The Which? investigation earlier this month showed up some interesting results – although not completely unsurprising to me.

The consumer charity rated 11 of the 36 pharmacies it sent mystery shoppers to as "poor", for either failing to warn that two ibuprofen products should not be taken together, or unnecessarily refusing the sale.

From the report, it seems some of the questions asked by staff in the pharmacies that were investigated appear to have been simply mechanical. It appears these questions were asked just because it is protocol to ask WWHAM, but without picking up on the key information needed to provide a safe sale. Is this an indication of low-quality training? Or simply a rushed staff member who is letting their standards slip due to pressures?

Speaking to customers while checking off WWHAM is a skill that people have varying success with. As someone who’s done this job for 10 years now, I have developed the ability to fit my questions into a normal conversation. Others – particularly those who are newer to the job – may struggle to do this, and can churn the questions out in what I would describe as a 'robot conducting an interrogation' fashion.

Sometimes the right questions do get asked, but there is no follow-up when a risk is identified. The only way that knowledge is developed is through studying.

I remember during my younger, fresh-faced days, the pharmacist who trained me would randomly pick products and ask me a series of questions about them. If I couldn’t answer his questions, he made me study to improve my knowledge and test me further.

At the time I thought it was tedious, but now I am always aiming to improve my knowledge, and ultimately provide a much higher level of expert advice as a result. It meant my training was more than just a tick-box exercise.

Tackling the challenges

The challenge is then, how do we imprint that onto others? And are the resources available to be able to do this?

Unnecessary restrictions [on the sale of OTC medicines] are something I’ve seen plenty of times before, and sometimes for the most unusual things. I remember working with a pharmacist who refused to sell more than one small box of citric acid powder to a 90-year-old patient who, considering the rest of the contents of her shopping, was planning on making some lovely elderflower cordial.

The pharmacist's reasoning was that she could have used the powder to inject drugs, or create explosives. These were ludicrous assertions considering: you can buy drugs and explosives cheaper online, in larger quantities; citric acid is going out of fashion when it comes to this alleged usage; and she told me she was making elderflower cordial, even showing me the cut-out recipe she’d found in a newspaper.

However, to play devil's advocate, there is a level of confusion between guidelines and law in some cases that does lead to some absurd results.

What does the law say?

Which? also conducted a separate "undercover scenario" – attempting to buy four 16-tablet packets of regular paracetamol – at 42 pharmacies, supermarkets and discount stores, to see whether they are adhering to Medicines and Healthcare products Regulatory Agency (MHRA) guidelines.

The MHRA's 'best practice guidance' from 2012 states: "The maximum pack size for pain relief medicines in a general sale outlet is 16 tablets or capsules. A pharmacy may sell larger packs containing up to 32 tablets or capsules under the supervision of a pharmacist. It is illegal to sell more than 100 tablets or capsules of either paracetamol or aspirin in any one retail transaction."

The two-pack maximum guidelines – which state "don't sell more than two packs in any one transaction" – are simply that: guidelines. You can sell as many tablets or capsules as you like – up to the legal maximum of 100 – as long as the individual pack sizes are not above 16.

Legally, places like Poundland – which the report alleged was "worryingly" selling three 16-tablet packets of paracetamol for £1 – could sell six packs and still be perfectly within the law. Buying 42 tablets for £1 is not a bad deal, and comes without questioning from a pharmacist, so little wonder why it might appeal to consumers.

Pragmatically one could also argue that restricting sales is, to a certain extent, simply lip-service. I'm pretty sure one could, if one wanted, acquire well over a thousand paracetamol tablets over the course of a day. However, restricting sales does limit the possibility of impulsive or accidental paracetamol overdose. There’s been many a time I have refused a sale when the patient did not realise there was a contraindication with one of their existing medications.

It’s an area of legislation that could be argued is not fit for purpose, and one I think needs updating. The Royal Pharmaceutical Society has already called for a change to the Medicines Act to prevent retailers from offering multibuy deals on paracetamol. But I fear the likelihood of this happening is low.

Benjamin D'Montigny is a dispenser and pharmacy branch manager in the south of England