent chemist can delegate to another absent chemist.  How will that help patients?)

• Every prescription should be seen by a pharmacist (on the premises or remotely) at least once during the dispensing process – to carry out a clinical assessment. The only exception should be repeatable prescriptions. Provided a pharmacist has carried out a clinical assessment of the original (master) prescription and there have been no changes since, subsequent batch issues can be dispensed by support staff with delegated responsibility without a pharmacist’s input.

(Another hypocritical impossibility that means, in effect, nothing other than to allow the chemist to meddle in the community for profit)

Colette McCreedy, Director of Pharmacy Practice, said, “ The NPA recognises the importance of making best use of the skills of all members of the pharmacy team and the need to set personal control and skill mix in a modern setting. However, in forming its position, the NPA Board has purposely adopted a cautious approach.

(Not cautious enough, simply spin)

Issues such as leaving the pharmacy premises and delegating dispensing cannot be taken lightly. – for the sake of the public and the profession. Moreover many of the developing community pharmacy services are predicated on access to a pharmacist.

It is important to move slowly and analyse the effects of any changes on the quality and safety of the pharmacy service, on access to the pharmacist and their acceptability to the public before any further changes are made.”

(Why not open a very public debate on this dangerous changes which will benefit not patients but only the chemists bank balance.  The only proper place for the High Street chemist is in his shop)

(6/5/06)