The History
In the late 90s, everyone agreed that the rules on supervision in Community Pharmacy needed to be reviewed as the practice of pharmacy was changing. The real shock came, however, when in 2006 the government proposed the concept of ‘Remote Supervision’ which would enable the operation of a pharmacy in the absence of a pharmacist.
Their argument was that the pharmacist had to be released from the Community Pharmacy so that important jobs elsewhere could be undertaken. The government argued that through remote supervision, the pharmacist could work somewhere else other than in the pharmacy to ease the pressures in the primary care system, whilst simultaneously being held responsible for anything that happened in the pharmacy in their absence.
This is both an astonishing and dangerous idea. When the PDA asked the government through lobbying in parliament, who the public attending a Community Pharmacy could expect to turn to with their urgent and unplanned medicines related queries, in the absence of a pharmacist, we were told by a government spokesperson that pharmacists would be able to delegate activities to suitably trained healthcare professionals such as pharmacy technicians. We were subsequently told that pharmacists operating remotely would have to make themselves contactable so that members of staff could always call them in the event of any major problems. These were extra-ordinarily shocking and dangerous developments. At that time, the pharmacy technicians register had not even been formally created, however, in a few brief words the long term government strategy for Community Pharmacy had been unveiled causing lasting resentment and disquiet within the profession and one of the unfortunate consequences was that it created tensions in the relationship between pharmacists and pharmacy technicians. Right from the start, the position of the PDA was clear; A Pharmacy without a pharmacist was never going to be as safe as a pharmacy with a pharmacist and the future being described by the government was not one that the PDA could ever support.
The list of reasons to resist this proposal is a very long one indeed, but here are just a few; It would represent a diminution of safety to the public, it would fail the public expectation that a pharmacist is available for them in a pharmacy to consult and in a strategic sense, it was a proposal that lamentably lacked ambition about how best to use one of the nation’s greatest healthcare assets, the Community Pharmacy being the most accessible healthcare facility in the whole of the UK.
It, therefore, represented a professional disinvestment in Community Pharmacy and this would ultimately lead also to a financial disinvestment. Many pharmacists will recall that over the years since 2006, the PDA has always been at the forefront of resisting this poorly thought out and dangerous idea and initially, it was the only pharmacy organisation that did. Over the years the PDA has organised many meetings, conferences, focus groups, and surveys to gauge opinions and to mobilise the membership. The PDA has not just been busy resisting the ill-conceived proposals, it has also been trying to find ways in which reforms on supervision could make the pharmacist more available to the public in the Community Pharmacy than is currently possible; the opposite effect of the government’s remote supervision proposal. These have been revealed over the years in strategy documents such as PDA Road Map (2013) and more recently in Wider than Medicines (2018).
By 2010, it was apparent that the government planners were in trouble, the proposals were receiving a very hostile reception and this was getting steadily louder. The Responsible Pharmacist regulations that the government had launched in 2009 in preparation for remote supervision had been slammed in an independent report and needed to be overhauled. The two-hour absence that the RP regulations had been permitted to enable pharmacists to develop healthcare services was simply being used by some employers to reduce their costs by allowing dispensing to start at 7.00 am. two hours before the pharmacist had arrived. The idea that RPs would have a few years of experience before they could aspire to this higher level of responsibility, the extra training and annotation on the register that RPs were supposed to enjoy as recognition of the extra responsibility never materialised. When lobbied, MPs from every party could simply not understand why this was even being contemplated.
The Rebalancing Committee
Unable to make any progress, not just because of hostile resistance but maybe because the idea was just of such poor quality, by 2012, the government decided to handover this poisoned chalice and created a Rebalancing Medicines and Pharmacy Regulations Board (Rebalancing Committee). Comprised of individuals handpicked by government officials, with meetings held in relative secrecy with confidential papers and brief minutes only released months after meetings were held, two of its main objectives included to deal with supervision and also to establish the role of the pharmacy technician. No surprise perhaps that the PDA was not invited to join this committee.
Shocking Revelations
In 2017 a highly secretive supervision sub-committee of this board which according to an article in the Chemist and Druggist was led by a senior government pharmacist came up with an idea that was even more alarming than Remote Supervision – they would simply allow pharmacy technicians to take responsibility for supervising the sale and supply of medicines from a Community Pharmacy.
This secretive proposal was so shocking that it was evidently leaked to the press in what can only be described as a quasi ‘whistleblowing’ action by an unknown Rebalancing Committee member. This report was so toxic, that the Minister of Health had to distance himself from it stating that it was not government policy.
The PDA has been vigilant and active on the defence of this matter since 2006 and over the decades has watched how several pharmacy bodies who initially were supportive of these proposals, perhaps because they could see that their operational costs may reduce as they would no longer need to incur the full-time cost of a pharmacist have moved their positions so there is now a general consensus on the vagaries of these proposals. With the Community Pharmacy Contractual Frameworks across all four countries radically changing to make them far more service orientated, the government is yet again considering supervision.
It is the PDA’s view that rather than become the victims of their proposals, we must now become the architects of our future and the time is now right for us to propose sensible and desirable changes on supervision in a proactive way.
At the PDA we seek professionally fulfilling and sustainable roles for our members, we want patients to see a wider range of services being delivered by community pharmacists in community pharmacies; at the very heart of primary care. We want to see pharmacists developing more comprehensive clinical relationships with their patients. We believe that we have several draft proposals on changes to supervision that would enable all these things, a plan which does not involve a pharmacy operating in the absence of a pharmacist. However, no changes are ever without risk and it is important to pressure test the concepts and assess any emerging scenarios that they may create. Consequently, throughout the Spring of 2020, the PDA is engaging members throughout the UK. Focus Group meetings have already been held and a survey is being issued to more than 30,000 members. Discussions with the GPhC and other pharmacy bodies have been held and efforts to gauge the support of Pharmacy Technicians to these draft proposals are also being made. Once a firmer picture has emerged, the forthcoming PDA conference will provide members with an opportunity to discuss some of these proposals.
This article first appeared in the February 2020 issue of Insight Magazine (posted to PDA members on week commencing 17 February).