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Light touch regulation of pharmacy owners endangers pharmacy

The PDA is concerned that the pharmacy regulator, the General Pharmaceutical Council (GPhC), is not utilising its powers when policing pharmacy owners who allow their premises to fall well below acceptable standards.

Sat 9th July 2022 The PDA

The PDA believes that a failure of enforcement is undermining the wellbeing and motivation of pharmacists and their teams and could seriously affect and endanger their patients as well as being a factor in workforce ‘shortages’

The PDA has seen a report concerning a pharmacy in Midlothian which was inspected recently and where there were multiple serious concerns; the inspector’s report included:

  • The pharmacy team was under a lot of pressure as it had very few team members and did not have a regular pharmacist. The pharmacy does not support its team members enough with training, so they do not have the skills or competence for their roles and the tasks they carry out.
  • Pharmacy team members did not follow a logical or methodical workflow for dispensing, they did not routinely undertake stock counts, this led to the high number of owings and created an increased workload, it increased risk of errors in some cases.
  • The pharmacy doesn’t always manage and deliver all its services safely and effectively, especially its dispensing service. A lot of the pharmacy’s dispensing was from managed repeat prescriptions. But the pharmacy was not following the correct process for these, so medicines were not ready as people expected.
  • The pharmacy does not adequately identify and manage all the risks associated with its services, so there is a risk of mistakes.
  • The pharmacy is sometimes closed unexpectedly during normal trading hours, so people cannot access its services. On the day of the inspection the pharmacy did not open until 9.30am while the locum pharmacists tried to familiarise themselves with the processes and outstanding work. They closed the pharmacy at 10.30 am as they were concerned that due to the disorganisation in the pharmacy, they could not provide a safe service.

The PDA believes most pharmacists would find the full GPhC inspection report shocking, although some may also find the scenarios described disappointingly familiar. The Inspector was clear that the pharmacy team and the locum pharmacists worked hard but struggled to complete the workload, they suffered a lack of support from the owner.

The pharmacy was part of a multi-million-pound UK pharmacy chain who appear unwilling or unable to recruit enough frontline staff. The report states that the regional manager, divisional manager and three experienced dispensers from other branches rushed to the pharmacy to help “after the locum pharmacist’s call to the superintendent pharmacist explaining that the GPhC inspector was on the premises.”

It is the role of the regulator to make sure people receive safe and effective pharmacy care and have trust in pharmacy. Yet, PDA members say that unlike the treatment of individual registrants, the regulator seems to apply light touch regulation to the major pharmacy chains when confronted with problems like those listed above.

This pharmacy in Midlothian was not issued with an enforcement order requiring it to address specific named problems within weeks or face the possibility of closure.  Instead, the regulator asked the business to produce an improvement plan.

Repeated issues at multiple chains

Worryingly a pharmacy in Gloucestershire, owned by the same chain, was found to be below standard and issued with an improvement notice in August 2019, which it complied with. It was re-inspected and found to still be failing patients in September 2020 and again in May 2021 when it was granted yet more time to improve; after failing a fourth inspection in March 2022 the GPhC finally issued it with an enforcement order. After three years of consistent reports identifying failures to their staff and patients, the company concerned managed to restore the pharmacy to an acceptable level of service within 28 days once required to do so by the enforcement order.

For there to be trust in pharmacy, from both patients and from pharmacists themselves, such issues must be resolved urgently. The PDA believes the GPhC are too slow to act in these cases, and asks that more use is made of the regulator’s power to issue enforcement orders. Robust action should be taken if there are repeated failures by a company, just as there may be if an individual registrant was found to have repeatedly failed to maintain standards.

If the GPhC do act appropriately and speedily it is to the benefit of the hard-pressed pharmacist teams who will want to prioritise their patients, but who are forced to practice in conditions dictated by their employers, and over which the individual professional may have limited influence.

Just as profits ultimately go to one group of shareholders, the PDA believes it is reasonable for the regulator to recognise that even the largest chains are a single entity when it comes to the corporations’ approach to standards, and that a more holistic approach should be taken.The PDA suggests that any multiple pharmacy owner who allows such situations to happen in one pharmacy and continually fails to address problems with urgency, should automatically be issued with an enforcement order in respect of any other pharmacies it owns that fail at inspection.

While the presence of a GPhC inspector to produce the sort of reports detailed above may be rare, pharmacists report the conditions described as not being unique. Some PDA members describe this as the tip of an iceberg.

Premises standards must be enforced

To practice at their full ability and maintain safety, pharmacists need the regulator to create a culture where pharmacy businesses understand that standards must be maintained for premises, just as standards are expected of the professionals that work within them, with serious consequences where they are not. Unfortunately, without such an atmosphere it appears that some pharmacy owners will continue to provide substandard environments for patients and staff.

It should be no surprise to the regulator, that such conditions are also a significant factor in the reduction of the number of pharmacists prepared to work in community pharmacy. Increasing regulatory enforcement on pharmacy owners to improve conditions is one way that the regulator could help resolve the current workforce challenges and install confidence in pharmacists that they will be provided with the environment and support to undertake their role.

If members are concerned about their working environment or require support, they should contact the PDA Service Centre.

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