This time two years ago, the BBC broadcast an Inside Out programme about dispensing errors at Boots. There were claims that workload pressures were a significant contributory factor and arguments that the General Pharmaceutical Council (GPhC) should establish minimum staffing levels.
Workplace pressure is a serious issue, and the slashing of NHS funding [in England] since 2016 has contributed to the problem. Against this background, I read with interest how GPhC chief executive Duncan Rudkin told C+D it would be “counterproductive” for the regulator to set a minimum number of staff in a pharmacy, because “every pharmacy is different”.
The GPhC’s standards require pharmacy owners to have “enough staff, suitably qualified and skilled, for the safe and effective provision of pharmacy services”. Pharmacies can vary widely in terms of their prescription volume, services and opening hours. Linking staffing levels to prescription volumes for the purpose of deciding whether overall staffing is adequate would stultify the development of services and new ways of working. It wouldn’t be compatible with the increase in automation and the use of hub-and-spoke dispensing models that the Department of Health and Social Care is determined to pursue.
GPhC papers indicate that insufficient staffing is the third most common unmet standard on pharmacy inspections. Clearly, its inspectors feel able to decide whether a pharmacy has enough staff to provide safe and effective services. If an inspector finds that the GPhC’s standards are not being met, this could be used as evidence of misconduct in fitness-to-practise proceedings. However, except in an extreme case, perhaps involving a fatality, I expect the GPhC would hesitate to bring fitness-to-practise proceedings over whether staffing is adequate, because where subjective opinions are concerned, the case might be difficult to prove.
There are less drastic measures the GPhC can take if an inspector concludes that the standard requiring a pharmacy to have enough staff is not met. First of all, the inspection report will be published, and that might be an incentive for pharmacy owners to up their game. Secondly, the GPhC has powers to serve an improvement notice or impose conditions of registration on pharmacy premises, requiring an owner to take specified steps.
These are just some of the types of measures the GPhC took recently in the case of pharmacies accused of inappropriately selling opioids online. The willingness of the GPhC to use these powers is a much better way to enforce its requirement for adequate staffing than any fixed system based on numbers.
David Reissner is chair of the Pharmacy Law and Ethics Association