Pharmacies will continue to fall short on over-the-counter (OTC) medicines advice unless staff are better trained or pharmacists become more involved, experts have warned in the aftermath of May's damning Which? investigation.

Poor advice would not be solved by more regulation or protocols, pharmacy leaders yesterday (July 8) told a debate set up by the General Pharmaceutical Council (GPhC) and Royal Pharmaceutical Society (RPS) to address the findings of the Which? report.

Which? found that 43 per cent of the 122 pharmacies investigated gave unsatisfactory advice on OTC medicines by failing to ask necessary questions to check patient safety. 

"Moving from establishing facts to making a judgement; we put pharmacists through a five-year course to do that and we expect counter assistants to do the same sort of thing." John Murphy, PDA

More on the Which? investigation Mark Robinson: Which way forward for pharmacy? The Which? scenarios – what would you have done? Which? report will not deter P medicine self-selection MORE NEWS

Which? senior health researcher Joanna Pearl told the debate at the Royal College of General Practitioners that counter assistants gave "significantly worse advice" than pharmacists in its investigations into pharmacy, which have run since 2004. Community pharmacy would either need to rethink counter assistants' training or involve pharmacists more in OTC medicines sales, said representatives from the RPS, Pharmacists' Defence Association (PDA) and pharmacy academics.

University of Aberdeen senior research fellow Margaret Watson, who specialises in the supply of non-prescription medicines, said there was "substantial evidence" that OTC consultations were below par in pharmacies.

Dr Watson argued that a lack of training for counter assistants, who were responsible for up to 70 per cent of these consultations, led to the poor advice. She called for follow-up training to address the "desert" that comes after the medicines counter assistant (MCA) qualification.

Although assistants knew the appropriate questions they should be asking, called the WWHAM protocol, they only asked an average of two questions and often failed to follow these up. "When they've gathered the information, they're not using it," she told the debate.

PDA director John Murphy said many consultations required pharmacists' skills. "What's coming through loud and clear is that that the pharmacist needs to be more accessible," he argued. "Moving from establishing facts to making a judgement; we put pharmacists through a five-year course to do that and we expect counter assistants to do the same sort of thing."

RPS president Martin Astbury suggested certain medicines should only be given out under the supervision of the pharmacist. Although regulation and protocols could not solve the problem, he said they could act as "building blocks" for safer supply of OTC medicines.

But Pharmacy Voice chief executive Rob Darracott said he wasn't "entirely convinced" creating more rules and protocols would tackle the problem. His comments were echoed by GPhC chief executive Duncan Rudkin. "We can put in place protocols until they're coming out of our eyes and still find this happening years from now," he argued.

Mr Rudkin said the new standards for registered pharmacy premises, which require owners and superintendents to gather patient feedback, could help monitor the situation. "We can use customers as our eyes and ears to tell whether the interventions are actually working," he stressed.

Improve the advice your counter staff are able to give by asking them to sign up for C+D's fortnightly Pharmacy Staff newsletter.

Pharmacist and director of consultancy at Medicines Management Partnership Mark Robinson was at the debate, find out which way forward he thinks is the best for pharmacy.

Which? factors

Speakers at the debate named a number of factors other than pharmacy staff that could be fuelling poor medicines advice

Time constraints

"I'm not defending some of the [Which?] results but I want to put them into the context of a 100 per cent increase in prescriptions in an NHS that's trying to save cash."

Fin McCaul, chair, Independent Pharmacy Federation

Uncertainty over new P meds

"We [Which?] do seem to see worse results on newer POM to P medicines. The main issue is lack of questioning or wrong information. So, for example, people said Pantoloc Control was prescription-only and patients needed to see their GP."

Joanna Pearl, senior health researcher, Which?

IT limitations

"The ideal situation is [an OTC medicine] would be recorded on the summary care record so the doctor was also aware the patient was taking that medicine. That would be a way of making an absolute difference to our patients."

Martin Astbury, president, RPS

What do you think is the primary reason for the poor medicines advice uncovered by Which?? Comment below or email us at [email protected] You can also find C+D on Twitter, LinkedIn and Facebook