Is self-protection restricting the evolution of pharmacy?


Ross Ferguson

ONE of the things that frustrated me most when I worked full-time in community pharmacy was being stuck within four walls all day.

If I left the building nothing could be done: inevitably if I popped out for 2 minutes to get a sandwich, by the time I scurried back to the pharmacy, there would be people waiting to pick up prescriptions, to buy some P medicines, or to drink some methadone. Because of course we didn’t shut for lunch.

Then if one wanted to take a little longer in the smallest room in the pharmacy (use your imagination here) again there would be people waiting.

A pharmacist’s life is one of restrictions, as we have to be on the premises and be able to intervene if required. That’s one reason it’s difficult to forge interprofessional relationships — unless they come to us we really don’t get to see them.

If, in an emergency I had to pop out to see a patient for 20 minutes — again the pharmacy comes to a standstill. A backlog awaits on my return.

The great supervision debate is a crucial one for pharmacy. I hesitate to mention the most cumbersome phrase I have heard of late: “A pharmacy without a pharmacist is just a shop”, with apologies to the person who coined the phrase, but is that the best we can do?* Let’s accentuate the positive.

When I reflect on days I work as a pharmacist now, many of the tasks I do can easily be carried out by technicians without my direct supervision. I think pharmacist colleagues would be amazed at some of the roles technicians currently perform in GP practices, and throughout primary and secondary care. And yes, some pharmacies do operate well like this with ACTs. The only problem I have with technicians is there isn’t enough of them in community pharmacy.

Again, a frustration for me when I locum is the drudgery of checking 500 items when I could be talking to patients — I don’t want to be involved in dispensing. I would, however, continue to clinically check acute scripts, and spend the rest of my time on minor illnesses and patient medication reviews, for example, for those on repeats. We need pharmacy technicians to help us fulfil our potential.

And before you ask — I’m not advocating we run pharmacies without pharmacists (they’d just be shops, right?), but I’m saying let’s be sensible. The stakes (the future of community pharmacy perhaps) and the tensions are high, and of course patient safety is paramount, but I think we can make changes without compromising safety, and we should make those changes.

For example, let’s take the brief absence from the pharmacy: with proper procedures in place, as a minimum, dispensed medicines should be allowed to be collected by patients; P medicines should be allowed to be sold within guidelines.

If we want to do the exciting stuff like our GP pharmacist colleagues: health checks and early screening for chronic conditions; diagnosis, treatment initiation, monitoring, follow ups and annual reviews; management of caseloads of people with long-term medical conditions; diagnosis and treatment of common clinical conditions; as well as occasionally leaving the building to visit people in their own homes or care homes so they too get the best out of their medicines, then something has to give (but never patient safety).

There has to be proper provision, and changes to supervision, that allows us to perform these roles. Of course an essential part of that would require referral to the pharmacist when necessary, and clear professional accountability. Some may argue that the responsible pharmacist regulations allow this flexibility, but if the pharmacist is on the premises and busy in a consultation room (and physically unable to intervene) how is that any better than being away from the premises for a short period? There’s even the oddity whereby the pharmacy delivery driver isn’t allowed to take away dispensed and checked prescriptions for delivery if the pharmacist isn’t on the premises.

Pharmacists need to get out of the dispensaries and stay out, we need to work closely with our pharmacy technician colleagues, and if appropriate changes to supervision can help with that, I’m all for it. We can then show our true value to our patients and our respective Governments.

I had cause recently to read a part of Prescription for Excellence, and the ambition was that all pharmacists would be independent prescribers by 2023 and that they we could be called “General practice clinical pharmacists, regardless of their setting”. That has to be the ambition for community — to be recognised (because we’re not) as clinical pharmacists.

So for me there are two issues: improving on the current supervision requirements to enable us to do more, and making better use of pharmacy technicians. We are an amazing resource in the heart of communities – we have to stay there, but to do our best for the profession and more importantly for patients we can’t deny the progress that is needed. If we want to expand our roles, then we have to welcome the ambitions of pharmacy technicians too.

If supervision stays exactly as it is, it’ll be a Pyrrhic victory for the profession, just like the success which stopped independents operating automated dispensing hubs — despite the fact multiples already do. At the extreme there is a threat (real or not, I don’t know), that pharmacy technicians will supervise pharmacies without pharmacists, but what I’m suggesting is that while this is completely unpalatable for the profession, we can’t let this possible extreme prevent us from suggesting improvements to what we have now. We need changes that will make pharmacists more accessible.

However, so far I haven’t seen anyone suggest positive changes, merely repeating the latest mantra and challenging others to declare their position. What we should fear is the status quo that resigns us to trudge on exactly as we are. Where has that got us? I don’t have all the answers (if any), but I do know we can improve on what we have.

Community pharmacy in England is under immense pressure, and no doubt nuances exist that I may be unaware of, but change is needed – part of that change should be encouraging more technicians into community pharmacy and freeing pharmacists to spend more, if not all, of their time with patients, like our much-lauded GP pharmacist colleagues. That’s what we need to focus on.

*Prize available for whoever comes up with a better phrase.


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