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Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead pharmacist, Health and Wellbeing Directorate, Public Health England
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a green cross imageJanuary 10 2018

The Pharmacists’ Defence Association is asking for pharmacists to contact it with any concerns they may have over working practices and patient safety. The call follows the BBC Inside Out broadcast ‘Boots: Pharmacists under Pressure?’ on January 8.

The programme focused on three patients who had died after being given the wrong medication, saying that human error was to blame. The programme also looked at how a former Boots employee, Greg Lawton, had raised concerns about staffing levels and patient safety but felt his report to head office was ignored.

The PDA says that any concerns brought to its attention by pharmacists will assist it in forthcoming discussions it is having with the General Pharmaceutical Council and will help inform future ‘safer pharmacies’ campaigns.

“If pharmacists find themselves working under unacceptable workplace pressure, this could place patients at increased risk,” said the PDA. “Unacceptable workplace pressure can also damage the reputation of our profession and the trust of our patients. Such circumstances have the potential to cause stress for pharmacists which can impact upon their physical and mental wellbeing.”

The PDA has previously questioned how effective the GPhC is when it comes to tackling pharmacy standards, as opposed to pharmacists’ practice. “The BBC documentary has now presented our profession with an opportunity for decisive action and we will be asking the government to reform the regulator as it cannot be in the public interest for the GPhC’s focus to be placed mainly upon individual pharmacists when things go wrong,” said the PDA after the broadcast.

“Since 2010 the GPhC has not set Standards for Registered Pharmacies in rules (which then need to be laid before Parliament), we need to know why this has not been done and we need to ensure that this is urgently addressed.”

The programme pointed out that of the GPhC’s 2,000 inspections of Boots pharmacies, 26 of the stores had been found not to meet adequate minimum staffing levels. This equates to 1.2% of Boots’ inspection, comparing favourably with the 2.4% ‘failure’ rate of the sector as a whole. The GPhC also told the BBC that the Boots pharmacies had consequently all improved to meet the expected staffing standards.

In the programme, Boots’ UK pharmacy director Richard Bradley, commented on the deaths of the patients. “One mistake like this is one mistake too many and my absolute assurance is, despite having our industry leading record, we will continue to focus on minimising the chance of it happening again,” he said.

Mr Lawton had expressed his concerns in a 55 page document with a range of evidence but left Boots more than two years ago. As such, his opinions “aren’t relevant to Boots today,” said Mr Bradley. “We continue to invest in more people, more pharmacists than ever before, that’s into our shops and it’s into our processes, helping to make things more safe … I’m absolutely confident that the resource is there to deliver the patient care. I am confident that we have enough staff.”

The company has employed more than 400 additional pharmacists and around 360 additional pharmacy technicians since Mr Lawton left the company. Boots also told the BBC: “Staff with pharmacy capability has risen by more than 2,400, with staff in those last two groups still in training.”

Boots analysis had also indicated that it has one of the lowest percentages of errors in the community pharmacy sector where harm was reported.

Following the broadcast, the GPhC issued a statement from the chief executive, Duncan Rudkin. “First and foremost, our sympathies go out to the families featured in the programme who lost their loved ones as a result of dispensing errors. I can assure them that we investigate all concerns raised with us, including any incident in which a patient is harmed by a dispensing error, and our focus is always on making sure that actions are taken to help prevent a similar error happening again,” he said.

“We have already carried out a robust and thorough investigation into all of the concerns raised by Mr Lawton and looked at evidence from a full range of sources, including evidence provided by Mr Lawton and from senior management at Boots, and our own regulatory activities. After carefully reviewing all the available evidence, we concluded that there was not sufficient evidence overall to suggest a risk to patient safety across the organisation.

“But we did use what we learnt through that investigation into Mr Lawton’s concerns, to inform the questions we now ask during inspections to help us make judgements on whether the pharmacy is meeting all of the standards, including in relation to staffing.”

Rather then prescribing staffing levels, the GPhC takes “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. It’s our role to provide assurance to the public that standards are met. If they are not, we take steps to ensure the necessary improvements are made,” said Mr Rudkin.

However, he described as “concerning” that some pharmacy professionals are saying that they feel unable to raise concerns about pressures. “We make clear to pharmacy owners in our standards that there must be a culture of openness, honesty and learning across all of their pharmacies.”

The Boots Pharmacists’ Association has also commented on the broadcast. It said that it had opposed the Department of Health funding cuts to pharmacy contract remuneration introduced in 2016.

“We were concerned about the potential impact this policy would have on Boots pharmacists, and held discussions with Boots about the implications of the cuts. As a result, we secured a commitment from Boots that pharmacy staffing levels would remain linked to workload, despite the effect of the cuts on pharmacy income,” it said.

“Whilst anything that can be used to further improve patient safety in the industry is welcome, it’s worth remembering that Boots have always been very aware of patient safety, and very vigilant about error reporting. Boots highlighted the increases in pharmacists and technicians employed over the last couple of years in the programme; however, the BPA continues to keep patient safety and staffing at the top of the agenda in our consultative meetings with the company.”

In a statement issued after an item had appeared on BBC News Online, but ahead of the broadcast, the Royal Pharmaceutical Society said: “Any concerns regarding patient safety must be taken seriously by both regulators and employers. We hear far too often than pharmacists are unwilling to raise concerns because of the risk to their career. All employers must encourage concerns about staffing levels to be raised by their employees without fear of consequence.

“The GPhC is accused by some of being too passive in the enforcement of regulatory standards and of becoming too dependent on organisations defining their own approach to quality improvement. The GPhC needs to demonstrate how they will improve the support they give pharmacists in raising public interest concerns and change the perception that nothing will change if concerns around staffing levels or other issues are raised with them. The Society is eager to work with the GPhC on behalf of the profession in any way it can to bring this change about swiftly.”

While not commenting on allegations made in the programme, as Boots is not a member of the National Pharmacy Association, the NPA said: “The BBC coverage highlighted the importance of fostering a learning culture in community pharmacy, which in turn underpins patient safety. 

“To that end, the National Pharmacy Association makes incident reporting forms available to independent pharmacies and shares the learning across the sector on a regular basis. The NPA’s Chief Pharmacist acts as the Medication Safety Officer (MSO) for all independent community pharmacies in England with fewer than 50 branches.”

Links:
BBC ‘Boots pharmacists raise staffing concerns’. January 8 2018                   
BBC Inside Out ‘ Boots: Pharmacists under Pressure?’. Available on BBC iPlayer for 30 days from broadcast January 8 2018                 
PDA statement 
GPhC statement                 
BPA statement  
RPS statement   
NPA statement  
Today’s Pharmacist coverage of PDA’s concerns regarding the GPhC’s approach to pharmacy premises                  

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