On 11 June 2018, the GPhC published its finalised “Guidance to ensure a safe and effective pharmacy team”, for pharmacy owners. The guidance can be found here and the PDA has commented on it here.
One of the sections within the guidance is ‘setting staffing levels and responding to concerns about patient safety’. Concerns over the GPhC’s approach to regulating staffing levels were featured in a BBC documentary on 8 January 2018 entitled “Boots: Pharmacists under Pressure?”. The PDA has considered the GPhC’s approach to staffing in more detail.
The GPhC’s Standards for Registered Pharmacies
The GPhC’s pharmacy inspection standards set enforceable requirements. Standard 2.1 is:
“There are enough staff, suitably qualified and skilled, for the safe and effective provision of the pharmacy services provided.”
This raises several questions:
- How has the GPhC been assessing pharmacies against this standard during its inspections?
- There’s only one specific minimum staffing requirement in pharmacy law/regulation – to have a responsible pharmacist on duty. During its inspections, does the GPhC only find the standard not met if there isn’t an RP on duty?
- If the GPhC can find that a pharmacy doesn’t meet the standard when there is an RP on duty, then exactly what level of pharmacy support staff (pharmacy technicians, dispensing assistants etc.) does it deem is acceptable in one pharmacy and not in another?
GPhC response to the BBC documentary
After the BBC documentary, the GPhC said “We take the clear view that setting the right staffing levels is best done by the people responsible for managing a pharmacy on the ground, rather than by the regulator at a distance.” (The GPhC’s comments can be found here).
This raises several questions:
- Among the large pharmacy multiples, staffing levels are often set at head office level, not “on the ground”. How does the GPhC assess the adequacy of the staffing provided?
- If it leaves the staffing decision to the pharmacy owner, during an inspection how can it criticize the levels the owner sets?
Concerns about the new GPhC guidance
We have various concerns about the new guidance and its effect on patient safety:
- The GPhC hasn’t specifically asked the profession what approach it should take to staffing levels. It hasn’t sought the expertise of organisations such as the PDA on this matter.
- It lists examples of what pharmacy owners should consider when they set staffing levels. Whilst the list may be thought-provoking, staffing is fundamental to patient safety. The wording means that pharmacy owners don’t have to even consider it (and because it’s guidance it’s not compulsory anyway).
- It places the power to set staffing levels in the hands of pharmacy owners (who are often non-pharmacists) and not pharmacists as the healthcare professionals. For example, it states (addressed to the pharmacy owner): “you develop, working with the responsible pharmacist, a staffing plan which takes account of how you manage risks and the individual context of the pharmacy.” Elsewhere where pharmacists are mentioned, it is to make them aware of the staffing plan set by the owner, or to ask owners to allow them to raise concerns if they’re not happy.
- It is remarkably vague in places. For example:
- “You carry out risk assessments that are specific to the pharmacy and the team working there”. It doesn’t say what the risk assessments should cover, who should conduct them, how often or how the identified risks are to be managed.
- “Each registered pharmacy has a contingency plan for short- and longterm staff absence, whether planned or unplanned”. The contingency plan might be that the remaining staff must soldier on. There’s no mandatory requirement to cover absences with a replacement member of staff, or to put additional staff in place to cover the increased workload outside of the absence period.
- “You actively review the actual number of staff in the pharmacy who are competent and trained to deliver the pharmacy services provided, against the staffing plan – in line with changing services, workload, feedback and concerns”. This guidance suggests pharmacy owners should review the number of staff, but doesn’t require them to change the number of staff to meet the expectations placed upon them.
The GPhC – a ‘peripheral player’ in tackling workplace pressure, but has powers to set standards on the working environment
The GPhC has said it should be a ‘peripheral player‘ in tackling workplace pressure. This seems odd given that some of its standards for registered pharmacies directly relate to that (e.g. relating to staffing levels and ensuring corporate targets don’t compromise patient safety or professional judgement).
However, the GPhC has powers in the Pharmacy Order 2010 to set enforceable standards (c.f. guidance) for registered pharmacies, explicitly including on “the working environment at and the condition of registered pharmacies”. The GPhC’s overarching purpose is ‘to protect, promote and maintain the health, safety and well-being of members of the public’, including by ensuring that pharmacy owners ‘adhere to such standards as the Council considers necessary for the safe and effective practice of pharmacy’. It appears to us that the GPhC is allowing pharmacy owners to set staffing levels themselves and that such an approach may be an abdication of its responsibilities.
What we’d like to see the GPhC do
The PDA would like to see specific minimum staffing standards required by the Standards for Registered Pharmacies, or in separate GPhC standards. There are various principles the GPhC could have used to specify mandatory minimum staffing standards included in the PDA’s Safer Pharmacies Charter. For example: “Staffing levels will be sufficient to allow all legal, contractual and regulatory obligations to be met; to meet the workload involved in following standard operating procedures and to carry out other work in accordance with the organisation’s expectations. All staff must be suitably trained and competent to carry out the pharmacy work they are involved in.” We think such standards are a reasonable thing to expect from the pharmacy regulator.
