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John D'Arcy: Supervision in pharmacies 'has got to change'

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John D'Arcy pharmacy supervision requirements
John D'Arcy: With the increase in scripts, something's got to give

Numark’s managing director has said the sector needs to take a “broader view” on the supervision of pharmacies, to allow pharmacists more “headroom”.

In a letter, sent to Royal Pharmaceutical Society (RPS) assembly candidates last week, contractors Mike Hewitson and Ben Merriman stated that “many community pharmacists are extremely concerned” that the Department of Health plans to “empower pharmacy technicians to supervise pharmacies”.

Speaking to C+D the day after the announcement of his upcoming retirement, John D'Arcy said supervision rules “have got to change” to allow pharmacists to complete additional clinical work.

"It doesn’t make sense to be...physically checking every single prescription you dispense,” he said on Tuesday (July 18).

“Some pharmacies can’t do any more scripts and do it safely. You look at the volume and think: something’s got to give.”

The debate over supervision has been "raging" throughout his 37-year pharmacy career, Mr D’Arcy said. “I am not for one minute suggesting we don’t have pharmacists involved in community pharmacy,” he stressed.

However, the sector needs to implement a system that allows for more “headroom, retains accountability, retains the importance of pharmacists” and “starts a process that allows us to do more of what we need to be doing”, he added.

“Sensitivities” around supervision

“I fully understand the sensitivity around...pharmacists becoming redundant...if you allow technicians to supervise," he said.

But Mr D'Arcy pointed out that “with supervision, if you don’t relax it, you become so busy that you can’t do it.”

Pharmacy teams cannot take on any more work, unless there is a “radical rethink” to the “process of adding value to prescription supply”, he added.

Although supervision cannot be ignored, the “bigger debate has to be around accountability”, Mr D’Arcy said.

"The key thing is to have a process – a quality assurance system – to say, 'I'm accountable for that prescription, and it if goes wrong, it is my name on the block'," he added.

28 Comments
Question: 
Do you agree with John D'Arcy?

janet maynard, Community pharmacist

if supervision needs to change then responsibility needs to change with it. I am not prepared to ahve a crimonal record for someone else's mistake EVER!

CAPT FX, Locum pharmacist

A few questions at this juncture to deal with the inadequacy of the Non-professionals running Pharmacy.

I When surgeons saw their workload increasing, did they push to have theatre porters or nurses or anaesthetists to be accredited as surgeons? The answer is no

2.  There is an ongoing shortage of GPs and I have not heard anyone saying Nurses, Pharmacists or Health care assistants should be accredited to be GPs or to take over their roles.

3. I flew British Airways, the other day and when the Pilot fell ill they said is there a pilot in amongst the passengers? They did not accredit or promoted a flight attendant to be a pilot for those critical few hours. They wanted a qualified pilot.

Theatre Nurses, Porters, Anaesthetists and Flight attendants they see and observe the real thing every day of their lives and at times correct the Professionals when they are having a bad day. For them to do this work they need to train like everybody, attain that qualification and do the job, simple.

In Pharmacy, we see a situation where a 23year old is a dispenser and within a few months is made Manager and in the process turning themselves into a Pharmacist. You go with the flow or else spend the day fighting with an ignoramus who knows nothing about what they are doing. This is a practical reality of Modern day the United Kingdom where Patient safety is being sacrificed for profit. The world used to take their cue on Pharmacy standards years ago and sadly that focus has turned to The Donald's USA. This is because subservient  Pharmacy bodies and their patriarchs the Pharmacy owners think the few months a dispenser takes to qualify is equivalent to five years it takes a Pharmacists to qualify. We see this every day when Non-professional Pharmacy managers usurp Pharmacists' responsibilities. 

I have and will always argue that in our current format where Community Pharmacists have no say in their roles, we do not qualify to be paid as professionals. The Department of Health can save a bundle in one fallen swop by declaring we are over-hyped storekeepers. We are now fighting amongst ourselves to say who is better and cheaper, a Pharmacist or Technician?.  

The man who is quoted in this article is one of the people i will be delighted to see out of the door. Men like him when they occupied higher office forget what it means being a Pharmacist. How about increasing the number of Pharmacists per Branch to deal with the increased work load. Training s technician or ACT is a stopgap measure, its like training a robot. They know dispensary stuff but do not have the knowledge of a Pharmacist. Our profession is a knowledge based profession, period. Don't expect Executives to appreciate this even if they are Pharmacist because most of them don't even remember what Aspirin is. Their suggestions or solution betray their abject ignorance about their own Profession. Yet the apparatus at the Heavenly GPHC jump at everything they suggest.

Pharmacy, in general, has never been known to fight as a group. We actually tear each other to pieces and then present these pieces of ourselves to the world as negotiators. We will lose this battle and Technicians will be the torch bears of our Profession. People who come up with these suggestions always win, look at the Responsible Pharmacist nonsense. They always prevail. 

I was tempted to try a rallying call like lets fight to the last Pharmacist but I will change to let's lie prostrate and make Mr D'arcy walk into the sunset with a big smile on his face. Job well done. 

Leon The Apothecary, Student

To begin I would like to correct you. Technicians are, in fact, professionals. The General Pharmaceutical Council, the same people that certify yourself as a professional, recognizes that these individuals are professionals.

You mention the shortage of GPs, yet have you not heard of the expanding roles of Nurses and ironically Pharmacists into independent prescribing and the much debating minor ailments role?

Jonny Johal, Pharmacy Area manager/ Operations Manager

Benjamin, technicians did not feature in many pharmacies I managed, you may think they are professionals, but they are not essential. Live with the fact. 

CAPT FX, Locum pharmacist

No, no, no they are not professionals. They are Technicians in the Pharmacy Profession. For me to be called a Professional it took me the first 24 years of my life followed by one pre-reg year. 

This is why our profession is confused. Some of my Technician colleagues never passed GCSE and they are Technicians and even Non-Pharmacist Managers.  It is this perception that is slowly sucking the life out of our profession. 

Political correctness and outright stupidity, as well as greed, prevents direct debate on why Pharmacy continues to be managed by personnel who get stressed and flustered by the mere prospect of doing an end of day cash balance. Never use the GPHC as a measure of who they register as a Profession. If someone would advocate for canines tomorrow, the GPHC will register them as a Profession. Their confusion about their basic role is evident every day of our lives. We practice every day in a regulatory vacuum and you only notice their existence in most cases when they prosecute an ethnic minority Registrant.

Your point about GPs is actually a reflection of my assertion. Nurses and Pharmacists have minor and peripheral Prescribing roles. They are not GPs. In Pharmacy Non-Pharmacist Manager usurp Pharmacist roles particularly those employed by multiples. I see this every day of my life. They gleefully do this because they know they will never be made accountable. Those who came up with this idea did this on the premise of separation of responsibilities, Professional and Administrative. Pharmacists as trained professionals have no doubts about this boundary, yet the Non-Pharmacist Managers are blissfully ignorant of the situation. It's because they are not Professional Managers, they know absolutely nothing about management and they never studied management. This extends to all non-Pharmacist Area Managers.  

Professionals are people who took the time to study and got certified and registered in a certain field. What we have in Pharmacy where a 23-year-old Area Managers' favourite becomes Manager after 6 months in a Pharmacy whose Pharmacist has 15 years experience, is unheard of. The quality of service derived from this Branch will be the 6 months treasure trove of the Manager otherwise there will be regular thunder and lightning exchanges every day. This is the practical reality in all Non-Pharmacist Manager run Branches because they now see themselves as Pharmacists. My advice to the GPHC is that register them, so they become accountable for their actions. 

Ilove Pharmacy, Non Pharmacist Branch Manager

Can't say much to that. The main Issue for the GpHC would be how to collect the subscription from the dogs. Joke regulator, inevitably joke profession. In all seriousness there is actually more professionalism in your local branch of Burger King. And the wages are pretty similar too.

Allan Melzack, Community pharmacist

Surely if there is too much work for one pharmacist then another pharmacist would be a useful addition. If you give supervision and control away to non-pharmacists then you define the end of the profession.

Ilove Pharmacy, Non Pharmacist Branch Manager

That is the sort of Common Sense Logic viewed as heresy by the GpHC and their allies.

Bharat Rajpra, Primary care pharmacist

"Some pharmacies can’t do any more scripts and do it safely. You look at the volume and think: something’s got to give.” Mr Darcy.i dont think this a realistical view. So...for those few pharmacies that cant do anymore scripts you want to change the rules for all?? Who doesnt want to do anymore scripts? Do you understand the funding cuts, category M Clawback???

DM X, Locum pharmacist

Has D'Arcy ever heard of an ACT?

Beta Blocker, Primary care pharmacist

And looks like 'the shoe' has already got the ball rolling...

Valentine Trodd, Community pharmacist

allow pharmacists more “headroom” to complete additional clinical work...

What, like more MURs?

Leon The Apothecary, Student

You'd actually have time to do them, then having to do the usual quick math of "Do I have time to do this, what kind of pile of scripts will be waiting by the time I return?"

Chandra Nathwani, Community pharmacist

Just don't let this become "Grenfell" of pharmacy! De-regulate if you cannot afford pharmacists but do not claim to represent me in any discussions that lead to de-regulation!

 

 

Yo Palumeri, Community pharmacist

surely we should convert pharmacy into a health CENTRE, with the  pharmacist in charge and delagating as they see fit to a much wider range of health professionals, and offering patient holistic solution.  Would require a very differnt skill mix without loss of supervision.

Leon The Apothecary, Student

I like the idea of a health complex, with the combined professionals working with one another in the same building. Although a question: Does the Practice Manager have to be a healthcare professional themselves?

Ilove Pharmacy, Non Pharmacist Branch Manager

Not enough profits for some multiples to implement. Benfeit to patients is irrelevant.

Ilove Pharmacy, Non Pharmacist Branch Manager

Pharmacists need more time for clinical services - haha

*This comment has been edited to comply with C+D's community principles*

L H, Community pharmacist

So, can I remotely supervise from gaol then?  ...as we're still on the hook criminally for any errors that occur.  Easy for those whose lives won't be ruined by other people's mistakes to push for a supervision change.

Leon The Apothecary, Student

Only if you allowed a person to supervise who wasn't capable of undertaking the role. It's basic principles of pharmacy inspections. However, good point - training and certification is a must for those who would undertake a supervisory role.

Ben Merriman, Community pharmacist

I have no worries about redundancy whatsoever, Mr D'Arcy.  I do, however, have worries that having a pharmacy with no pharmacist able to intervene where necessary will lead to a reduction in the quality of care patients receive as well as risk their safety.  

Pharmacy technicians are of course an invaluable part of the profession but to equate the skills and knowledge they aquire during a two year part time course with those attained during a four year Masters with an additional year of full time pre-registration training is patently nonsense.  Accrediting more technicians with accuracy checking qualifications is surely the solution to the problem you pose, Mr D'Arcy.  Further to that, allow technicians (regulated healthcare professionals in their own right) to take responsibility for their roles and the part they play in patient care.  

I'm not aware of a single pharmacist who spent five years of training to make sure a label matches a box and the prescription.  So why not allow the pharmacist to free themselves from the checking bench and interact with patients, do medicines reviews, optimise medication regimes via supplementary prescribing arrangements, use our skills as experts in medicines.  I'd be happy if I never had to check a single prescription again!

Of course, we already have ACTs in today's pharmacies but we need more.  Given the reduced funding being faced by pharmacies, with the global sum cuts, reductions via category M, increased DTP models with reduced discount and branded generic prescribing, how on earth can anyone afford to invest in their staff and train them to be the best they can be and allow the pharmacist to do the same?

Paul Samuels, Community pharmacist

Just a thought--who takes  legal responsibility for errors?-- even allowing for ACTs involvement --its' unclear?

Leon The Apothecary, Student

RP has the responsibility to ensure that staff on site are appropriately trained for their roles. That means that the ACT is capable of checking the accuracy of prescriptions, as evidenced through their logbook and reaccreditation. A basic professional principle that can be found on the General Pharmaceutical Council website. The answer is quite clear Mr Samuels.

Ilove Pharmacy, Non Pharmacist Branch Manager

You aware that if you're not checking prescriptions that you're redundant. There are no viable NHS clinical services in community pharmacy. Multiples know this but have hoodwinked everybody and now pharmcy technicians/ambassadors/apprentices/whatever will be riunning the show as they can be legally paid below minimum wage. A most amazing con trick in plain sight and will save them millions. Downside is redundancy or salary little more than minimum wage for the unfortunate survivors of the cull.

janet revers, Community pharmacist

yes.....spot on

Sham Kiani, Community pharmacist

Well said!  

Suraj P, Superintendent Pharmacist

Nailed it with this comment

John [email protected], Community pharmacist

Perhaps if the numbers of pharmacist hours employed was increased to nearer the levels found in pharmacies in the past the work levels might not be a problem

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