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PDA deals with various ‘critical incidents’ involving GP pharmacists

PDA: Some cases involve pharmacists prescribing inappropriately

The PDA is currently handling several “critical incidents”, including cases of patient deaths, involving GP pharmacists prescribing.

The Pharmacists’ Defence Association (PDA) is becoming “increasingly concerned about incidents of unsafe practice”, after seeing a rise in the number of “critical incidents that may harm patients” involving GP pharmacists, it said yesterday (November 19).

It is also “in the early stages of dealing with cases where patient deaths have been reported”, it said.

The increase in serious incidents has emerged as the number of independent prescribers working in GP practices has risen, the PDA claimed.

“Some of these recent cases are linked in some way to pharmacists prescribing inappropriately or offering poor advice, often underpinned by an assumption of competence, which was ill-founded,” it explained.

The PDA urged members with prescribing responsibilities working in all settings to adopt “significant levels of caution” and highlighted four prescribing scenarios that would be considered “high-risk”.

These are: prescribing for patients when they are not physically present; prescribing without reference to a patient's clinical records; prescribing for walk-in patients where diagnosis may be required; and prescribing different medicines during shortages.

While the General Pharmaceutical Council sets standards and expectations on the conduct of employers, “healthcare professionals are responsible for their own conduct and will be held accountable for their actions”, the PDA warned.

28 Comments
Question: 
Are you an independent prescriber based in a GP practice?

V K P, Community pharmacist

these are not jsut a handful who are tarnishing the reputation. it is all of them. they are all wannabe doctors. infact they are barefooted doctors who have assumed they have the comptence and consciously embarked on the prescribing path and exposing patients to harm. this is not the role of a pharmacist. the incidents were bound to happen as all the wannabes who failed to get into med school found another way in and forgot how they did not manage to get into med school in the first place. carry on providing inferior quality patient care and we shall see further blemish on the pharmacist title. pharmacists should refrain from asking to raise blood test and be able to see blood test results. they are only asking for more liabilities with all the information without the resources to cover for the time spent on interpreting the results. what are they going to interpret in the first place?

 

Greatly Pedantic Highly Clueless, Senior Management

Unfortunately, this is not surprising. Relatively inexperienced pharmacists (Band 7) are being thrust into clinical roles they are not trained for. The training they receive from CPPE under the GP pharmacist training pathway in my opinion is not fit for purpose and questions need to be asked. As per usual with CPPE, there is plenty of fluff on reflective learning involving Post-it notes but nothing for example on how to order blood tests on Systm One and what tests are appropriate (something that clinical hospital pharmacists would rarely do).This is something that primary care pharmacists do on a regular basis. 

Locum Pharmacist, Locum pharmacist

I have seen some spectacular prescribing errors made by gp's in my almost 20 years as a pharmacist.These of course are swept under the carpet.

Richard Binns, Primary care pharmacist

 

The article is discussing incidents which have resulted in patient death, I very much doubt similar incidents are being 'swept under the carpet' because they have involved a GP.

 

 

 

A LOCUM, Community pharmacist

When it comes to the blame game GP's are professional experts at pointing the finger at others. In comes a newby member of staff, the IP , you can write the rest .................

Arun Bains, Community pharmacist

Comments like this cheapen the profession and make pharmacist seem unpragmatic and childish 

A LOCUM, Community pharmacist

Its obvious you know very little about GP's , its not childish , its the truth

Richard Binns, Primary care pharmacist

'its not childish , its the truth'

No that's quite a damaging accusation against another group of professionals, formed from personal opinion, made on a public forum

I don't see were 'blame' comes into this, its about being professionally accountable for your own actions, and I'm sure the individuals involved in this currently feel terrible about the situation they find themselves in and the implications to the patients and their families involved

Making comments like that above is just plain insensitive to all involved

Benie I, Locum pharmacist

Whilst pharmacists continue to flight eachother and cut their own throats GPs continue to negotiate better deals  for themselves from the government.....

Leon The Apothecary, Student

I am sure they feel free to can make disingenuous comments because they can do so under a pseudonym. 

Snake Plissken, Student

It would be great to have further details of these incidents. We have no numbers or rates of which these incidents are occuriing compared to other HCP. It would be interesting to see how other HCP, especially GPs would deal with such patients. A bolam test would do a great deal to shedding some light on these events.

These cases are sad and does influence our thoughts on whether pharmacist belong in a GP practice. To balance things, how about we have some success stories on where GP pharmacist have positively impacted and saved lives. This week a patient I had referred for an chest-xr due to symptoms she presented with actually turned out to have a mass and was promptly referred onwards to oncology for further tests. It was either making this intervention or saying to the patient sorry, go and see the gp which could have left the patient another 4-6 weeks for a routine appt.

A B, Community pharmacist

Would be useful to know if the percentage of pharmacist IPs being investigated is any higher than IP nurses, paramedics, physios etc.? Or at least the number of cases the PDA is dealing with so we can judge how prevelant these incidents are, without facts we're speculating on the merits of pharmacist IP. It is inevitable there will be some incidents, unfortunately some critical, involving pharmacist IPs, as there is with any healthcare professional.

The key is that pharmacists shouldn't take on roles they have not been adequately trained for and GPs should not ask them to. I've heard of cases where newly qualified IPs (not just pharmacists) sit in with a nurse or GP for a couple of sessions then all of sudden can have their own unsupervised clinic. This shouldn't happen. 

Leon The Apothecary, Student

Agreed, this information on its own does not really paint a clear picture regarding what is going on. For example, one could deliberate that the reason why PharmIP incidents are increasing is because PharmIPs are being used more.

D Change, Community pharmacist

I honestly think this IP is nonsense. It's great to give pharmacists new roles but that is one job way above their qualifications will ever get. In desperate times the government will lower the standards to provide patient care. That's what happened. suddenly we can become prescribers even though we've had barely any true tested training.

Pharmacists belong in pharmacies. They dispense medications and some advice when necessary. Occasionally services like Flu Jabs and reviews ( the later which have now been withdrawn) are great and useful services to provide. This new age drama around the profession is simply just low level fog that cloud the eyes of the newly qualified person to dream about "clinical" prescribing roles which they'll never be fit for.

I'm not a negative person. But when things are going wrong when we had never been fit for the job in the first place...we shouldn't be asking ourselves why...instead, what do we do with our futures.

Leon The Apothecary, Student

I have to disagree with you completely. I'll add another example of paramedics being given prescribing powers, when 20 or so years ago, they mostly just drove ambulances.

Pharmacists are actually in an ideal position to be prescribing medicines. The skill that they perhaps lack is diagnostics, and it would not be unfeasible to include this into a prescribing course. 

It is my opinion that you could remove a pharmacist from a dispensary once a clinical check on prescriptions has been conducted. Pharmacists very rarely dispense medications, that's done by dispensers and technicians, and more frequently, by automation. There is little value to having a pharmacist dispense.

Craig Marsh, Community pharmacist

So do you think nurses are better suited to prescribing roles than Pharmacists?  The key is gaining qualifications (and experience) that will enable you to prescribe in that area, such as the advanced clinical skills course specifically designed for Pharmacists prescribers by the university of Manchester.  If you don't move with the times, you'll get left behind.

Nahim Khan, Primary care pharmacist

Does the 'D' in D Change mean "Dont Change"?
NMP does work and is sucessful. This is a case of being asked to do things you're not competent in doing.

 

 

Richard Binns, Primary care pharmacist

A lot of posts on here show a lack of insight into nmp roles, maybe CD could look outside the sphere of community pharmacy in these articles and site examples such as specialist nurse roles in chronic disease management and palliative care as examples of where nmps have improved patient care. If pharmacists undertake this professional development alongside their core skill set relating to the use of drugs then there is an important role for them within the nhs, but only if they practice responsibly within their competencies

anti-depressed Pharmacist, Manager

10-13 years to become a GP, and only half a year to become an IP Pharmacist. IP Pharmacist specialise in one field but the whole point of a GENERAL practitioner is to have general knowledge of everything.

Government just want to save money by not employing another GP.

Richard Binns, Primary care pharmacist

Or delegate the gps workload responsibly I. E. Chronic conditions nmps, acute presentation anp/gp, complex patients gp/mdt

Richard Binns, Primary care pharmacist

Obviously with the fail safe to escalate to gp in a consultants role if something doesn't add up or someone feels their overstretching professionally

Leon The Apothecary, Student

Richard, I've been studying PPs who have been doing this exact thing! 

Ronald Trump, Pharmaceutical Adviser

There's a minority of cowboys out there tarnishing the reputation of the majority of sensible, competent pharmacist prescribers. Only an idiot would think that if you've dispensed a medication that you automatically become competent in prescribing it.

Proving competence is a challenge for IPs especially as some may move into more generalist roles. GP's are competent to prescribe as generalists beacause they have done there F1, MRCGPs exams etc which prove their compentency as generalists. Pharmacist prescribers need to tread very carefully when prescribing any medicine outside of what their specialist area is (i.e what topic they did for their IP). IMO any medicine you prescribe you should be able to prove competency through obtaining relevant accredited qualifications (which includes teaching and assesment on diagnostics, the disease, patient scenarios etc) , clinical supervision in practice, mentorship.

Although IP status gives you the legality to prescribe almost anything, if you cannot prove your competence then you will fall down in a court of law, and more importantly you may harm patients.

Leon The Apothecary, Student

Excellent points! Would you then say that the training for independent prescribing for pharmacists should be more comprehensive? What should be included?

Richard Binns, Primary care pharmacist

Thank you, completely agree, really well made point

Reeyah H, Community pharmacist

'prescribing different medicines during shortages'  

So what do prescribers do? Leave patients with nothing? There's always a risk when patients stabilised on eg. a certain CCB is switched. It's not the pharmacist's fault if stocks are not available?

 

 

 

 

 

N O, Pharmaceutical Adviser

""offering poor advice, often underpinned by an assumption of competence, which was ill-founded,""

Don't warn them, warn Cheap Pharmacist.

Richard Binns, Primary care pharmacist

You know you can actually make a point without the continued childish name calling and passive aggressive posturing. Give it a go sometime, people might actually identify you as the insightful professional you strive to be

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