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Clear approach to expertise in clinical settings needed


Clear approach to expertise in clinical settings needed

The dynamics and rules of a GP practice are different to those in a pharmacy. Community pharmacists need to be aware of this as they move between the two settings, writes Claire Ward...



Any organisation performing a leadership role should be trying to create the right environment and with the safest guidance to protect both their members and patients.

So it was right that the Pharmacists' Defence Association (PDA) should issue guidance in the last couple of weeks responding to certain member cases that the defence and legal team are currently dealing with. In the last month they have had a number of serious incidents reported and more worrying, some have escalated cases which have led to patient deaths.

The real challenges are coming from pharmacists currently working in GP surgeries, though not exclusively. Inevitably many GP Practice pharmacists have come from community pharmacy and are now, with some training, in a different kind of clinical environment.

In some cases they are seeing patients who have clinical needs and personal expectations that are different to those they might have if they had walked in anonymously off the street into a community pharmacy. It is also the case that the pressures in the GP surgery are leading some GPs to pass that on to the pharmacist and expecting them to deal with a more extended and complicated clinical case load.

Speaking as a patient for a moment, I make a judgment call as I think most people do about where they might seek appropriate treatment. I have a good idea of what would be appropriate to see my high street pharmacist for. I would expect a different level of treatment and expertise if I had made an appointment to see someone working within the GP surgery.

For more serious and urgent issues I would use A&E or a similar level of service and again would expect a level of service and expertise beyond that available in the GP practice or the local pharmacy.

In the same way that I am consciously considering the levels of competence, experience, access and appropriateness – even in broad terms – I expect that a pharmacist is undertaking that same thought process in relation to their own level of experience and competence; the dynamics and rules of GP practice are different to those in a community pharmacy. I doubt that I am unusual in this respect.

So the guidance issued to all pharmacists by the PDA is an important reminder that pharmacists – wherever they work – need to work with an understanding of the expectations placed upon their respective location and then to work within the limitations of their expertise and competency levels; this may change as they move to and from a community pharmacy to a GP practice.

Pharmacists should not be afraid to assess this before making a decision on prescribing that may have consequences simply because of the patient mix they are seeing in that environment. The use of the form My Boundaries of Clinical Practice statement issued to PDA members is a valuable tool to allow pharmacists to regularly reflect on their competency and to record it so that they can evaluate the levels that they work to.

The PDA recommends that in new settings it is not appropriate to assume that experience gained from community pharmacy is the same to be applied as a pharmacist in a GP surgery or even when working remotely within an online or distance selling pharmacy where a lack of access to patients can provide other risks. In new settings with high risk patients and prescribing its appropriate to consider the competency levels before making a clinical decision or prescription.

As the communication with members recently explained, in the event of a coroners inquest there will be an assessment of clinical competencies and the process adopted to assess how these have been reviewed in light of a treatment or clinical decision, especially if linked to the root cause of the death. So it is good and safe practice in addition to the protection of a pharmacist’s career to complete one of these forms and to be consciously aware of the boundaries of ones personal competencies before making key decisions.

This must of course only be the start of what the PDA, as a leadership organisation, should do to create the safest environment for patients and pharmacists. Surely there should be a wider push across the profession for a documented acceptance of a competency framework which allows a transparent approach to the level of experience and expertise appropriate to the clinical setting and patient mix.

Improving the safety of care should be in the interests of patients, pharmacists and those who represent the profession. The PDA has proposals to make in light of its experiences, it has already met with the General Pharmaceutical Council and it will be sharing its concerns with the government once the elections are over.

Done in the right way, the valuable role of a pharmacist in a GP practice can be a very powerful and beneficial one providing huge benefits for patients as well as professionally fulfilling careers for many pharmacists in the future. It's time for all organisations to work ensure that the stable yard door is firmly secured before any horses get a chance to bolt.



Claire Ward is director of public affairs at the Pharmacists’ Defence Association.






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