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'Remote pharmacy supervision could allow flexibility in a crisis'

Mike Hewitson: It’s really important we keep pharmacists in pharmacies

The option to remotely supervise a pharmacy in a crisis as a last resort could be helpful for pharmacists in some situations, says contractor Mike Hewitson

Whether pharmacies can ever be responsibly supervised without a pharmacist on-site has been a key debate in the sector over the last three years. The controversial issue arose again as a result of the pressures on the sector caused by the COVID-19 outbreak.

In March, the General Pharmaceutical Council (GPhC) announced that pharmacies could open in emergencies with a pharmacist accessible by video link or phone to enable them to continue supplying medicines. The council stressed that this should only happen when the responsible pharmacist has had to leave unavoidably at short notice and when no locum cover could be secured.

Pharmacy professionals are split on the topic. Mike Hewitson, owner of Beaminster Pharmacy in Dorset, says that, if carefully managed, the option of supervising remotely could help responsible pharmacists to continue to supply medicines in a crisis.

The decision to have a pharmacist supervise remotely could be used when "there is no other way my patients can access their medicines”, he tells C+D in a podcast.

“If it was snowing outside and not safe to get to work, and I have patients that need medicines, then potentially I probably would be prepared to [remotely supervise the pharmacy] short-term on a very occasional basis. But I certainly wouldn't be happy to do that to, for example, attend a meeting.”

He stresses that “it’s really important we keep pharmacists in pharmacies because it’s a really important part of the service we offer”. If a pharmacist does have to resort to supervising remotely, however, this should be “accountable, transparent and justified”, not a routine action or used as a cost-saving exercise, he says.

Listen to the podcast to hear more from Mr Hewitson on:

  • How the responsible pharmacist should be the one to make the decision on supervising remotely, not a superintendent pharmacist located outside the pharmacy.
  • The importance of having adequate safeguards for remote supervision.
  • The risks of replacing a pharmacist with an AI chat bot.
  • Every incident of remote supervision should be logged with the GPhC.

Please note, the sound quality of this podcast may be affected as it has been recorded remotely during the COVID-19 outbreak.

18 Comments
Question: 
What do you think of remote pharmacy supervision?

Invictus Maneo, Student

Whatever happened to planning ahead?
Wouldn't a responsible approach be to make extra provisions to relocate a Pharmacist or more Pharmacists for any given period in anticipation of extreme events?
Emergency funds should be available for such exigencies?

Why should standards drop in crises, especially when the Pharmacist is the essence of a Pharmacy? Can a neurosurgeon dictate inasive surgical procedures remotely to a theatre assistant ever?

Graham Morris, Design

Be very, very careful of what others wish for! Thin end of the wedge.

Anthony Chape, Community pharmacist

There is a instrinsic fault in any premise of allowing remote supervision. The very nature of human behaviour dictates that what ever becomes permissible (even in the extreme) becomes a right a few years further down the line. It's not that it's the thin end of the wedge, its the idea that once the horse has bolted, that there will ever be a time when or if, it could be reigned in.

There is no good time to allow remote supervision as any default position. If there are extreme pandemic circumstances, then produce legislation in the moment that deals with the problem, but generalised remote supervison is not good. 

We ned the confidence and professional courage to say that what we do is important and adds real value and that recognises the professional presence of a pharmacist is necessary in the moment, not just a financial inconvenience.

Reeyah H, Community pharmacist

I agree with Mike. It's quite clearly to be used only in exceptional circumstances. 

Mike Koumis, Community pharmacist

There is no valid reason for remote supervision. With approximately 50,000 registered pharmacist and 3,000 qualifying yearly; there are more locum pharmacist than plumbers. Of course , we all know a DIY job is a lot cheaper than getting a professional in!

Mike Hewitson, Superintendent Pharmacist

Hi Mike, this isn't about routine remote supervision. I made it clear in the podcast that this has to be exceptional, at the discretion of the RP and must have adequate safeguards to protect against abuse. I am not talking about using it to cut the wage bill or to undermine locum or pharmacist pay rates. 

Kevin Western, Community pharmacist

....and as soon as there is a chink in the armour, it will be chipped away at until you can remotely supervise if there is any chance a pharmacist might not be available... then it will become routine...i'm very surprised if you are really  this naive Mike.

Benie I, Locum pharmacist

You may not be talking about it but that is exactly what it will be used for.

David Jones, Community pharmacist

“If it was... not safe to get to work" - there you have it. What one person considers safe is open to potential abuse. Looks very wet out there. Wow that wind is very strong. This is a non-starter hopefully.

C A, Community pharmacist

“If it was snowing outside and not safe to get to work, and I have patients that need medicines, then potentially I probably would be prepared to [remotely supervise the pharmacy] short-term on a very occasional basis." Mike Hewitson, owner of Beaminster Pharmacy in Dorset

Right lets play out the "once in a decade adverse weather event" scenario. 

The weather for what ever reason is so severe that the pharmacist/owner can't get to work - is it OK for the company to ask the staff to get to work?

If the rest of the staff can't get to work, the shop will be closed and empty, so then remote supervision doesn't really help now then does it? 

For the multiples it's a bigger problem as they like using pharmacists that travel 100+ miles each way to get there, but the simpler solution seems to be use locally located locums... except they cost more, or offer to put locums up locally, which is what happened during the 'beast from the east' but again that costs more.

Mike Hewitson, Superintendent Pharmacist

 

Hi, 

As I say in the podcast, Remote Supervision should only ever be an absolute last resort. I don't advocate that it should be used routinely, and should be subject to safeguards to avoid abuse. 

The situation with snow happened to us a while back where I could not get in to work as I live in a different town, but my staff could all safely walk to work. We had a patient that urgently needed a medicine which we had already dispensed but were not able to legally supply because there was no RP on site to supervise the transaction. What do you do in that circumstance? Supply and break the law? Or don't supply, and fail in your professional duty to make the care of the patient your primary concern? Putting some provision to allow for the RP to make the decision is in my mind a sensible precaution. 

In rural areas like ours there are not huge numbers of pharmacists, let alone locums. We already pay in excess of the going rate and it seems fanciful to think that anyone is going to travel hundreds of miles to get here, especially if there were adverse weather conditions for example. 

Leon The Apothecary, Student

I believe a dispensary can act remotely.
I don't believe a pharmacy can.

C A, Community pharmacist

Maybe the DoH will just downgrade all pharmacies to dispensaries then...

Chris Locum, Locum pharmacist

There is no fallow year. There are sufficient numbers of pharmacists. We have not been ravaged by an outbreak of ebola (thankfully). I suppose the ridiculous Government notion of curfew might cause a problem with late-night pharmacy closing and workers getting pulled over by the plod, but then these politicians appear to be completely clueless anyway.

Pear Tree, Community pharmacist

Let's stop the pretence remote supervision is about emergency or patient need. It's mostly about money and, sadly, depreciation of the role of the pharmacist in the eyes of employers. I would be very interested if employers  defined what would be described an"emergency" in black and white. Maybe Death? Once in a generation weather event? Locum cancelling shift three days before shift was due? Or maybe the only available locum had a bit of self-respect and declined £18/hr on sunday night?

Mike Hewitson, Superintendent Pharmacist

Hi, 

I believe it should be for the RP to decide, with adequate safeguards to avoid undue interference or reprecussions from the owner or superintendent.  I do not believe that Remote Supervision should be used in anything other than exceptional circumstances. 

Pear Tree, Community pharmacist

The main reason pharmacists should say NO to remote supervision is abuse of RP policy which seems purely crafted to shift responsibility from owner to the pharmacist in the first place.  It's written for a fictional land where employers would provide adequate provision to run a pharmacy safely. We know who wields real power in pharmacy land. Employers dictate, bully, and extract maximum value at the lowest risk while the pharmacist risks losing job, car, mortgage, and family life if he/she stands up to employers. The abuse of MURS, NMS, chronic understaffing are just a few examples which show who calls the shots.  It'll only be a matter of time before RP is required to supervise multiple pharmacies with a few ££ incentives thrown in or else. 

Andy Krestoff, Locum pharmacist

The reality is as described above, any further relaxation of the RP rules is the equivalent of turkeys voting for Xmas.

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