In June 2018, the General Pharmaceutical Council (GPhC) published its guidance on how to ensure a safe and effective pharmacy team. The guidance tells pharmacy owners that they are responsible for making sure the whole pharmacy team – both registered pharmacy professionals and all unregistered staff – provide safe and effective care and services.
We tend to assume that when something goes wrong in a pharmacy, it will be the owner, the superintendent or responsible pharmacist who will be in the firing line. However, it is worth remembering that before dispensing errors were partly decriminalised in April 2018, non-pharmacists who were among those convicted of a criminal offence included a pre-registration trainee.
In the peppermint water case, a pre-reg trainee incorrectly made up a preparation for an anti-colic treatment for a four-day-old baby who later died. And in a different case, a Lloydspharmacy healthcare assistant gave a patient sertraline instead of spironolactone. So the GPhC’s reference to unregistered staff is significant.
The GPhC says that unregistered staff should only carry out roles for which they have the necessary skills and competency. Such roles might include:
- providing information and advice on symptoms and products
- selling and supplying medicines
- receiving, collecting and dispensing prescriptions
- delivering medicines.
I was put in mind of these important patient-facing roles when I read the recent Supreme Court judgment in a case involving Michael Darnley. Mr Darnley attended the A&E department at Mayday Hospital in Croydon with a head injury, and told the receptionist he was feeling very unwell. The receptionist told him he would have to wait four to five hours to be seen.
He was not told that he would be seen by a triage nurse within 30 minutes when a decision would be made about how soon he needed to be seen by a doctor. If Mr Darnley had been told about being triaged, he reasoned he would have stayed at the hospital. Instead, after about 20 minutes, he left because he was feeling too unwell to stay. His condition worsened after he left, and he suffered serious brain damage.
Mr Darnley sued the NHS trust responsible for the hospital. The Supreme Court held that the trust owed Mr Darnley a duty of care, even though it was a non-medically qualified receptionist who had not followed the trust’s standard procedures, and had given misleading and incomplete information.
There are, of course, significant differences between an A&E department and a pharmacy. But some of the roles performed by unregistered pharmacy staff will involve a duty of care to patients. Mr Darnley’s case brings the recent GPhC guidance into sharp focus.
David Reissner is a consultant at law firm Charles Russell Speechlys LLP