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Why COVID-19 has shown that remote supervision can never be supported

More pharmacists should be available to the public, not fewer, which is why the PDA doesn't support remote supervision, says Mark Koziol

The C+D blog published last week (July 13) from Rowlands superintendent pharmacist and Company Chemists Association (CCA) board member Margaret MacRury has re-ignited the debate and yet again raised serious concerns about the plan to operate a pharmacy in the absence of a pharmacists aka remote supervision.

The blog states that during the COVID-19 crisis, community pharmacy demonstrated its value as the “third pillar” of healthcare in delivering NHS services alongside GPs and hospitals. When access to the latter was restricted, community pharmacies kept their doors open, providing not only medication, but also trusted professional healthcare support and advice.

It claims that our country needs the community pharmacy network as a critical local healthcare access point and that an opportunity now exists to encourage the public to “think pharmacy first”. Who could disagree with any of these sentiments?

However, when the article later dwells upon viability issues and pharmacy closures in England and the fact that the current community pharmacy contractual framework may not be fit for purpose, it appears to propose that the panacea would be to embrace and promote new regulations about pharmacy supervision.

Given past events, it is unsurprising that many pharmacists who commented on the blog are concerned that the spectre of remote supervision is being raised again and as they quite rightly state, it makes no sense at all.

Undoubtedly, the reason why pharmacy was able to really prove its worth during the pandemic is because it delivered so much resilience to the nation’s healthcare system - which was arguably lacking elsewhere as GP surgeries, hospitals and dentists closed their doors.

Community pharmacies saw a large increase in footfall during the height of the lockdown, even though regular shoppers were no longer coming into the larger multiple pharmacies at lunchtime to buy sandwiches or cosmetics from the beauty counter.

If community pharmacy gets the recognition it deserves in a post-COVID-19  environment, it’s because pharmacists up and down the land proved they could be relied upon to make professional judgements and work flexibly in the interests of patients facing crisis situations. They did this despite the strict rules that otherwise govern medicines and pharmacy practice. This, surely, is the new normal we as a profession should aspire to.

The PDA agrees that the rules on supervision need amending, but if the public are to “think pharmacy first”, then pharmacists should continue to be able to make professional judgements and act in the interests of patients going forward, and even more pharmacists through a second pharmacist arrangement should be available to patients in community pharmacies.

Indeed, such an arrangement would be far more efficient than the traditional, broken and costly GP practice system. New rules on supervision and any new funding arrangements must make pharmacists more available to the public in a community pharmacy and not less so, as would be the case if remote supervision ideas were adopted.

During the pandemic, the PDA saw evidence indicating that pharmacists from some multiples were asked to remotely supervise more than one pharmacy simultaneously, and some companies developed elaborate guidance on how pharmacies could operate in their absence. We examined the standard operating procedures from some companies that would have normalised the operation of pharmacies without pharmacists.

When we contacted pharmacies, we learned that some businesses chose to operate with a pharmacist available only for limited hours in the day. It was claimed that the pandemic had created shortages of pharmacists, but this does not tally with our member surveys indicating that many available locums were not contacted – while others even had their bookings cancelled.

Perhaps some companies were shrewdly trying to create their own preferred future, one with reduced overheads and fewer pharmacists available to the public. It is evident to me that remote supervision is, for some of them, a desired objective. But in advocating this, have they considered the reduction in patient safety resulting from the absence of the pharmacist, not to mention the opportunities to improve the patient journey that would be lost?

These actions earned their superintendents a warning from the GPhC. Businesses were told that “operating a pharmacy in ways that are not compatible with the law cannot under any circumstances form part of a standard operating procedure”. The PDA believes that they got off very lightly and this cavalier way of working must never be allowed to happen again.

If Rowlands has a problem with funding in England, then why not simply join the rest of the sector in seeking to get this addressed? They could at least seek parity with the more forward-thinking pharmacy administrations in the other countries of the UK.

We now have a once in a generation opportunity for greater recognition of community pharmacy, but this surely must be based upon the greater availability of the pharmacist. We must not squander it by squabbling over a choice of two stark options: The first is a race to the bottom driven by a cost-cutting exercise to maximise short-term profits. The other is a richer, more professionally fulfilling role for pharmacists – delivering benefits for the health service and a dramatically improved patient journey.

Let our deeds match our words when we say that we no longer want community pharmacies to be seen as shops, but instead as healthcare facilities that are committed to the provision of safe patient care and working as part of an integrated patient facing primary care team.

Judging by the views expressed at the National Pharmacy Association conference last week, health secretary Matt Hancock agrees with this sentiment. He indicated that the door for discussions and the funding to create a win-win situation for government, taxpayer, pharmacy and patients is ajar.

Mark Koziol is chairman of the PDA

 

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