GPs ask pharmacists to act outside competency
Pharmacists’ Defence Association (PDA) director Paul Day has revealed the organisation is receiving a growing number of cases relating to pharmacists in GP practices being asked to carry out tasks that are beyond their competency.
Day said some pharmacists had approached the PDA for help and advice having been asked by a doctor to run a clinic unsupported. Another pharmacist said they were asked to push through a bundle of prescriptions without checking each one first. Many of the cases heard by the PDA involved newly qualified pharmacists.
“A whole range of issues are coming up from primary care. We’re clear that pharmacists should not ever act outside their competency. That’s not safe practice,” Day said in an interview with Independent Community Pharmacist to be published next month.
“There’s an issue that perhaps a partnership of doctors running a private business, albeit it’s got NHS branding all over it, will say ‘it’ll cost us X to get a locum doctor in, why don’t we get a locum pharmacist on the team instead?’
“That’s ok as long as you are only asking them to be a pharmacist but we’re finding new risks where pharmacists are being presented with ‘you can do all these things’ and the pharmacists are not necessarily competent to do all those things. You’re there to be a pharmacist, you’re not there to be a GP or junior doctor.
“There’s questions over running clinics and if you’re there, unsupported by a GP and you’re running a clinic, if it’s a specific clinic and it’s in the realms of your independent prescribing qualification, that may ok, but you need to be clear on diagnosis process and that you’re only dealing with the stuff you’re competent to deal with.
“People come to a general practitioner with a general illness. These sorts of things are unfolding as the increase in GP practice pharmacists goes up.
“(These are) all newly qualified pharmacists who are now into primary care, GP practices, and for us there is a new area of casework coming up for us where pharmacists are saying ‘actually, I’ve been asked to do this by the doctor but is that my job, should I say yes, how do I manage that? And it’s a different world.’
“With GP practice, it’s a growing area of issues, casework for us, because there’s this new wave or complement of pharmacists entering in and they’re not clear what their roles are.”
NHS England (NHSE) has said it wants to see 2,000 pharmacists working in GP practices by next year.
Primary Care Networks will each get around £38,000 to hire what NHSE describes as a “clinical pharmacist,” or pharmacist working in a GP practice, from next month.
“There’s two key factors for us. Firstly, anyone moving into community pharmacy, and it’s particularly high risk if you’re a newly qualified pharmacist who has almost instantly done an independent prescribing course and then arrive in primary care, what’s your experience level?" Day said.
“But if you’re a community pharmacist who’s been in community pharmacy for 10 years and you move across, it’s a new world.
“Moving across from community pharmacy, you’re no longer in a place where there are sales targets or MUR targets but there’s a whole different set of challenges to manage and our message to people is be clear of our competency, what you can and cannot do. Do not act outside of your competency because you are at risk if you do so.”
When asked how many cases the PDA has received, Day said: “Enough. I don’t have numbers but enough. In shorthand we’ve sometimes said they are not there to be mini-doctors.
“I’m aware of a case where a pharmacist said ‘a doctor said to me ‘here’s a pile of repeat prescriptions, just sign them through.’ But I’m a pharmacist, I’m going to check every one properly. That’s not how we do it.’
“There’s also that working relationship if you’ve come from, say, a CCG where there’s more structures into a GP practice where the partners are the owners, they are smaller employers, and the partners are pretty powerful because they own the business.
“There is a GP shortage so it’s important the burden isn’t placed on pharmacists because as always, as we know, if something goes wrong and you’ve acted outside your competency, people, other than us, do not run to help you. They say ‘you acted outside your competency, it’s your fault.’”
ICP has contacted the British Medical Association for a response.