Views on supervision

More cautious views

Again in line with the quantitative analyses presented previously, community pharmacists, followed by hospital pharmacists tended to be more negative or cautious about potential changes to

supervision. Many comments related to their perception that pharmacists should be present in a pharmacy, some commenting that otherwise patient safety may be put at risk.

“I fail to see how the absence of a pharmacist can enhance patient safety. In my opinion, if a pharmacist needs to be away, another pharmacist should be present. Being contactable simply is not good enough just like if a man comes in to ask for EHC for the woman, we always ask the woman to come in and have a consultation, we do not just contact the woman over the phone! Patients feel and expect the Pharmacist to be present at the pharmacy. The reputation of the profession is at stake.” (CP - 342)

“I do sincerely believe that a pharmacy should have a pharmacist – Why else call it a pharmacy and not a drug store!” (CP - 991)

“I think pharmacist supervision is still needed. In hospital pharmacy staff including assistants, technicians etc are constantly asking questions and checking with the pharmacist.” (HP- 22)

Pharmacists, and particularly those in community, noted that patients expected pharmacists to be present and accessible, and that they could (and did) ask to speak to the pharmacist to answer their questions or concerns. Indeed, there was a strong feeling among many that the accessibility of pharmacists without the need for an appointment had always been a strength of community pharmacy. Losing this was seen as a potential loss of professional standing and reputation.

“Many patients regularly ask to speak to the pharmacist despite there being fully trained and competent staff in the pharmacy. As a result I genuinely believe that the public want a pharmacist on the premises and the function of a pharmacy during an absence would concern patients and increase the risk level to the public.” (CP - 456)

Numerous community pharmacists, and some hospital pharmacists, also voiced concerns about changes to pharmacist supervision requirements as potentially opening up further opportunities for pharmacy organisations, in particular larger multiples, to save money and maximise profits, at the expense of patient safety.

“Large multiples and business owners will abuse the absence period, for financial reasons, less pay, provide further services.” (CP - 1300)

“My biggest concern would be with the multiples and how they would manipulate and bend the rules for their own commercial gain. -- Basically if a pharmacy is open, a qualified pharmacist should be present and if the argument is to allow us to do more services/ extend our roles then two pharmacists should be employed instead.” (CP - 456)

“If the responsible pharmacist has control over what can be delegated in their absence and not the employer then I would be glad to see changes.” (CP - 488)

As the last two quotes illustrate, those who were supportive of an extension of more clinical and patient-centred services, raised the importance of professional autonomy and a possibility of employing more than one pharmacist. Others commented that it was important to use skill mix effectively, but that this should not necessarily enable a pharmacist’s absence, but free their clinical skills (also) within the pharmacy.

Positive views

Many comments were made, particularly by PTs in both sectors, to support the effective and appropriate use of skill mix, thus using support staff competences and skills as well as pharmacists’ clinical skills to the full. Some expressed that this would be the only way to expand pharmacists’ services into more clinical and patient-centred areas, whether from within or outside the pharmacy premises.

“I feel that there should be a recognised professional model that frees up pharmacist’s time so that pharmacists can perform enhanced services without having to worry about the routine dispensing of medicines.” (CP - 927)

“I think we need to respect the qualifications and training of technicians and let them do what they are trained to do. By only letting them carry out their job when a pharmacist is present, it’s like taking an independent pharmacy prescriber, they can only prescribe with a doctor in the room. - By letting technicians do the technical aspect of pharmacy, it allows pharmacists to concentrate on clinical matters.” (HP - 1183)

“Often pharmacy technicians and ACTs are just as capable and intelligent of doing a task as a pharmacist is. - By delegating more work to a technician the pharmacist is then free to do and carry out clinical advice to patients and concentrate on services like MURS, NMS etc.” (CPT - 2315)

Two community pharmacist respondents acknowledged that, even under current supervision arrangements, a pharmacist could not always hear all goings-on and intervene accordingly, without another member requesting their input.

“Support staff that are correctly trained should be able to work without a pharmacist being present. It is naïve to think that a pharmacist’s presence means that he/she can see and hear everything that is happening, e.g. when conducting a MUR in a consultation room with the door shut (as per request). “Supervision” would be impossible!” (CP – 214)

“Many set ups don’t even allow the pharmacist to overhear what is being said on the pharmacy counter – e.g. [very large pharmacy store]. One would have no idea what is being sold or said.” (CP – 816)

The option of being able to contact a pharmacist without delay was therefore emphasised.

“In hospital pharmacy we regularly work without a pharmacist present but contactable at all times and support staff are invaluable.” (HPT - 2134)

“As the technicians are more than capable of doing the repeats, smoking and healthy living, they need back up when they find something unusual or significant, but if that’s only a phone call away at the most, it would be enough.” (HPT – 2743)