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Record learning outcomes

Mukesh Lad, chief executive of Mr Pickford's Pharmacy and chairman of Pharmacy Northants-MK, shares his experience of a recent GPhC inspection

We've all had those dreaded HMRC envelopes drop through the post, and I'm sure you recognise that automatic reaction of thinking you've made an error on your tax return. Instead, it's just a new tax code!

This happened to me recently, but the letter wasn't from the taxman. Even worse, was a dreaded GPhC inspection visit. My manager and I were hit by instant anxiety.

Luckily, we'd both attended an NPA presentation that provided us with valuable information for the day of reckoning. Don't pass up the chance to attend one of these events if it's offered you. They are extremely informative with detailed insight into the thinking and mechanics behind the entire process.

So the following day, armed and ready with our newly-acquired knowledge, we arrived at our pharmacy ready for implementation action. We barely had a week to turn it all around when one Friday morning the inspector arrived.

Unnerving moments

I'd forgotten quite how unnerving it is to realise you have a 'patient' in your practice, albeit one you don't recognise, who's watching your every move and noting them with interest. No introduction and no clue as to his real identity until, in his own good time, he approached the pharmacy counter, introduced himself and asked to speak to the responsible pharmacist or manager.

With introductions all done, the first request to the pharmacist was for the CD key. What a relief to see staff following our SOP and having the keys on him!

With a casual approach to the counter assistant the inspector enquired about her role, qualifications and how she handled the sale of medicines. Was she is involved in the dispensing process? Did she put deliveries away in the dispensary? Did she dispense? Did she have a qualification to dispense?

He talked about her relationship with the pharmacist and management in general, and about the ability to talk openly. Did she feel listened to? Was there two-way communication in the shop between staff and management?

Next was the dispensers' turn. What did they understand about standard operating procedures? A discussion about all aspects of dispensing processes then ensued. Which clinical services were provided? Did the pharmacy provide a blood pressure monitoring service? Did we deliver NHS Health Checks and seasonal flu vaccinations on site? How was this advertised?

Testing, testing . . .

The questions were seemingly endless and include information about regular testing of equipment such as the blood pressure monitor and the CardioChek point-of-care testing kit. Did we perform routine checks for accuracy and safety? As most of our equipment was recently purchased we had no problem in passing the test with flying colours.

Luckily, we'd both attended an NPA presentation that provided us with valuable information for the day of reckoning

Be prepared for every aspect of your business to be inspected. Nearly an hour was spent in the consultation room reviewing every SOP on site. Some were incomplete and some were not available at the time of the visit €“ all details were noted without fail.

A dispenser was asked whether she had a regular appraisal. Did she feel it was an interactive process that gave her the opportunity to raise concerns? If so, were they addressed appropriately?

The pharmacy manager was next in line for the SOPs cross-examination. But it didn't stop there. Data protection and governance issues were explored in depth. Examples of MUR/NMS data storage were discussed. Were near-miss logs used and incidents reported? A detailed explanation was called for and an illustration of the learning outcomes by the member of staff being interviewed. Remember that it's always necessary to give specific examples of these events and the learning that changed our process and ultimately improved patient safety.

Keep calm and carry on

Considerable time was spent reviewing the CD audits, register and patient returns. Not content to stop at this, the inspector then interrogated the pharmacist. I can't emphasise enough just how stressful this experience can be, while the pharmacist still has to oversee the normal day-to-day running of the business.

Multi-tasking is also the order of the day for the inspector. While he's talking to individual members of staff, he's also walking throughout the practice and dispensary area looking at details such as the condition of the sink area. He asked to look at the fridge temperature log and checked it thoroughly. He asked staff about the expiry date checking and whether we had a process, and they all spoke about our date checking matrix. So far, so good.

He asked the pharmacist about NHS Mail and security around transfer of patient information. Did he get medical alerts, such as drug recalls and patient safety information?

A working lunch

One o'clock and lunchtime. Did you really dare to think the inspection process might stop for a moment of respite? Well think again! The inspector had a working lunch, discussing various issues with the pharmacist, including his concerns about governance and the ease with which people could peer through the small glass panel in the consultation room door infringing on patient confidentiality.

Information governance and confidentiality issues were next on the agenda for the pharmacist, together with suggestions on how to overcome them.

Just as all hope of an interlude was fading, the Inspector retired to the consultation room to write up his report. Once complete, all that remained was for our pharmacist to sign an agreement that it was an accurate reflection of what had just taken place.

Four hours later and the ordeal was finally over. Or was it? To date, there's no such thing as an 'excellent' pharmacy. Or is there?