PCT dispensing visit

If some PCTs haven’t started these inspections of dispensing premises yet, they will.    The DDA Ltd and the GPC have long welcomed the concept so maybe we should all be prepared and learn how best to present ourselves.    This is probably as much support as you will get, so let’s get on with it.

If the pattern follows that of pharmacy your PCT will first send a dispensing self-assessment form in an attempt to see how you run your dispensary.   The PCT will check this and follow it up, already briefed on your weaknesses (of course, there will be none) with their visit.

It is important to realise right from the start that as the visiting official will, almost by definition be a pharmacist rather than a dispensing doctor, the visit will potentially be biased against dispensing practice.   For commercial reasons chemists do not believe that dispensing by doctors should exist and may not be able to withstand the temptation to down-rate your dispensary.  

By preparing well for the pharmacist's visit you will not only protect the future of dispensing practice by defeating pharmacy's arguments against it (not that they aren't doing very well themselves on that score) but you will continue to improve on the already excellent service you provide to your patients.

Be prepared!

Pre-visit form

The pre-visit form, if any, may arrive anything between two and four weeks beforehand and could be a simple questionnaire or could also contain suggestions about what the PCT will be expecting a well-run dispensary to be doing.

The visit – what they will be looking for

1.   Every dispensary should have a dispensing protocol (or Standard Operating Procedure) and it should be displayed, and used, in the dispensary.   It must be freely available for all dispensary staff and locum doctors.  There is such a protocol in The Complete Dispenser – 5^th edition.    Feel free to copy it.

The Inspector will be watching to see that it is either consulted or instinctively followed.    Remind staff not to be taken off their guard.    Better still, make sure that they understand the reason for every procedure and can answer any questions they may be asked.

Checking of all items before releasing to patients is mandatory.    Is this manual or by IT means such as bar-code or RFID?

Discuss the dispensing protocol at a pre-inspection dispensary meeting.

2.      The condition of your dispensary will be assessed from the viewpoints of hygiene, safety and suitability,    Details of what the inspectors will be expecting are laid out in Your own Pharmacy.

In brief:

            The size of the dispensary and fitness for purpose.

            Cleanliness of counters and all equipment  

            Do you have standard hygiene procedures in force?

            Efficient heating, lighting and ventilation

            The type and effectiveness of your dispensary fridge and records kept

            How your medicines are stored/shelved etc. inc temperature conditions

            Cleaning facilities

            Staff conditions – including toilets, hand-washing facilities

            Protective clothing for staff,  including plastic gloves

            Condition of cupboards

            Do you have the standard reference works readily available?

  3.        Dispensary staff  

             Do they follow standard hygiene procedures at all times?

             Are they qualified?

            Are they taking qualification courses?

            Which qualification?

            What emergency cover procedures do you have in case of staff absence?  

4.         Stock

            The safety and efficiency of your supplies

            Checking procedures on receipt of wholesaler and other supplies

            Chasing up "out-of-stock" efficiency

           Controlled drug procedures and registers will be especially highlighted.

           Returns” procedures and disposal policy.

Dispensing protocol and SOP

In addition to following the procedures mentioned earlier, the inspector will be checking your significant event procedure.

If an error is made does the practice learn from it?  

GPs have been reporting significant events for some years now and there is a specific section on dispensary errors, the opportunity to take advantage of these and, of course, how to avoid them, in The Complete Dispenser – 5^th edition.

Keep an on-going record of all such events in a register with details of what has been done in an attempt to avoid similar errors.   Show it to the inspector.

How does the practice deal with patient complaints?  Is there a proper procedure set up?    Are complainants given a copy of the procedure taken following a complaint?   Are they told the outcome of their complaint?

Make it obvious even to a pharmacist that your dispensary is well run and that you do care.

Prescription monitoring

This includes everything from ensuring that prescription charges are collected to the proper keeping of blank and used forms. 

It also includes an SOP to ensure that part-filled prescriptions are completed speedily.

Minor illness advice

Is there a minor illness SOP in your dispensary?

Although this is not part of any contract, your staff are frequently asked such questions by patients who have faith in them.

What steps have you taken to ensure that they have that knowledge?

Can they do more than answer questions? 

For instance, it is a good idea for them to be able to produce and give out leaflets with simple advice.   Some IT systems can download such information.

The ultimate (and why not?) is for your dispensary to avail itself of the opportunity to sell OTC preparations to its dispensing patients.     Yes, it is legal.  See The Complete Dispenser.     Contact me for help about this.

Are your staff able to advise which preparations are appropriate in all circumstances?

Do they know when their expertise has been exceeded and when to call the nurse or doctor?

Can the advice/sale be written on the patient’s records through the IT system?

Healthy life-styles

In dispensing practices this is more the field of the doctor or the nurse.   Are they readily available?    Can leaflets on the subject be given to patients by the dispensers in the meantime?

Audit  

Do you carry out patient satisfaction surveys and have you evidence of the results?

Are any or all of the above audited by the practice and discussed at dispensary meetings?  

Finally

Look up the Pharmacy New Contract to see if there are any services there that your dispensary can better.  That will, after all, be what the PCT chemist will be looking for.

Information about the vast majority of the above subjects may be found in either of my two books; Your own Pharmacy (Radcliff) or The Complete Dispenser – 5^th edition (CIG).  Details of how to obtain the books is on www.countrydoctor.co.uk together with a significant amount of other useful information.

David Roberts (13/6/06)