Good GPhC regulation? You must be joking
The GPhC’s answer to our plight is more regulation, guidance, legislation, pressure, targets and rising fees. It should cut its own costs and review its own efficiency before doing anything else, says Sid Dajani…
I can’t recall who said ‘rules are for the guidance of wise men and the obedience of fools’ but I couldn’t agree more, especially when best practice and patient interests should influence regulation rather than be inhibited by it.
I have a sincerely held belief that the overwhelming majority of pharmacy and NHS staff come to work every day determined to do a good job. However, if regulation becomes too much, we’ll be struggling with an avalanche of demand, trying to hit impossible quality targets, gateway criteria, audits and response targets.
When policing pharmacies becomes more important than professionalism, you can bet your bottom dollar the regulator becomes more important than the relatives and patients we serve.
There is fear. Fear of criticism, retribution and humiliation. Fear of what results will be published and the lack of appeal. It’s a familiar tale; governments emasculate pharmacy funding, make deep slashing cuts and pretend the reverse is true.
When pound starvation results in system failure, the cheap solution is unrealistic inspection and more regulation, enabling the government to blame the people delivering the service and avoid criticism - instead of empathising, appreciating, understanding and supporting the profession to make a stand against more cuts and give us leeway to implement the Falsified Medicines Directive and new software systems.
The GPhC’s answer to our plight is more regulation, guidance, legislation, pressure, targets and rising fees. It feels like we are being shoved around by people who think they can inspect improvement into performance - rules invented by the same sort who believe in flogging dead horses and who think you can make a pig fatter by weighing it more.
We had the GPhC consulting on making unannounced inspections, publishing their findings and changing inspection outcomes. Their consultation was as predictable as a North Korean election.
The GPhC wants to raise over £750,000 a year to combat an increasing workload. Why is there no GPhC consultation on cost-cutting and reviewing its own efficiency? It could consider moving out of expensive premises in Canary Wharf to a cheaper location as a part of an inner-city regeneration programme - where many pharmacies are found.
It could discuss appointing an independent panel to review Council members’ remuneration and governance but above all, it could review the worthiness of referrals in fitness-to-practise cases. Because unnecessarily high rents and costs of unnecessary litigation should not be passed on to registrants and pharmacy owners.
The GPhC’s answer is that the rises are still below inflation but that’s no excuse; it has a guaranteed set income, regardless of inflation which increases each year, with new registrants outstripping those leaving practice. And let’s not forget, pharmacists have not had a pay increase despite increasing workloads and unlike the GPhC, owners do not have the luxury of stable business planning due to monthly tariff changes. I’d say the GPhC should cut costs before increasing our hard-sought fees.
The theory is a pharmacy should be run to consistently high standards regardless of the regular pharmacist being present. I get it. I want that too for my patients regardless of my being present.
However, unannounced inspections are not the right solution to enhance service because regulation should be about the management of safe practice and not about finding fault to penalise.
Surely, a mystery shopper would be a better idea because an inspector wanting to see paperwork, audits, logs, records, CPD, history of consistency, get access to evidence-based practice, see the usual leadership in action and ask deep, searching questions. Surely the inspector wants to see the superintendent (or the regular pharmacist) who will know where everything is - either in files or on the office computer.
Otherwise it’s a wasted journey, more bureaucracy, more paperwork and more work for them in chasing that up, in addition to extra work for the absent pharmacist who is already coming back to a large mountain of paperwork. That could all have been efficiently prepared and presented with a planned visit. I fail to see how unannounced visits improve regulation.
Running a pharmacy these days is a bureaucrat’s dream and a practitioner’s nightmare; it seems to have been designed by the sort of people who have six ballpoint pens in their breast pocket and have no idea how to run a market stall let alone a pharmacy. Its rigidity has made life unbearably difficult for thousands of pharmacists, such as locums who do not fit neatly into the system.
In addition, the GPhC’s controversial method of assessing premises has dented the confidence of many pharmacists and made them hate their jobs. This is not in our patients’ best interests.
So, a good inspection report would simply depend on you kissing your rabbit’s foot and hoping your staff muddle through your paperwork in your absence as well as you. Because if they don’t, then you’ll feel as robbed and as unlucky as the poor three-legged rabbit.
Publishing inspection findings
The GPhC can tell us there is a problem, they can report it, they can tell the press, they can stand on the top of a hill with a megaphone and shout about it, but it won’t fix it.
There are staff shortages due to the worst financial cutbacks in history which are over and above austerity measures, vertiginous medicine shortages due to political influences, massive new practice workloads around FMD, ever-increasing work pressures thanks to ineffective professional representation and disjointed leadership and so much more besides.
If the GPhC must publish its findings, it would be fair and just for a contractor to have a response published next to those findings. The GPhC seems fond of counting pharmacies’ troubles but as far as I know, nobody counts our collective successes, victories and triumphs.
I go into pharmacies, read website reviews and see ‘thank you’ cards pinned to the wall especially at Christmas time. If every pharmacy receives 50 cards a year and there are 11,500 pharmacies, I make that 575,000 very happy people. That doesn’t need regulation because sometimes our most unhappy customers are our greatest source of learning and it is in our best survival interests to give people the highest standards of care.
Regulation should support us to deliver consistent and best all-round patient care nationally without it being overly expensive or as burdensome as it is now.
The GPhC is a curious regulator, part quango, part unofficial government department. Before it, the Royal Pharmaceutical Society of Great Britain used to consist of little more than a secretary and registrar who kept the register of pharmacists who were qualified to practise pharmacy and we had various committees including the statutory committee to regulate and police the profession. Today, the GPhC is a vast organisation with a huge budget, guaranteed income and a seemingly insatiable yearning for power. It employs a host of administrators who mostly have little or no experience of pharmacy in practice.
The GPhC does nothing to improve the quality of pharmaceutical care or medicines optimisation, it does nothing about poor commissioning, lack of resources, poor patient choice for instance, or the over-prescribing of antibiotics, but its staff constantly make statements about how pharmacists should practise pharmacy.
The real problem with the GPhC, however, is that it has been given the job of licensing pharmacists and premises. After Harold Shipman, it was decided in high places that something had to be done to protect the public from dangerous healthcare professionals.
Shipman had spent years methodically slaughtering over 200 of his patients and ministers were embarrassed. It was decreed that some form of regular testing should be introduced, not just for GPs but all healthcare practitioners, so that we in practice could be assessed.
The plans for regulating us were drawn up in 2008, implemented in 2010 (with the split of the RPSGB into the RPS and the GPhC) and designed to weed out rogue practitioners and make sure there would not be another Shipman.
Since 2010 the GPhC has built an empire and designed an entirely bureaucratic system for regulating premises and pharmacists which is guaranteed to increase its own power and income and largely ignores the fact that if Shipman were still alive and practising, he would sail through with flying colours. The proposed regulatory process and the revalidation scheme only further serve to increase our workload and increase our risk of errors.
Before you reach for the green ink and write to me, I am not excusing poor practice, rudeness, sloppy care, dirty premises, bad training or poor service but I am saying we need to get a sense of proportion and think more about light touch regulation because the risk is that by distracting pharmacists from the work they should be doing, the inspection and the revalidation scheme will cause, not prevent, further harm to patients.
It’s no wonder that, by its own admission, the GPhC is seeing an increasing workload which can only be down to two things – distracting over-bureaucracy and over-kill regulation adding to stressful workload pressures or poor regulation resulting in unnecessary low-grade referrals.
Every owner must unequivocally comply with their legal obligations, always work above minimal standards like complying with the Pharmacists’ Defence Association’s safer pharmacies charter, make staff happy and implement safety policies, even ones that are ghastlier than the boils on a witch’s sloppy face during a plague outbreak.
Since the GPhC’s consultations on costs and visits won autocratic approval, pharmacy feels more like that unlucky three-legged rabbit every day.
Sid Dajani is a member of the English Pharmacy Board.
Picture: LumiNola (iStock)