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Home  »   Latest News   »   Am I fit to be a pharmacist? The online pharmacy model and fitness to practise

Am I fit to be a pharmacist? The online pharmacy model and fitness to practise

Over the last few years, the PDA has seen a dramatic increase in the number of pharmacists being investigated by the GPhC regarding their involvement with online pharmacies, particularly those who prescribe remotely. Significant numbers of pharmacists are appearing before Fitness to Practise Committees with more waiting in the pipeline for their case to be heard.

Tue 6th June 2023 The PDA

One of the main functions of a Fitness to Practise (FtP) Committee is to decide whether a registrant is fit to be a pharmacist. The Committee judge this question on the day of the hearing and not as it was at the time when things went wrong. In regulatory terminology where there are significant concerns about a registrant’s ability to practise safely and effectively, a committee may decide a pharmacist’s fitness to practise is impaired. Without a shadow of a doubt most pharmacists can demonstrate that they are competent to routinely supply prescribed medicines to patients and they can do this without any problems, but the test ‘Am I fit to be a pharmacist?’ is not limited to the dispensing and supply function, it goes much further particularly for a pharmacist prescriber.

When deciding if a prescribing pharmacist is fit to practice, the committees are guided by four questions:

  1. Is the pharmacist a risk or a potential risk to patients?
  2. Has the pharmacist breached a fundamental principle of their profession?
  3. Would public confidence in the profession be lost if a committee did not find impairment?
  4. Has the integrity of the pharmacist been lost?

The whole area of online pharmacy cases brings a sharp focus onto all of the four questions above.

It is so much easier to put something right that has gone wrong during the processes in a ‘bricks and mortar’ community pharmacy. However, it is much more difficult to recover a professional reputation when things go wrong in the online pharmacy sector when behaviours and/or attitudes to pharmacy are brought into question.

An online (or selling at distance pharmacy) may have received ‘approval’ from the GPhC to open for business, but that does not mean that the pharmacy systems offer safe patient-centred care to the public. The pharmacist as an autonomous regulated healthcare professional has a clear duty to ensure that the systems they operate under provide a safe appropriate supply for each patient on every occasion. Ultimately, the pharmacist is responsible and no one else. If the pharmacist has concerns about the running of the pharmacy, then it is their duty to put matters right and/or self-report and/or walk away.

Committees are always mindful that pharmacists ‘act as the gatekeeper of medicines in society’ and if the pharmacist relinquishes that responsibility, then it is going to be difficult to re-establish the confidence of a committee, never mind the public. What would the public or other pharmacists think if they heard that a professional had metaphorically let go of ‘the keys to the drug cabinet’? Would they expect that a strong message be sent out to everyone that pharmacists must maintain standards and keep the confidence of the public? The simple answer is yes, they would.

The question of impairment is not one established by looking at a table of factors, it is a decision made by a committee using their professional judgement based on the facts of the case and any evidence provided by the registrant. This means that there are no set guidelines as to how to win the argument that fitness to practice is not impaired. However, it takes a lot to persuade a committee that a pharmacist has repaired the reputational damage when the committee is constantly reminded of numerous reports of vulnerable patients dying after being prescribed highly addictive or potent medicines which were easily purchased from various online pharmacies. The council put forward the view that some online pharmacies are just commercial organisations with little care for patient safety and the responsibility for ensuring patient safety sits firmly on the shoulders of the individual prescriber.

That’s not to say that a professional reputation cannot be repaired. Careful targeted work to demonstrate that the pharmacist has learnt from previous errors may persuade a committee that the registrant has recovered from the matters that went wrong and is fit to continue with their career. However, currently, FtP Committees are taking a firm stance on maintaining public confidence in cases involving online pharmacist prescribers, typically by suspending pharmacists for significant periods of time and requiring a review before they can resume practice.

The best way of dealing with these issues is prevention rather than cure. A lot of thought and careful preparation is the best way forward before working in this sector. The regulator will never set out in detail what to do or not do but will only give guidance. Following this closely as well as other guidance issued by other professions and reputable organisations should help pharmacist prescribers develop a way of working that guarantees a safe and effective service to the patient.

Download the ‘Revisiting competence for pharmacist prescribers and non-prescribers in all settings’ document here

thumbnail of Revisiting competence for pharmacist prescribers and non-prescribers in all settings

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