Words into Action - The First PDA Annual Conference.

Birmingham I.C.C, Sunday 27 March, 2005.

The first PDA members conference was held at the International Convention Centre in Birmingham on Sunday 27th of February. This landmark event was attended by almost 150 delegates.

Delegates came from many distant parts of the UK and in the comments section, contained in the post conference assessment, one delgate wrote 'I now truly feel in touch with the PDA'. The event witnessed the launch of the PDA's very first Policy initiative on Violence in Pharmacy. It saw delegates involved in focus group work on the PDA policy on Staffing Levels and Workload and it allowed members to get their concerns 'off their chest' in a special members session. Delegates were provided with risk management information on how best to handle dispensing errors and many delegates took advantage of the unique employment 'contract clinic' which was staffed throughout the day by PDA lawyers.

In a first Annual Report presentation, PDA Director Mark Koziol explained how the disproportionate influence of the employers via their employer organisations would need to be counterbalanced by equally well-organised and well-presented arguments reflecting the individual pharmacist agenda. He suggested that with the opportunities presented by the New Contract there had never been a better time to do this. He also explained that the vast majority of employers are genuine in their ambitions to run a decent pharmacy operation and that the PDA would want to work with them to create 'Win-Win' scenarios for them and for their employees and locums. However, the PDA would not tolerate the small minority of employers who operated questionable employment policies.

WORDS INTO ACTION

There were plenty of words spoken at the PDA conference and a commitment was given to turn them into action. Despite snowy conditions and motorway closures, almost 150 delegates attended the very first conference of the PDA. Judging by the delegate surveys returned at the end of the day, the event was an overwhelming success.

Where are we going?

Setting the scene for the day Conference Chairman John Murphy explained to delegates that the two main objectives of the PDA were to assist individual pharmacists who were finding that their professional lives were becoming risk prone in this increasingly litigious and regulated Society and also to redress the imbalance of the very strong employer lobby within the profession of pharmacy by articulating the concerns of individual pharmacists. John explained that 100 years ago virtually all pharmacists were owners of pharmacies and consequently, the various pharmacy bodies set up at that time were very representative of the broad constituency of pharmacists. However, in the years that followed, things changed dramatically to the extent that today only about 10% of pharmacists are owners because the rest are either employees or self-employed individuals. Unfortunately though, for this large majority of pharmacists, the pharmacy bodies are still performing the task of looking after the employers interests and this means that it is the small minority interest within the profession that dominates the professional agenda.

Talking about the Policy development work of PDA, Mark Koziol said;

'The mainly employer led inertia within pharmacy has taken more than 100 years to establish itself, so the approach that we use to waken up the individual pharmacists agenda will need to be effective. The development of PDA Policy is an extremely important part of that work. It is a process which involves literature searches, brainstorming sessions, wide-scale surveys, focus group meetings and consultations. Whilst this process can be slow, it does ensure that the Policy of the PDA once it is announced, is built on firm foundations and will allow PDA to argue the corner for individual pharmacists effectively and decisively'.

Mark indicated that large-scale surveys of pharmacists that had been analysed by research institution MEL in Birmingham had shown that 81% of pharmacists felt that the quality and availability of support staff were putting patient safety at risk. Furthermore 72% of pharmacists feel that they are expected to take professional responsibility for matters that are outside their personal control.

'These are matters that the PDA will be addressing and we know that by pursuing the patient safety argument, it will be very difficult for any detractors to argue against staffing level improvements'. He said.

Immediate short-term issues facing the PDA were;

• Opportunities provided by the new NHS contract for all community pharmacies.
• The roll out of PDA membership services to the Hospital Pharmacy sector.
• The establishment and training of the network of PDA representatives to assist with internal disciplinary meetings.
• The launch of a more balanced 'contract for services' document to be used by locums.
• The need for a legal test case to allow the courts to establish the appropriate balance of liability facing a pharmacist and his employer in the event that a dispensing error is made. This would go a long way in resolving the question that has still to be answered between PDA and the NPA over who is responsible for what when an error occurs.
• Taking on more office based pharmacist staff so as to meet the growing needs of the members.

Violence in Pharmacy

PDA Advisory Board member Shenaz Patel, launched the first official policy of the PDA which was on Violence in Pharmacy. ?More than 50% of pharmacists have been subjected to violence, the threat of violence or abuse and almost 50% of them felt that measures subsequently taken by employers were insufficient?. said Shenaz.

She then went on to describe the full policy (a synopsis is described on page 5, the full document and Personal safety resource pack is available on www.the-pda.org or by contacting PDA on 0121 694 7000).

It happened to me

Workload

In a session which allowed PDA members to get matters 'off their chest' two pharmacists described what scenarios they had recently experienced in the workplace.

Bob Gartside described an important principle that relates to work, he said;

'Any job should be so designed and structured that it can be handled on an average day by average personnel with average equipment. You shouldn't need Michael Schumacher to drive the bus or Ellen MacArthur to sail the ferry'.

And yet, said Bob Gartside, the work situation in pharmacy could rarely be described as average. Bob provided some useful statistics and research references which all indicated that pharmacist workloads in the UK were far too high.

He concluded that 'Nothing except more staff can bring workloads down to acceptable levels for patient safety'.

Termination of locum contract

Richard Schmidt described how he worked for a small multiple and over a period of time had developed a fairly comprehensive role within the organisation. He described how he began to develop SOP's, how he had been involved in securing staff buy-in, how he had helped to improve the IT systems and how he even turned up to one branch on a weekend to fix the plumbing because a reliable plumber could not be found! However, as a result of what Richard felt were a series of inappropriate management strategies he was prompted to set his concerns in writing. He felt that the net result of his efforts was that his long-term booking was cancelled and the owners no longer required his services. This, felt Richard, demonstrated perfectly the vulnerability of the individual pharmacist in trying to wrestle with the standards agenda.

The role of the Society on Pharmacy Regulation

'Music played in a dispensary area is not conducive to the delivery of high quality patient care' said Mandie Lavin, the Society's Fitness to Practice and Legal Affairs Director as she addressed the PDA Conference. Mandie also indicated that since starting in her role she had noticed that what is different from her previous nursing roles was the dominance of the 'big players' in pharmacy.

Mandie Lavin came to the conference to describe the new regulatory realities at the Society. As she delivered her presentation it became clear why there had been such a huge increase in the number of disciplinary cases heard against pharmacists. Mandie explained how the Shipman enquiry and the establishment of the new over-arching regulator CHRE, were some of the reasons why the Society was developing its regulatory role. Mandie felt that the existing arrangements for discipline in pharmacy meant that the Statutory Committee had few remedies at its disposal. It could effectively rebuke a pharmacist or it could order a striking off.

'The existing regulations stem from the 1968 Medicines Act and we are constantly having to look creatively at the structures that currently exist so that we can begin to meet the requirements of the modern regulator'

'However', explained Mandie, 'the new Section 60 Order which is yet to be delivered by the Government would give the Society a wide range of far more appropriate measures, such as the ability to impose conditions of practice, the ability to apply a range of remedial measures, the right to require a pharmacists to undergo training or mentoring. Whilst the new regulations would still allow the Society to order a striking off in relevant circumstances. This would ensure that the Society could meet any disciplinary needs with more appropriate remedies than is currently the case'.

PDA Director Mark Koziol referred to the fact that PDA representatives go along to support members at meetings when they are interviewed by the Society's inspectors, he said that PDA members valued this service greatly and felt that it was highly beneficial in a RPSGB interview situation. He asked what the Society's view was of PDA representatives going along to assist members in this way. Mandie responded by explaining that RPSGB inspectors will always make it clear to pharmacists that they could have a representative present at an interview.

The Syndicate Sessions

Three syndicate sessions were held and these dealt with;

• How to deal with the aftermath of a dispensing error to prevent it from turning into an official complaint.
• Employment law case studies.
• PDA policy focus group, which was used to help underpin the PDA Policy work on Staffing levels.

Question time

Although the Council of the RPSGB is made up of mainly elected members of the profession who are very sympathetic to pharmacist concerns, most of the day to day activities are led by the employed staff at Lambeth and they are all very keen on regulation, was the sentiment expressed by Martin Astbury an RPSGB Council member. Indicating that these were his personal views and not those of the Council, Martin went on to say that the outcome of this very next Council election would be very important as in many ways it would determine whether the newly elected Council will have the will to handle some of the issues at Lambeth.

Martin Astbury was joined on the Question Time Panel by Professor of Law and Ethics Joy Wingfield and PDA Director Mark Koziol.

Mark Koziol felt that the presentation made by Mandie Lavin set out the reasons why regulation would be the primary objective of the Society, irrespective of the will of the membership, however, he did agree with Martin and urged all pharmacists to read the election statements of the candidates in this years elections very carefully.

The matter of Standard Operating Procedures was a big issue for delegates and the question of whether pharmacists would face an additional risk if they chose not to observe the SOP laid down by employers was explored. Joy Wingfield explained that it was for pharmacists to decide whether the SOP at any particular pharmacy where they were in sole charge was up to the job, in her experience, most employers would try to ensure that such SOP's would be appropriate. However if pharmacists' felt that it was not, then they were entitled to add, subtract or replace with a more suitable one.

Alan Nathan, a past member of the RPSGB's Ethics Infringements committee was concerned about the peppermint water case because, in his experience, in such serious cases the Company and Superintendent had always been subjected to some form of disciplinary action by the Society and yet in the peppermint water case whilst the pharmacist and Pre-reg were called to face professional disciplinary proceedings, the employer involved was not. He thought that this was very strange.

Joy Wingfield explained that as far as she knew the Society had carried out a full investigation and that was the outcome. Mark Koziol felt that the Peppermint Water case showed very clearly why it was important not to rely on an employer or an employers insurer when trying to defend your reputation and it was crucial to have your own independent insurance protection.

The conflict of interest faced by the NPA in their attempt to provide PI insurance to both the employers and individual pharmacists was the subject of a passionate concern expressed by one delegate who said that he had taken out individual pharmacist PI insurance with the NPA, subsequently he had an incident which involved a dispute with an employer. He explained that when he contacted the NPA for assistance, they told him that they could not assist, because the employer involved was one of their largest members and contributed a significant sum to their annual income.

The Question Time event concluded with a question on whether the Society could truly be both a regulator and a membership body. The general feeling was that eventually the government would decide to take all healthcare regulation away from the various healthcare regulators and that the Society would return to what it was when it started in the 1800's – a membership body for pharmacists.

The Future of the PDA National Conferences?

A survey of delegates gave the event an overall 92.2% approval rating and one delegate wrote anonymously 'This meeting brought the PDA alive for me today, Thank You'. The overwhelming message from delegates was that it's about time someone addressed the uncomfortable issues in pharmacy.

The next PDA Conference is already being organised. Members will be notified.

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