The Pharmacist Defence Association (PDA) has published a statement raising concerns about the levels of training and competence of pharmacists working in general practice. The statement comes as the number of pharmacists working within general practice has increased dramatically in recent years. The PDA say they have noticed a ‘predicted’ upturn in queries from this group of pharmacists. These developments have caused the PDA some concern and has triggered the need to publish the statement.
The PDA has said that:
“Regulatory organisations and senior NHS bodies in a small number of cases are questioning the competence of the pharmacist to undertake the duties they were involved in. We are therefore advising all members currently involved in or considering a move into diagnosis and prescribing (the highest risk activity both from a patient safety and an liability risk perspective) to dedicate some time to reflecting on their experience and training and identifying which areas they feel competent to practice in and which areas require further training or additional support from another clinician.”
“We are aware that some opinion leaders in the primary care arena have expressed irritation in the past with the “Boundaries of Clinical Practice” (BCPS) document which we recommend that our members complete before choosing an appropriate level of indemnity cover; they have claimed that filling it in was not necessary. This view may be compounded by the advent of the Clinical Negligence Scheme for General Practice which means that clinical negligence cover is available without individual clinicians having to make any sort of application or declaration of their experience.”
As part of the statement, the PDA has highlighted some cases that have come to light recently. They have said that these incidents give cause for concern and highlight the fact that there are potential competence and training issues in this group of pharmacists. A brief summary of the cases in question are outlined below:
“A Pharmacist returning to general practice after a break of several years referred to the pharmacy regulator by the employer due to allegations of errors and near misses whilst carrying out audits, medicines reconciliation and clinics.”
“A pharmacist working on a locum basis investigated by NHS England for providing evening clinics from a branch practice with no doctor available on the premises for clinical supervision.”
“Pharmacist with limited general practice experience providing patient facing care as part of triage service identified as a potential risk to patients by a regulator requiring further investigation.”
“A Pharmacist with no prior general practice experience taken on to provide minor ailment clinics. When asked about an unrelated health issue, an unchaperoned examination took place resulting in a minor problem being erroneously diagnosed. The patient was subsequently placed on an urgent 2-week wait pathway and diagnosed with cancer.”
The PDA has highlighted that there are a variety of emerging roles in primary care which pharmacists are well equipped to take on; however, they have stated that it is essential that careful preparation is made to build up relevant experience and that robust governance and supervision arrangements are in place whilst competence is gained in new areas of practice.
They conclude by stating:
“The absence of these working practices could support an allegation of maverick behaviour. Such behaviour can also result in mistakes and harm to patients and could seriously damage the profession as a whole, as well as threaten this new area of practice.”
“Doctors have to undergo an additional 3 years of training to qualify as a general practitioner; 18 months in hospital and 18 months in a training practice. The PDA believes that if pharmacists are expected to shoulder a wide range of prescribing and in some cases diagnosing responsibilities within emerging primary care structures, then similar levels of training and support should be provided.”