Pharmacists and work-related stress

The recent tragic case of Alison Stamps is another example of the wider issue of workplace morale and stress in the Pharmacy profession, which is a safety issue both for pharmacists and their patients. It was one of my disappointments, as a member of the Royal Pharmaceutical Society’s English National Board, to see a failure of all pharmacy organisations to effectively grapple with this issue in a meaningful way. Meetings were held, platitudes were spoken, but no substantial action was taken. Sometimes concerns about target culture were dismissed as pharmacists who did not wish to engage with changing professional roles, rather than as substantial concerns about the way metrics could be mis-used by poor management structures.

It is pleasing to see that concern has reached Parliament about this issue. We must do better.

Transcript here. Video below.

Image from My Diliff – Own work, CC BY-SA 2.5, https://commons.wikimedia.org/w/index.php?curid=1634181

Leaving the English National Board

For the past three years I have been serving as an elected member of the English National Board of the Royal Pharmaceutical Society, and for the past year the Society’s Assembly. The nominations for the 2016 elections closed on the First of April at 12:00, and I made the difficult decision not to submit my nomination.

Significant workplace responsibilities and pressures over the next 12 months, as well as challenging work as Chair of Governors at a local school, have led me to regretfully decide that the wisest choice is not to stand at this moment in time. If I was to serve on the RPS board, I would wish to do so at full capacity. The members who elect Board Members should accept nothing less.

I will attend my last assembly and board meetings this month. Over the past 3 years under the leadership of David Branford and Sandra Gidley, and the Presidency of Ash Soni, I have seen the board become more tightly focused, with a series of successful campaigns (such as the Pharmacists in GP surgery campaign) to raise the awareness of the role of pharmacists in new and existing roles. It has also become a more responsive organisation, dealing with multiple consultations and media enquiries.

It has been a pleasure to work with the staff at the Society, who deeply care about pharmacists, and with my fellow elected board members. Working in different sectors, the board pull together for the good of all pharmacists. I have learnt much from both staff and fellow board members, and I hope that my contribution over the past 3 years years has been useful.

The Society has also completed a complex move to a new headquarters. Despite celebrating its 175th anniversary this month, the Royal Pharmaceutical Society is still in many ways a new organisation, finding its feet after many years of a difficult dual role as a regulator and professional body. Much work remains to be done to secure the long-term future of the organisation, and take the final step to Royal College Status. I see the continued development of the Society’s Faculty as a crucial part of this strategy.

After years of slow motion, a number of changes in education, technology, and NHS funding structures are changing the environment pharmacists are working in faster than ever before.

It has been said many times that pharmacy has been at a crossroads, it now appears to be in a Formula 1 race. It is the Society’s role to support pharmacists through this challenging time, which has both significant opportunities and threats. Certainly, in my talks with pharmacists, the individual pressures they are under seem ever higher. There has never been a greater need for a professional leadership voice.

I wish those who have submitted nominations good luck in the coming elections. They should find it hard work, but rewarding.

I would like to thank Helen Gordon, the RPS Chief executive, Howard Duff, Dr Catherine Duggan, all the staff I have met and worked with, and my fellow board members. Finally, and most importantly, many thanks to those who voted for me back in 2013, and who placed faith in me.

Anthony

Pharmacies can sell anti-vaccine books.

Goya, "Los Caprichos": The sleep of reason produces monsters, 1799.

Last August I submitted a complaint to the GPhC (the pharmacy professional regulator) about two homeopathic pharmacies. Both pharmacies were selling anti-vaccination books. The GPhC’s tagline on their website is “Upholding standards and public trust in pharmacy”, so I felt given the misleading nature of such information I ought to send in a complaint.

They have now made a decision not to refer the complaint to the investigating committee. They have instead issued advice to the two companies reminding them to adhere to the Professionals Standards set by the GPhC (bold emphasis my own):

4.3 Explain the options available to patients and the public, including the risks and benefits, to help them make informed decisions. Make sure the information you give is impartial, relevant and up to date

6.2 Not abuse your professional position or exploit the vulnerability or lack of knowledge of others

6.4 Be accurate and impartial when you teach and when you provide or publish information. Do not mislead or make claims that you have no evidence for or cannot justify

It has been interesting being a complainant to the GPhC, and I have had no complaints with the staff I have dealt with, who were professional in their approach to me.

My original complaint was that anti-vaccination books were being sold from registered pharmacies and that this was incompatible with being a member of the pharmacy profession (by breeching the Professional Standards 2012 – see above). I also argued that this put patients at risk by promoting anti-vaccination books.

This was the GPhC’s series of points that address my complaint.

GPhC Ruling Homeopathy

The following are some brief partially formed thoughts.

The first argument that the books are “hidden” seems irrelevant. Virtually all websites require members of the public to navigate around the site to find items for sale. The argument that the books are therefore some form of hidden item, and that clicking through to them is some sort of explicit consent to be misinformed is an assumption.  In any case, the professional standard that “Make sure the information you give is impartial, relevant and up to date doesn’t have a qualifier “except where you have hidden it behind the counter or off the front page of your website”. It also isn’t clear that the professional standards related to misleading or providing out of date information only applies to patients/customers. The same surely applies to the supply of information to other practitioners, and that should include even homeopathic practitioners.

That point also applies to the second bullet point. The fact that the customer profile of the books was homeopaths or customers with a clear interest in homeopathy does not absolve the pharmacies of their professional responsibility. If a patient decides to buy a drug that interacts with other medication which would cause harm, the pharmacist has the right and responsibility not to supply. The same applies here. There is a professional responsibility not to sell information to either homeopaths or customers that may cause harm to children (either through a parent’s decision not to vaccinate, or a homeopathic practitioners decision to advise patients on the basis of the information in these books). The buck stops (or rather doesn’t) in the pharmacy (see professional standards 4.3, 6.2, 6.4 for clear statements to that point).

The third bullet point, seems to be suggesting that the pharmacists’ professional responsibilities can be diluted by telling customers to seek independent medical advice. Really? Comment is made about training of staff members. One hopes they don’t use the books they sell as training material…

The fourth point, about not receiving a complaint. I am a member of the public. I have complained. Homeopaths aren’t going to complain. Do we have to demonstrate harm before drawing attention to poor practice? I have no doubt that dangerous professional practice found on a registered pharmacy related to the supply of prescribed medicine when a GPhC inspector visits would be dealt with on the basis of future risk to patients. Why is this any different?

Is the sale of misleading anti-scientific material about vaccination from a registered pharmacy “Upholding standards and public trust in pharmacy”?  Put that starkly I suspect most would say no. Breaking this case down into constituent “trees”, the “wood” starts to dissolve. This needs to change.

The professional standards are clear: “Make sure the information you give is impartial, relevant and up to date.” There is no possible way that the sale of anti-vaccine books is compatible with this statement. If anyone can explain how it is in the comments, I would be most grateful.

When it comes to the professional responsibilities of pharmacies supplying anti-vaccination books, the buck should stop here. Sadly, in this case, the books are staying there instead.

Be better than the average: The Yellow Card App

For the past 50 years the Yellow Card scheme has been an essential patient safety resource. Like the UK’s blood donation scheme it depends on altruism. Reports are made by by patients, carers, and healthcare professionals of suspected adverse drug reactions (side effects) to medicines.

It saves lives. It reduces morbidity. It creates safety information for others.

Yet, the average number of reports per healthcare professional is less than 1 per year.

If you want to be better than the average healthcare professional, then download the Yellowcard app (IOS here and Android here) and take the time to report just one ADR this year.

You have benefited from Yellow Card data if you are a patient or a professional. Give something back. Report the next suspected ADR you come across.

Better still, make it a habit of your professional practice.

Registered Homeopathic Pharmacies Can Sell Anti-Vaccine Books

[There is an update at the bottom of this webpage, which I will keep updated as further information arrives]

Last week, I discovered that two UK homeopathic pharmacies (Helios and Ainsworths) were selling anti-vaccination books. This is no surprise, since homeopaths have a track record of engaging with anti-vaccine views as found by Schmidt & Ernst in 2002 (as one example), and on occasion have been found to be providing ineffective homeopathic alternatives to vaccines in the UK. Concern has been expressed that regulators are not taking this issue seriously enough.

This is the sort of book they were selling (several were for sale).

Anti-vaccine book sold at Helios
Anti-vaccine book sold at Helios

Pharmacies in the UK are regulated by the General Pharmaceutical Council (GPhC), they exist to ‘protect, promote and maintain the health, safety and wellbeing of members of the public by upholding standards and public trust in pharmacy.’ The GPhC has stated in 2011 that they would continue to monitor the situation in one pharmacy after the selling of homeopathic malaria prevention treatments‘the information gathered as part of the (recent Newsnight) investigation including the original complaint may be taken into account if we receive any further complaints about the pharmacy professional in the future.’

I was therefore hopeful that action, or at the very least an investigation, might happen when I complained to the GPhC about the two registered pharmacy premises who were selling the books, and additionally I noted that a homeopathic preparation (pertussin homeopathic remedy) that could be used as a homeopathic vaccine was being sold by one.

Despite being pretty much an absolutist on free speech, I feel this is appropriate. That is, I do not have a problem with the publication or selling of anti-vaccine literature from bookshops, my only concern is that registered healthcare professionals are supplying this material from registered premises.

In my opinion, the selling of anti-vaccine books by a registered pharmacist/pharmacy is incompatible with the Code of Conduct for Pharmacists.

I have received a prompt response from the GPhC this morning to my complaint. They have not investigated my complaint, but have looked at whether it sits in their area of jurisdiction.

GPhChomeopathyresponse-1

 

The response raises a number of issues for me since it dropped through the postbox this morning:

1. How can someone be fit to practice as a pharmacist (which includes knowledge) and knowingly sell an anti-vaccination book?

2. Is selling an anti-vaccine book from a pharmacy purely a commercial matter? I might agree if I had complained about hair dryers or cameras. Does the pharmacy regulator not have a role in public health? Remember they exist to ‘protect, promote and maintain the health, safety and wellbeing of members of the public’. Does this mean anything if pharmacists can sell anti-vaccine books? Can they sell cigarettes on this basis too?

3. There is a hole in regulation. Selling anti-vaccine books, and selling homeopathic remedies that are suggested in those books is tantamount to putting an indication on the remedy.

4. There is no evidence that a registrant is acting outside of their competency. Isn’t a pharmacist in control of a registered premises? If so, isn’t the fact the book is on sale evidence they are dangerously ill-informed, and a threat to public health?

5. There is no evidence they holding themselves to be anti-vaccine specialists.  I am not sure that is important. I was not making the accusation they are anti-vaccine specialists in my complaint, but implying their are vaccine ignorant. Selling anti-vaccine books shows a startling lack of knowledge of immunity, the science of vaccination and public health. How is that compatible with professional registration as a pharmacist?

I’m not a fundamentalist on homeopathy, I can see how differing health beliefs of patients might lead them to use such products, despite the lack of plausible mechanisms, and evidence for their effectiveness. I also have some issues on how pharmacists are targeted as suppliers of homeopathy by skeptics, when they may well be employees with little to no control over stock in their store (unlike their superintendent pharmacists). However, in this case it seems clear-cut to me that products dangerous to public health are on sale from a registered pharmacy, which is under the control of a pharmacist.

And there is apparently nothing to be done about it.

NOTE: A big thanks to eagle-eyed Rob who spotted this material in the first place

UPDATE 11th September 2015

The GPhC have noticed this post and treated it as a complaint, and combined it with a review of my initial complaint. A Fitness to Practise investigation into these concerns has been initiated, an apology was issued about the initial letter’s inaccuracies, and the GPhC are identifying improvements that can be made to the initial assessment of concerns. They have promised to keep me updated about progress on the investigation. This is reassuring news.

 

 

Fringe session at the Royal Pharmaceutical Conference 2014

Birmingham Library

If you are attending the Royal Pharmaceutical Society’s Conference this Sunday and Monday, Birmingham and Solihull RPS would be pleased to see you at our breakfast Fringe session at 8am until 9:30am on Monday the 8th of September 2014. There will be coffee and danish pastries… Further details should be in your Conference Pack and at the registration desk. There is a form to register at the end of this post.

Here’s what you can see, and there will be time for Questions and Answers.

Innovation in pharmacy practice: Three case studies.

1. West Midlands Emergency Department Project (8:10am until 8:30am)

Health Education West Midlands identified a role for the Pharmacist in areas such as pre-discharge medicines optimisation in the ED and Acute Medicine Units, as well as within Clinical Decision Teams in the undertaking of medicines-related and minor¹s-focused clinical duties. This project aims to develop enhanced roles for Pharmacists, to improve patient safety, the patient experience and to increase capacity in the acute care pathway.

2.RPS BNFc QRG and SCRIPT Paediatric E-learning Modules (8:30am-8:50am)

SCRIPT eLearning is an established innovative and interactive eLearning programme to improve prescribing competency. Initially commissioned by Health Education West Midlands for Foundation trainees, the project has recently been extended to Paediatric Specialist Trainees, with 12 modules commissioned for development in collaboration with the University of Birmingham and Birmingham Children¹s Hospital. This exciting project sees Paediatricians, Specialist Paediatric Pharmacists and Nurses collaborating to develop module content that will improve knowledge relating to prescribing and therapeutics, with the overall aim of reducing medication errors in the paediatric setting. The learning will be made available online at www.paediaticprescriber.org.

3. PINCER: The use of a pharmacist led technology intervention method to show a reduction in patient harm (8:50am-9:10am)

The PINCER trial published in the Lancet February 2012 demonstrated that a pharmacist-led technology intervention method was effective in reducing a range of medication errors in general practice. Walsall CCG medicines management team has implemented a systematic process across all member practices to implement these safety interventions utilising the expertise of the informatics team and a software tool from PRIMIS. The improvement is safety and quality of prescribing has been demonstrated by the reduction in numbers of at risk patients across all categories and reduction of new patients identified.