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

Information sources for adverse drug reactions

Earlier this year, I attended the PRIMM conference, where some work I have been involved with was presented (led by Prof Janet Krska’s team at The Medway School of Pharmacy). Patients were surveyed about their information sources for adverse drug reactions.

Some of the outcomes are in line with prior research, such as a significant proportion of patients finding patient information leaflets less than easy to understand. General Practitioners were the top source of information on adverse drug reactions (69%). Pharmacists were less well used than General Practitioners(28%), and were beaten by the internet (37%). This is despite only 14% of respondents trusting the internet.

So despite being viewed as easy to access (76%) and trustworthy (73%), Pharmacists are not being appropriately used to address information deficits about adverse drug reactions. This is a pity. As the healthcare professional with arguably the greatest knowledge of medicines, Pharmacists should be a key source of drug safety for patients, and be able to interpret the drug safety data in the context of the patient’s particular circumstances. Certainly, they are in an accessible position to reduce the workload of General Practitioners in this area.

O’Donovan B, Rodgers RM, Cox AR and Krska J. Patients’ use of information sources regarding side effects Pharmacoepidemiology and Drug Safety, 2017; 26:15-16 (Prescribing And Research In Medicine Management (Uk & Ireland) Annual Conference 2017, University Of Coventry London Campus, January 28th 2017: “Deprescribing – Is Less More?”)

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.

Let’s have some over-the-counter evidence

I have an editorial in The Pharmaceutical Journal on over the counter medicines and pharmacists relationship with them. Here’s part of it:

While the secret shopper work carried out by the consumer watchdog Which? in 2013 investigated[1] the quality of advice on OTC medicines given in pharmacies at the point of sale, an earlier report[2] in Which? published in 2012 focused on OTC products themselves. Among the products that were judged to be below par were sub-therapeutic doses of drugs, dubious herbal slimming tablets, oils that allegedly reduce scarring and some highly implausible alternative remedies. A pharmacist drawing up a local formulary of prescription drugs for a GP would take into account evidence of effectiveness, advice from evidence-based guidelines and a positive risk-benefit ratio. How many OTC products would reach the required standard?

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