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Why COVID-19 has shown that remote supervision can never be supported

“New funding arrangements must make pharmacists more available”

More pharmacists should be available to the public, not fewer, which is why the PDA doesn't support remote supervision, says Mark Koziol

The C+D blog published last week (July 13) from Rowlands superintendent pharmacist and Company Chemists Association (CCA) board member Margaret MacRury has re-ignited the debate and yet again raised serious concerns about the plan to operate a pharmacy in the absence of a pharmacists aka remote supervision.

The blog states that during the COVID-19 crisis, community pharmacy demonstrated its value as the “third pillar” of healthcare in delivering NHS services alongside GPs and hospitals. When access to the latter was restricted, community pharmacies kept their doors open, providing not only medication, but also trusted professional healthcare support and advice.

It claims that our country needs the community pharmacy network as a critical local healthcare access point and that an opportunity now exists to encourage the public to “think pharmacy first”. Who could disagree with any of these sentiments?

However, when the article later dwells upon viability issues and pharmacy closures in England and the fact that the current community pharmacy contractual framework may not be fit for purpose, it appears to propose that the panacea would be to embrace and promote new regulations about pharmacy supervision.

Given past events, it is unsurprising that many pharmacists who commented on the blog are concerned that the spectre of remote supervision is being raised again and as they quite rightly state, it makes no sense at all.

Undoubtedly, the reason why pharmacy was able to really prove its worth during the pandemic is because it delivered so much resilience to the nation’s healthcare system - which was arguably lacking elsewhere as GP surgeries, hospitals and dentists closed their doors.

Community pharmacies saw a large increase in footfall during the height of the lockdown, even though regular shoppers were no longer coming into the larger multiple pharmacies at lunchtime to buy sandwiches or cosmetics from the beauty counter.

If community pharmacy gets the recognition it deserves in a post-COVID-19  environment, it’s because pharmacists up and down the land proved they could be relied upon to make professional judgements and work flexibly in the interests of patients facing crisis situations. They did this despite the strict rules that otherwise govern medicines and pharmacy practice. This, surely, is the new normal we as a profession should aspire to.

The PDA agrees that the rules on supervision need amending, but if the public are to “think pharmacy first”, then pharmacists should continue to be able to make professional judgements and act in the interests of patients going forward, and even more pharmacists through a second pharmacist arrangement should be available to patients in community pharmacies.

Indeed, such an arrangement would be far more efficient than the traditional, broken and costly GP practice system. New rules on supervision and any new funding arrangements must make pharmacists more available to the public in a community pharmacy and not less so, as would be the case if remote supervision ideas were adopted.

During the pandemic, the PDA saw evidence indicating that pharmacists from some multiples were asked to remotely supervise more than one pharmacy simultaneously, and some companies developed elaborate guidance on how pharmacies could operate in their absence. We examined the standard operating procedures from some companies that would have normalised the operation of pharmacies without pharmacists.

When we contacted pharmacies, we learned that some businesses chose to operate with a pharmacist available only for limited hours in the day. It was claimed that the pandemic had created shortages of pharmacists, but this does not tally with our member surveys indicating that many available locums were not contacted – while others even had their bookings cancelled.

Perhaps some companies were shrewdly trying to create their own preferred future, one with reduced overheads and fewer pharmacists available to the public. It is evident to me that remote supervision is, for some of them, a desired objective. But in advocating this, have they considered the reduction in patient safety resulting from the absence of the pharmacist, not to mention the opportunities to improve the patient journey that would be lost?

These actions earned their superintendents a warning from the GPhC. Businesses were told that “operating a pharmacy in ways that are not compatible with the law cannot under any circumstances form part of a standard operating procedure”. The PDA believes that they got off very lightly and this cavalier way of working must never be allowed to happen again.

If Rowlands has a problem with funding in England, then why not simply join the rest of the sector in seeking to get this addressed? They could at least seek parity with the more forward-thinking pharmacy administrations in the other countries of the UK.

We now have a once in a generation opportunity for greater recognition of community pharmacy, but this surely must be based upon the greater availability of the pharmacist. We must not squander it by squabbling over a choice of two stark options: The first is a race to the bottom driven by a cost-cutting exercise to maximise short-term profits. The other is a richer, more professionally fulfilling role for pharmacists – delivering benefits for the health service and a dramatically improved patient journey.

Let our deeds match our words when we say that we no longer want community pharmacies to be seen as shops, but instead as healthcare facilities that are committed to the provision of safe patient care and working as part of an integrated patient facing primary care team.

Judging by the views expressed at the National Pharmacy Association conference last week, health secretary Matt Hancock agrees with this sentiment. He indicated that the door for discussions and the funding to create a win-win situation for government, taxpayer, pharmacy and patients is ajar.

Mark Koziol is chairman of the PDA

 

16 Comments

Anonymous Anonymous, Information Technology

We are not the "third pillar" we are indeed the first pillar. No other healthcare provider has such ease of access. More than 90 percent of people have a pharmacy within 1 mile (around 60% for GP surgeries), we are open longer hours and have virtually no waiting time. Where else can you see a medical professional with no appointment, no gargantuan waiting time and be given advice for free?! I'm afraid our leaders (donkeys) are not making the most of our USP!! The NHS fare no better as there is no incentive for patients to use us (the cheapest option for them too) first.

We have shown our worth when nearly all of the GP surgeries shut yet we by some apparent magic remained open. But let's see how much of a slap in the face we get when we receive our inevitable NHS funding cut when all of this mess has to be paid for!

Kevin Western, Community pharmacist

"The PDA agrees that the rules on supervision need amending, but if the public are to “think pharmacy first”, then pharmacists should continue to be able to make professional judgements and act in the interests of patients going forward, and even more pharmacists through a second pharmacist arrangement should be available to patients in community pharmacies."
As was clearly demonstrated by the rowlands article, this is counter to the aim of most of the multiples and is also demonstrated by the PSNC - it has no mechanism for considering professionalism, impact on Pharmacists or anything other than pure income. which is obviously driven my the majority contractors.
Their objective is, clearly, to reduce staff costs by getting rid of obstructively professional people and exploit Pharmacy as a cash cow as much as possible.
The fact that this would lead to huge deregulation once there were no Pharmacists required in Pharmacies, and REALLY open the doors to amazon et al obviously doesnt bother them, they will have made their money and run.
The posited changes to the PSNC are already being opposed by the same people who see their influence being lost and, god help us, sensible negotiations taking place!

Freelance Chemist, Pre-reg Pharmacist

The PDA is like a sleeping dragon, sweat shop owners your put on notice. I will have an announcement very soon and will require all your help to get maximum publicity, as it would seem the GPhC only respond when the media pay them some attention.

Working through the chaos of March, April and May was probably one of the hardest things I’ve done in my 30 years as a pharmacist. In some ways though, it was almost the most enjoyable time? I was in a position where I had to use my professional judgement, make decisions about patients quickly, decide between different ways of working and, most importantly, I was left alone (professionally) to do these things. We didn’t abandon SOPs but we had to quickly recognise where we had to work around them-for the sake of our patients health and, sometimes, our own sanity. We proved ourselves to be brave and tirelessly professional when other healthcare options were simply not available to patients because of closed doors. We showed that, while other health professionals hid from the public, we could be relied upon to put our patients first at a time when our normal ways of working were having to be updated on a daily basis. I wouldn’t want the exhaustion, the abuse and the fear again but I would welcome the chance to work as a real professional again. How I wish that the PDA could be published in the media? Maybe the public, and other health professionals would finally realise what we’ve been doing since the middle of March?

Mark Boland, Pharmaceutical Adviser

We didn’t abandon SOPs but we had to quickly recognise where we had to work around them-for the sake of our patients health and, sometimes, our own sanity

Why didn’t you abandon them? SOPs are utter nonsense in normal times. I have yet to see a set of SOPs, which if followed, wouldn’t lead to much worse outcomes than if they were ignored. For all the SOPs that now exist, why are the vast majority of dispensaries still comedically disorganised and unsafe? On the rare occasion I have ever worked in an organised, intelligently operated and safe dispensary, it is because the pharmacist has used their professional judgement to ignore the mindless procedures.

As it pertains to COVID 19, the chains didn’t do anything to help their employees other than to send useless posters and announce pretend safeguards. Most branches were left to wing it with chairs, boxes, tape and handwritten signs. Branch staff should think themselves lucky that the fatality rate of COVID 19 is so low, had it been higher, hundreds of workers would have likely died because of the lack of genuinely effective support and guidance.

Freelance Chemist, Pre-reg Pharmacist

I don’t no of any pharmacist or tech that actually follows SOPS. They need to be got rid off, waste of time. All they are good for is sacking a person when they’d two out of line.

Because, in the event that a serious or fatal dispensing error occurs, you wouldn’t have a leg to stand on if it could be shown that you hadn’t had least followed the spirit of the SOPs. Love them or hate them (and I certainly don’t love them) SOPs could end up saving your neck in a FTP case against you? We’re always free to exercise our own professional judgement-it’s expected of us, but there’s not much point in being a professional if you’ve been struck off the professional register is there?

Jacqueline Bradley, Locum pharmacist

The PDA are the lighthouse for pharmacists. Now where is the GPhC’s thoughts...........?

Benie I, Locum pharmacist

Give them a break. They're busy seeking out and reprimanding all those high earning locums. There are so many of them up and down the country so it'll be a while.

Axed Locum, Locum pharmacist

A brilliant article from Mr Koziol of PDA. What surprises me is that he was invited for his highly respected view by this editorial, which is biased in favour of the greedy contractor slave masters. This is a very logical and sensible article, a complete contrast from the superintendent of Rowlands, Margaret MacRury.
In a very diplomatic manner, he conveyed the message to these greedy contractors, if you can't hack it, pack it and allow to be taken over by forward thinking pharmacy organisations.
Lets have more of these articles, rather than those on pleads of poverty and hardship from these disingenuous contractor slave masters manipulating the NHS contract in concentrating their efforts confined to running a repackaging sweat shops.
Also lets have an article on fair remuneration for Locums and employed Pharmacists. The latter group which has already started to benefit from PDA's intervention.

Benie I, Locum pharmacist

The editorial mysteriously become deaf to any slights real of perceived against teh multiples/GPhC. At times it is akin to reading a comic.

Yorkshire Pharmacist, Community pharmacist

Paying the PDA membership fee is quite possibly the only professional fee I pay which I feel is worth it

Kevin Western, Community pharmacist

when you contrast this with the almost gibberish of the previous article on the topic, the difference is stark. one is reasoned and logical, the other is an ill thought out meandering to justify the unjustifiable

Benie I, Locum pharmacist

The PDA do fantastic work for pharmacists and the article states 'Mark Hancock agrees with the sentiment' Lets see what happens once the multilples start their backroom bribing or lobbying. All of a sudden remote supervision becomes'the only way forward for healthcare blah blah'

Locum from yorkshire Pharmacist, Community pharmacist

The GPhC is there to uphold patient safety and the full provision of pharmacist supervision. It was heartening to read that some transgressors were hauled in. Well done the Council! I
How is it proposed that a pharmacist should be capable of operating through a webcam lens and.., furthermore be able to perform an effective intervention if need be through the remote system?
I think the pharmaceutical legal teams must be aghast at the cheek of that.

Axed Locum, Locum pharmacist

Should have been hauled in front of the FTP committee.!!

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