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Beware the law of unintended consequences


Beware the law of unintended consequences

Changing legislation on supervision is all very well but what does the DH want from us exactly, asks our correspondent

I wonder how many of us are left who remember the furore over supervision back in 1989. I attended the special general meeting of the Royal Pharmaceutical Society (RPS) where an unprecedented vote of no confidence in the Society’s council was put forward.

The RPS was advocating a relaxation in supervision to enable pharmacists to take on extended roles. There was vehement opposition from the so-called ‘final checkers,’ who insisted that such a move presaged the death-knell of pharmacy and wanted pharmacists to micro-manage everything in sight. The outcome was that supervision requirements did not change.

However, supervision, and how closely a pharmacist needs to be involved, has rumbled on as an issue ever since. There was a spat over dispensing doctors because they did not personally supervise the dispensing of medicines. More recently, the idea of remote supervision was mooted, where a single pharmacist could supervise a number of pharmacies via video links. That also seems to have gone quiet. And now, just this month, pharmacists have been horrified by the revelation that a working party established by the UK’s four chief pharmaceutical officers has made the radical recommendation to change the law to allow pharmacy technicians to take responsibility for dispensing prescriptions and the sale of pharmacy medicines.

Strict secrecy
There has been some consultation, but little or no transparency. Strict secrecy was to be maintained, with documents marked ‘Sensitive’ and ‘Not For Wider Circulation’ – until the plans leaked. Martin Astbury was a member of the working party when he was RPS president and has since revealed that ‘all the community pharmacists [on the party] pointed out what folly this was.’ Despite this, it has been reported that the DH programme board responsible for rebalancing pharmacy legislation (sounds suspiciously like a euphemism to me) has accepted the proposals in principle. What is being proposed is similar to the way pharmacy practice has developed in hospitals, with technicians checking one another for accuracy of dispensing after a pharmacist has performed a professional check of the prescription.

It works well in hospitals, but the culture and team structures and sheer numbers of staff in hospital pharmacies are very different from community pharmacies. We are told that the proposed change in legislation for community pharmacy is intended to optimise the skill mix and maximise the involvement of the ‘whole pharmacy workforce, especially pharmacy technicians.’ This means that ‘pharmacy professionals are available in the right place and the right time – not necessarily in a pharmacy.’ “Hogwash,” according to Martin Astbury.

Salt in the wound
I have several concerns about the proposals, not least their insensitive nature following the pay cut imposed on us. It feels like salt is being rubbed into the wound. That apart, as Numark managing director, John D’Arcy has pointed out, the expected outcomes of this change are completely opaque. He has asked for clarity regarding the DH’s expectations.

Not long ago, I wrote in a similar vein asking for the DH to communicate to us what it is they want from community pharmacy. It’s all very well to come up with vague laudable statements about making pharmacy professionals more available, but what is it likely to mean in practice? Available to whom? Available to do what? And – what does it auger for the future of community pharmacy? We’ve all heard of the law of unintended consequences. I have a strong feeling that this law is lying in wait for this particular proposal.

Do you remember the bland, complacent claims that politicians made about the increase in university fees to £9,000 a year? That figure was a maximum, they insisted. And what happened? Almost immediately, every university charged the maximum for every course.

It seems to me that such a change in legislation could very quickly lead to a situation where most prescriptions and sales of pharmacy medicines are made without the supervision of a pharmacist. If that were to occur, why would a pharmacist be needed to operate a pharmacy?

The DH has said it will consult with the public on these proposals. Why? Is the public sufficiently well-informed? John D’Arcy says there is a need for better use of pharmacy teams, but not if it means making the existing dispensing model redundant. He’s wrong. He’s stuck in yesterday’s thinking. The existing dispensing model is already redundant. There is most certainly a need for better use of pharmacy teams, but the DH must tell us what it wants from those teams so we can work together to achieve it.

Changing legislation on supervision is a blunt instrument that is likely to result in a transformation that nobody actually wants – unless it’s accompanied by proposals that clearly show what the DH wants from community pharmacy in the future. Otherwise, it’s a disaster in waiting that we must oppose with everything we’ve got.

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