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The ‘poisoned chalice’ of supervision: where are we today?

Following a panel on supervision at the 2021 Pharmacy Show in Birmingham in October, C+D gathered panellists and pharmacy body representatives to discuss their views on pharmacy supervision and how the debate around this historically controversial topic will evolve in the coming months as a new supervision discussion group is formed. 

How did it all start?

 

Discussions specifically about “remote” supervision have been around since 2005, Pharmacists’ Defence Association (PDA) chairman Mark Koziol told C+D in an exclusive interview. Back then, the Department of Health (DH) was debating the same issues we are today; whether the model of pharmacy supervision was “fit for purpose”.

The 2005 Health Bill proposed allowing registered and suitably trained staff working in the pharmacy to oversee medicines supply – “not what we asked for”, Mr Koziol told C+D.

 “What we got was this idea of not having a pharmacist in the pharmacy at all, that pharmacies could be supervised by a pharmacist that was not on the premises” – the equivalent of “send[ing] a bloke with a flamethrower" to tidy a house, he said.

It is no wonder that the government then struggled for several years to make the necessary legislative changes to see this through, Mr Koziol added, “because they couldn't satisfy the patient safety auditors”.

Responsibility for supervision reform was then passed like a “poisoned chalice”, Mr Koziol said, from the DH to the newly constituted rebalancing medicines legislation and pharmacy regulation programme board in 2013.

Following widespread controversy in 2017 within the pharmacy community after C+D exclusively revealed plans to allow pharmacy technicians to oversee medicines supply, conversations around pharmacy supervision effectively ended – only to resume in early 2021 with the recent formation of a Community Pharmacy Supervision Practice Group, Mr Koziol explained.

 

Purpose of upcoming talks

 

Association of Independent Multiple pharmacies (AIMp) CEO Leyla Hannbeck said: “Nobody wants [the supervision conversation] to be lingering for years and years again", noting that there has to be “some resolution coming out of” the formation of the new supervision practice group.

The purpose of upcoming talks – due to start once a chair and secretary are chosen through group consensus – is to bring various pharmacy bodies and professionals together to “look at how pharmacy operates at the moment” and identify “examples of where things could potentially be improved”, Dr Hannbeck said.

“We want to make things easier,” she stressed.

For Mr Koziol, it’s about crafting “something that's fit for purpose for the 21st century”.

Dr Hannbeck and Mr Koziol are both part of the supervision group, representing AIMp and the PDA respectively. While no announcements have been made about who will chair the sessions, Dr Hannbeck told C+D she does have a favourite among some potential candidates and that she hopes the incoming chair will “put a pace to discussions and robust study”.

“I think it's important for everybody to be participating in these discussions, either through their representative body, or separately,” Dr Hannbeck said. “It’s important that everybody’s views are heard.”

 

What’s on the table?

 

Whenever the “emotive and controversial” issue of supervision is brought up “people start thinking that the whole idea is to get the pharmacist out of the pharmacy and replace pharmacists with some sort of a robot or give everything to technicians to do,” Dr Hannbeck said.

But that's not the case. “We are not talking about remote supervision,” she stressed. “From [AIMp’s] perspective, a pharmacy without the pharmacist is not a pharmacy.”

What is on the table is improving the “functionality” and “flexibility” of pharmacy processes, Dr Hannbeck said. For example, at present, a medicine that is already bagged up cannot be dispensed if the pharmacist is not present.

The supervision working group will also make sure that “patient safety” and “social care” are “highest on the agenda”, she added.

 

Do pharmacy bodies support change in supervision legislation?

 

Representatives from pharmacy bodies present at the Pharmacy Show's supervision panel and others interviewed later by C+D  disputed changes to supervision legislation, though Rowlands director Margaret MacRury told C+D last month (October 17) that pharmacists should allow trained staff to take over some responsibilities under standard operating procedures.

CEO of the Pharmacist Cooperative, Tohidul Islam, told C+D that making “further regulatory or legal changes” would only “weaken” existing supervision regulations.

It would allow companies that had pushed the limits of responsible pharmacist regulations – allowing pharmacists to be out of the premises for a maximum of two hours – “to abuse the law even further and start opening pharmacies without a pharmacist”, he warned.

“We do need more pharmacists in the pharmacy to do the clinical services, to do the day-to-day talking and dealing with patients, but changing legislation that doesn't need to be changed isn't the way forward,” he said.

 

“The future for a successful community pharmacy sector"

 

Mr Koziol said the future for “a successful community pharmacy sector” lies in the pharmacist being “more available to the public”.

“We want to make sure that the pharmacist can react both proactively and reactively when patients walk through the door,” he continued, with the pharmacist becoming “responsible for clinical checks and prescriptions”.  Having an independent prescriber in pharmacy premises is key to achieving that, Mr Koziol said.

“The kind of model of practice that we are advocating is one where you find more than one pharmacist working in a community pharmacy setting,” Mr Koziol stated, akin to GP practices that house several GPs, nurses and other healthcare professionals.

“We see there being a really vibrant and exciting role for community pharmacy going forward,” he concluded.

Join C+D's next Big Debate on November 16, 7-8pm, to discuss how pharmacy supervision can be modernised without compromising patient safety.

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