I was attracted to a website recently under the banner of “The 10 most well-paid, low-stress jobs”. It featured mathematicians, statisticians, technicians and a number of other job titles ending in “icians”.
However, number nine on the list was pharmacists. Alongside what appeared to be a hurricane-assisted average salary – $121,000 (it was an American site) – was a statement to the effect that this is a straightforward, mechanistic job associated with minimal stress.
Try telling that to the thousands of pharmacists who day in, day out are trying to cope with an ever-growing volume of prescriptions, increasing demands for commissioned and private services, and the 1.6 million patients and customers daily demanding a wide variety of health-related interventions (in large part because the pharmacy is the only readily accessible point of entry to healthcare in an NHS system at breaking point).
In particular, try telling that to Antrim pharmacist Martin White, who in 2014 inadvertently dispensed propranolol instead of prednisolone to a patient who died shortly afterwards. His error resulted in a four-month prison sentence (suspended for two years). And as if this was not enough, he has now been suspended from the register by the Pharmaceutical Society of Northern Ireland. The regulator acknowledged that there was no evidence that Mr White had acted in a “deliberate, reckless or wilful fashion”. Further, it said this was “an isolated incident in an otherwise unblemished career”. In short, a momentary lapse of concentration has blighted a pharmacist’s professional career, possibly to the extent of never practising again.
Patient welfare and safety underpins everything pharmacists do, and making a mistake is every pharmacist’s worst nightmare. As Mr White’s case highlights, the consequences of a dispensing error can be catastrophic; a patient can die as a result, and there could be irreparable damage to one’s professional reputation. It is no surprise therefore that pharmacists pay particularly close attention to this aspect of their role, and it is the principal reason why most pharmacists insist on carrying out a final check on prescriptions. It also results in a very safe system – the number of serious incidents is, thankfully, very rare.
Paradoxically, the error made by Mr White was exactly the same error as made by another pharmacist, Elizabeth Lee, back in 2009, which was also linked to the death of a patient. She too received a custodial sentence (three months suspended), which was quashed on appeal.
Both Mr White's and Ms Lee’s convictions were based on an anachronistic component of the Medicines Act which makes any dispensing error a criminal offence. The offence is one of strict liability and so there is no defence. And as the Lee and White cases demonstrate (and there have been others), prosecution is not some theoretical possibility, but an ever-present reality.
The campaign to decriminalise dispensing errors has been successful to the extent that “decriminalisation” became a workstream of the Department of Health’s “rebalancing medicines legislation” programme board. The board agreed that as pharmacists are only human, there should be a defence available for those who make an inadvertent dispensing error.
A Department of Health consultation on the decriminalisation of dispensing errors was issued at the start of 2015, which received widespread and unqualified support. Since then – at the risk of gross understatement – progress has been slow. Time after time we get assurances that changes to legislation is on the way. The former pharmacy minister David Mowat said he would be pushing the amended legislation through – he didn’t. More recently, the current pharmacy minister Steve Brine has again hinted that reform is just around the corner. He has also suggested this is a personal priority for him.
We wait with baited breath to see whether he carries through on this.
Alongside this, there is now a fresh move to reconfigure the supervision arrangements in community pharmacy. A significant barrier to any debate on this issue – and to any delegation by pharmacists – is the likelihood of being prosecuted in the event of an inadvertent dispensing error. This provides another important reason why the progress on decriminalisation should be introduced as a matter of urgency.
John D'Arcy is managing director of pharmacy support services provider Numark
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