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Unannounced inspections could uncover low staffing levels, GPhC told

GPhC: A common argument was that surprise inspections might not show pharmacy in its true light
GPhC: A common argument was that surprise inspections might not show pharmacy in its true light

Unannounced pharmacy inspections could help uncover poor practice such as low staffing levels, “a number” of pharmacy professionals have told the regulator.

The General Pharmaceutical Council (GPhC) proposed making inspections “unannounced as a general rule” – a potential shift from the current policy of giving pharmacies between four and six weeks’ notice – in a consultation that closed in August.

The GPhC received 812 written responses from individuals and organisations to its 12-week consultation. Of the 684 individuals who responded, 62% said unannounced inspections would “provide more assurance that pharmacies are meeting [GPhC] standards every day”, while 31% said they would not, and 7% said they did not know, according to documents released ahead of a council meeting held last week (November 8).

Half of the 123 organisations who responded said that unannounced inspections would provide more assurance that standards were being met, while 40% said the opposite, and 10% said they did not know.

The GPhC said “a number of respondents, mainly pharmacy professionals, were in favour of unannounced inspections due to their potential to uncover potentially poor practices – [such as] low staffing levels or unfollowed standard operating procedures”.

However, “a lot” of respondents “disagreed” with the unannounced inspections because they were “seen as unfair to pharmacists and [would give] the impression they were not trusted to do the right job”.

“Respondents often said that unannounced inspections would be disruptive and stressful for the pharmacy team, adding to the existing burden in community pharmacy,” the GPhC said.

“A common argument was that there might be an emergency or an isolated incident of poor performance on the particular day of the inspection, which might not show the pharmacy in its true light,” the regulator continued.

“There were a few mentions of a disproportionate impact of unannounced inspections on small independents, compared to big multiples,” the GPhC noted.

Patient care “would not benefit”

“Some” respondents said unannounced inspections would mean the pharmacy team would be “unprepared” and not know what to expect during visits, the GPhC said.

Others said that “patient care would not benefit” from unannounced inspections “in the long-term, as the pharmacy team would be ‘inspection focused’ all the time”.

“A regressive step”

There were also respondents who were “sceptical” that surprise inspections would prevent poor practice, “as those who were breaking the rules would do so regardless”, the GPhC heard.

“A few” respondents perceived the move “as a regressive step, as this used to be the norm at the time of the GPhC’s predecessor”.

“A group” of respondents shared the view that inspections are currently “pretty much unannounced”, as the window of four to six weeks gives “little notice of when the inspection would actually take place”.

Would unannounced inspections be possible?

Some respondents were also concerned that key staff or evidence may be unavailable in the pharmacy at the time, which could hinder unannounced inspections, the GPhC said.

For example, respondents wrote that “a locum working on the day might have limited knowledge of the services provided by the pharmacy or the whereabouts of key documentation”.

Premises that respondents said might be difficult to access unannounced included internet pharmacies, as well as pharmacies in airports, the GPhC noted.

In the consultation document, the GPhC acknowledged that “there may be situations when it is not possible for us to inspect a pharmacy unannounced”, such as prison pharmacies and those in “other secure environments”.

But respondents also flagged “exceptionally” busy periods – such as Christmas and Eid, during stock-taking, and in newly opened pharmacies – when “unannounced inspections might not be possible” or could “have an adverse impact on patient safety”.

Read the summary of responses to the consultation in full here.

Do you want GPhC inspections to be unannounced?

Honest Pharmacist, Community pharmacist

The store I worked at had an announced visit and all it meant was that the LP Area Manager made sure he was there and blatantly lied to the GPhC Inspector and the staff were too intimidated to say anything for fear of retribution. He lied about training time, staffing levels and also said there was no pressure about MURs when he was carrying out disciplinaries on Pharmacists that didn’t hit the unachievable targets. 

Chemical Mistry, Information Technology

Then what!!!!!!

Maybe there could be a two tier inspection system?

A "soft" inspection for unannounced visits that could identify obvious dangerous practices by simply observing the dispensary. It would soon become apparant if there were staff shortages or clear breaches of standards.

A full inspection could be carried out with prior notice as it is done now so staff don't feel pressured into finding paperwork from here, there and everywhere at short notice to show the inspector it has been read and signed.

This may not be possible with the number of GPHC inspectors employed, but might be worth considering.  

Benie Locum, Locum pharmacist

I believe the GPhC werer also told that multiples were enforcing targets for MURs on hapless pharmacists and punishing them when they weren't met. I still have not heard of any action taken by the regulator so now they've been told that these visits will uncover low staffing levels where is the evidence the GPhC will do anything about it ?

Meera Sharma, Primary care pharmacist

Agree with unannounced visits - if that is what it is going to take to tackle HQ greed and poor staffing levels, then so be it. However, the GPhC should be fair - if a locum is in on the day, then by all means allow the normal staff to produce paperwork. After all, why is the locum being left on his own - that in itself is not safe practice is it? The staff shoudl follow the SOP to show the locum where all the relevant paperwork is - which I bet never happens. Poor staffing and dangerous dispensaries will not be uncovered in any other way.

John Smith, Locum pharmacist

Inadequate staffing levels, which are almost always the result of proprietor greed, is the single biggest danger to the safety of the public. It has and will continue to cost lives in the future, as well as have a serious impact on the mental health of pharmacists. For the GPhC to still not have tackled this subject while claiming to protect the safety of the public is an utter dereliction of duty.

 I for one am absolutely sick to the back teeth of working in incredibly dangerous, understaffed stores, multiple and independent alike, while being told that as RP, it is my duty to ensure safe staffing levels. No, it is the duty of the superintendent pharmacist with oversight and enforcement by the GPhC. As a locum or employee pharmacist, it is not my job to hold greedy owners to account on thier staffing levels.

And many times I have worked in stores that ship in staff from other branches in anticipation of a visit from the inspector, only for said staff to disappear again after the visit. Absolute scandal.

Yes to unannounced inspections, and yes to standards for safe staffing levels. It is truly unbelievable that we are still waiting on these basics.

David Moore, Locum pharmacist

I started my pharmacy career in the days of unannounced visits. I got quite used to dispensers brushing past me, dropping the controlled drugs key in my pocket.
But on a serious note, if the inspector called when a locum was present, they didn't object if not all the documentation could be found. They could recognise a poor pharmacy and make a subsequent visit.

Graham Morris, Design

I'm from the era of unannounced visits. Not a problem if you run an efficient pharmacy. Never had any problem whatsoever. What it will do is to identify staff under immense stress and allow the inspector to pursue staffing levels against the pharmacy script numbers. A well run business should have nothing to worry about. Those who understaff and overwork their staff may well have a different perspective. The GPhC should encourage some of us retired pharmacists to "inspect" pharmacies, I'd do it for nothing to protect the profession from the pressures of accountants and shareholders! May be a breath of fresh air for us old timers to say it as it is! 

Leon The Apothecary, Student

I respectfully disagree with Keith, standards are named as such because they should standard, and an unannounced visit should have little bearing on what is seen in an inspection, moreover it would be far more insightful.

My opinion is an inspector shouldn't be there to bore holes in a premise, but to help fill them up. Finding what's wrong with a place is far more important than our egos, in my humble opinion.

We are supposed to be patient-focused, this is one way we can show it. 

Keith Howell, Primary care pharmacist

Nope. CQC use announced inspections for GP surgeries. Why should it be different for pharmacies? Inspections, like examinations, are tense, stressful, events which don't always reflect actual practice. A little forewarning is only fair.

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