View from the ground, by Ben Merriman

merriman ben

For longer than I have been a pharmacist there has been a debate around the supervision of pharmacies. This debate has recently been re-ignited following publication of documents indicating that the Rebalancing Medicines Legislation and Pharmacy Regulation Programme Board is considering changes to the legislation surrounding medicines sale and supply. The discussed change would mean any transactions made in a pharmacy would be under the supervision of a registered pharmacy professional, rather than a pharmacist as is the case now. I’ve seen an unprecedented reaction of anger, frustration, and even shock from my pharmacist colleagues following revelations that the Government is considering allowing a ‘registered pharmacy professional’ to be able to supervise the sale and supply of medicines.

So, does a pharmacist need to be on the premises all the time for the pharmacy to run safely? In my opinion, and that of many like-minded individuals, the answer is a resounding yes. Responsibility and accountability for the safe and effective supply of medicines must remain with the responsible pharmacist. The people we work for, patients, expect nothing less than a pharmacist on the premises, there when they need them. In short, a pharmacy without a pharmacist is simply a shop.

There are countless times in a pharmacist’s day when they are asked to leave what they’re doing because ‘a patient needs a word with a pharmacist’. In my 11 years as a pharmacist, not once have I heard the phrase ‘may I speak to a registered pharmacy professional’ or ‘may I speak to the pharmacy technician, please?’ If a patient goes in to a pharmacy, they expect, and rightly so, that a pharmacist—an expert in medicines use and minor ailments—will be there and ready to help them in any way they need.

I work with some fantastic pharmacy technicians, some of whom I’ve helped to train, and without them I would not be able to do what I do now for patients. Technicians are regulated healthcare professionals and have a massive role to play in community pharmacy. If any legislation should be changed, for example, that which allowed them to act under a Patient Group Directive for ’flu vaccines or emergency hormonal contraception, it would benefit both the sector and patients. But to liken their training (a 2-year, part-time, distance-learning qualification) to a rigorous, 4-year Master’s degree followed by a year of hands-on learning in a preregistration year is ludicrous. Furthermore, given the huge difference in training, expecting a technician to be able to field the questions faced by a pharmacist, both from the general public and fellow health professionals would, I believe, lead to an unfair amount of responsibility being placed upon technicians.

Emergencies and pandemics aside, however, I can think of absolutely no situations where the loss of a highly trained expert in medicines and minor ailments who is serving the public is an acceptable trade-off for efficiency. I am all in favour of allowing every member of the pharmacy team to train and develop their careers, to be the very best they can be, and help with the health and wellbeing of patients.

Currently, with no change to medicines regulation, there are plenty of examples where the personal involvement of the pharmacist is not necessary. For some time now, the final accuracy check of a prescription has been made by suitably trained pharmacy technicians, but this is only once a pharmacist has clinically assessed that same prescription and used their expertise, judgment, and responsibility to intervene if deemed necessary. The smoking cessation services and Healthy Living Pharmacy scheme run in many of the pharmacies I work at, and have next to no pharmacist involvement. Medicines counter assistants, dispensers, and technicians run these and do so with confidence, knowing that if any clinical issues beyond their competency arise there is a pharmacist there to act as a safety net, able to advise and intervene as necessary.

In closing, operating a pharmacy without a pharmacist on the premises simply cannot offer patients the same safe and effective service as they get now, nor the pharmacy technicians the same protection of operating under a fully qualified and experienced pharmacist. In times of financial constraint, now is not the time to experiment with the legal framework that has made us one of the country’s most trusted professions. We must not allow the Department of Health to further deprofessionalise and depersonalise the supply of medicines and healthcare advice by removing pharmacists from pharmacies.