“People will be alarmed that some pharmacists are missing out on asking their customers the basics.” That’s what Which? magazine editor Ben Clissit said after the publication’s recent report claimed three in 10 pharmacies were not following over-the-counter (OTC) advice guidelines.
Inexcusable? Yes. Surprising? Perhaps not.
The community pharmacy landscape continues to change and adapt as funding in England is cut, dispensing errors are scrutinised and more people are signposted through our doors. With the ever-increasing footfall of minor illness, the pharmacist’s time becomes increasingly precious.
While, of course, this should never compromise patient safety, it is beginning to test our healthcare advisors and their qualifications to the limit. Let’s remember, these individuals are people who often do not have a medical background and try their utmost to cover every question, in whichever (OTC) acronym they learned, as they attempt to triage the presenting complaint.
Was it WWHAM, ASMETHOD or perhaps SIT DOWN SIR?
Now correct me if I’m wrong, but these acronyms were designed to make things more memorable, right? I mean...Who is the patient? What are the symptoms? How long have you had the symptoms? A… Hmmm, perhaps not as easy as I remember.
Now imagine being the counter assistant, who is serving the mystery shopper, with a queue of impatient people behind them and nobody who can help to serve. They can't remember which questions to ask. They’re worried about annoying the patient in front of them. They don't want to cause a fuss and make all the other patients think they're antagonistic. They're not sure whether there's any problems with the medicines in the transaction. Perhaps they should ask the pharmacist? No they can’t do that, they’re too busy. What will all these people think if they just walk off? The pressure builds.
Suddenly, missing out on asking the basics or skipping a couple of essential questions seems inviting for this colleague. As non-healthcare professionals, perhaps they don't understand the importance of those questions.
As pharmacists, we do understand their importance, and I would be very surprised if pharmacists themselves are “missing out on asking their customers the basics”. I would be the first to step in if I overheard one of my colleagues missing out the vital questions highlighted in the Which? report. But what if this interaction occurred while the pharmacist was providing a medicines use review or any of the other valuable service consultations, and intervention just wasn't possible?
I firmly believe that pharmacists and their teams are perfectly positioned to offer the expert advice which treats minor illness and improves the health literacy of their patients. I do, however, think that as a profession we must help to unburden our counter assistants by removing the confusing acronyms and instilling the principles of differential diagnosis, allowing greater understanding of conditions and their therapies, while improving confidence in scenarios like the one above.
It seems increasingly likely that as the number of patients rises, the role of our healthcare assistants will become progressively more specialised, triaging patients through our dysfunctional health system. As such, OTC consultations like those in the Which? report must become a thing of the past. This will only be possible, however, with the correct investment in workforce development and a rethinking of counter assistant courses.
Andrew Mole is a Boots pharmacist based in Plymouth
The views expressed in this article are Mr Mole's and do not necessarily represent those of Boots