AFTER ALL THESE YEARS, I'M NOW A RESPONSIBLE PHARMACIST

And I have a card to prove it! I haven't figured out how I've got away with it all these years, behaing irresponsibly. I guess that someday it was always going to catch up with me, and from today I must put aside all childish things and behave responsibly.

The trouble is, when I read closely all the different protoccols and interpretations being offered (imposed?) by different companies, I'm not that sure what has changed in reality, other than the long overdue farce that a pharmacy was hitherto breaking the law if sales of GSL medicines were allowed to take place when the pharmacist was not present, when the petrol station down the street could sell what they wanted. When I was getting some milk the other day from a supermarket which didn't have a pharmacy, I noticed Canesten Combi on the shelves on open display and available for anyone to buy. So, if a pregnant lady describes symptoms which match thrush, if it the first episode, we are obliged to refer to the GP to ensure that there are no underlying problems with the pregnancy. Or she can just walk to the supermarket and buy it to avoid the hassle, because in a previous pregnancy we did the same thing and the GP prescribed Canesten anyway and grumbled about our incompetence. When I later explained the referall protocol he (the GP) was non-plussed and clearly unaware, which speaks volumes for inter practitioner communication.

But, I digress. I have always worked on the basis of if I'm the pharmacist on duty, I'm responsible. I accept that where there are two pharmacists on duty, there needs to be a clarification of roles etc., but as we all know, that's a rarity. So what has changed? I now have a card telling everyone I am responsible.

I can't speak for anyone else, but I have never had a problem with patients/customers knowing I'm responsible, I make it plain. Whether it's tryingto make eye contact as soon as they are near enough, whether it's the interaction between the staff and myself, whether I just have one of those faces which says "I have a very responsible job around here - if anything goes wrong, I'm responsible!"

In practice, I think the way the regulations have been framed and get interpreted will make them unworkable. We now have too many chiefs and not enough indians. We have Pharmacist (Responsible or Second), Pharmacy Manager/Store Manager, in either capacity rarely a pharmacist but with poweres deferred or devolved (until it goes wrong, then everyone turns to the Pharmacist), ACT's and so on.

Who takes the wrath of the patient if an error is made? If the ACT gets it wrong but the Pharmacist has made the clinical check? The fact is, we all make mistakes, so to single individuals out will not work as it all too often allows us to evade accountability. To quote a football adage, "We win as a team and we lose as a team". This change in regulations may have created a Responsible Pharmacist, but is it in danger of losing accountability? Only time will tell.

Swine flu vaccination? Don't call us!

So there you have it! According to an article in The Chemist and Druggist, the Health Minister, Andy Burnham, has not included Pharmacits in the list of Health care Professionals who should receive vaccination against swine flu http://tinyurl.com/n4393h .

This surely shows either how little the government (and especially this particular Health Minister - formerly Minister for Pharmacy, no less) know or care about the profession. With that in mind, and leaving aside the obvious health issues not just for pharmacists, but for all members of all pharmacy teams, is the penny ever going to drop with us all that we need far more that the proposed new professional body (which the overwhelming majority of the profession did NOT vote for). If this is the best they can do, we need to really take charge of our own destiny and explain, lobby and utilise the media in the way other groups do. There doesn't seem to be anything other than the deafening sound of silence from our leadership.

Most of us have families, some of whom themselves might be vulnerable individuals. To exclude us wholesale from the programme beggars belief, given the likelihood that as a group, we are more likely than most to come in contact with the public. How many pharmacies are either collection points for anti-virals or will inevitably be the front line in meeting potentially infected people face to face, seeing the public are being told not to go to work, to A & E, the GP - but theyare not being told to avoid the pharmacy, where they can at least buy medicines to treat their symptoms or collect prescriptions.

Co-op Pharmacy withdraw from NPA

Official notification today that the Co-operative Pharmacy has withdrawn from the National Pharmaceutical Association. This has implications for all pharmacists and locums, especially with regard to PIA. Whilst the Co-op have a history of insurance via the CIS (Co-operative Insurance Services), so this doesn't seem an unreasonable move, the small print may yet need to be checked as to how it might impact on indemnity insurance. We should all be checking our own policies carefully to make sure we have adequate protection in the rare event that we need it.

On the plus side, they have set up their own helpdesk which they claim will do the same job as the NPA Information Service and this is available during store opening hours. Perhaps we could get some constructive feedback on how this is working from locums where they have to use it?

On a broader front, it does beg the question as to whether the NPA will be damaged by the loss of such a large cohort of members - the Co-op is now the third biggest pharmacy chain in the UK so this will represent significant loss of revenue to the NPA as well as loss of members. Will it affect service levels and support generally in the future? Only time will tell.

Where does the responsibility lie with The Responsible Pharmacist?

There seems to be more confusion over The Responsible Pharmacist regulations, at least as far as some companies are concerned. I quote what one has sent out to all it's branches and regular locums recently.

" The Responsible Pharmacist will be responsible for the establishment, maintainance and review of a range of Standard Operating Procedures (The Superintendent's Office will be writing these and sending them out from July 2009)."

I know I can be a bit slow on the uptake, but surely this statement alone demonstrates either a lack of understanding by this company (there are others, this is just one example) or reflects the general malaise that has taken root in our half baked rush to a new professional body. If The Resposnible Pharmacist is the person who establishes, maintains and reviews, then the Superintendent can surely not write these, otherwise (by definition) the Superintendent is The Responsible Pharmacist. Assess and advise by all means - two heads are better than one, at least in most cases.

If The Responsibile Pharmacist is unable to excercise their responsibility (because the Superintendent has taken responsibility) how are they responsible?

In other words, when things go wrong, and we all know that things go wrong, who will bear responsibility? If we have a professional body now or in the future worth and credibility, surely now is the time to resolve this looming disaster before it affects a patient and we all look like fools. I can make a fool of myself, without any help from anyone else assisting, but this begs the question "Do these people have a clue about anything?"

I believe I know the answer - WYBMADIITY?

So, what's the question?

Swine Flu -where's the locum contingency?

We've worked hard as far as we have been able over the last two or three years to persuade many groups (Companies, PCT's, LPC's, locums, pharmacies) to have contingency plans in place should their pharmacy be affected by any pandemic, not just this current Swine Flu outbreak. Few people appear to have thought us relevant and so have either ignored us or, as we suspect, might not have given the remotest thought to community pharmacy.

If your manager, pharmacist or locum gets hit wirh Swine Flu, what do you plan to do? Call or -email us and assume we can fulfil demand? Have you considered the possible cost? We have enough of a fight getting the summer holidays covered for some pharmacies at a cost which they feel to be reasonable, what will happen to costs in a pandemic?

We might have to persuade people to work in your area from another part of the country. Such people will need accomodation in most cases. They might not want to come to work in an area where Swine Flu has taken hold in any case, irrespective of what they might want to charge.

If you're a locum, are you aware that you have a contractual liability to provide a replacement if you are unable to fulfil a locum booking? Swine Flu is no exemption from this obligation, but in real terms, could you obtain a replacement?

As usual, down at the coal face, too little thought has been given to keeping the pharmacy network going if and when things do go wrong. Some long days and nights look to be in store for those left holding the baby and thos of us who will do our best to help.

Greedy locums save the day?

Have you ever noticed that when a company can't get a locum for a particular day, some of their staff complain that they will have to resort to using "a greedy locum". What they mean, of course, is one of the last minute or emergency locums, or more often than not, someone who has already worked a full week and offers to give up their day off to help. If anyone else does overtime, don't they normally get extra pay such as time and a half or double time? Not pharmacists, they (apparently) are greedy for asking to be paid more!

Of course, if there is a need for a locum, it either means that someone else is off sick or for other good reason, a mistake has been made in the booking process, so a pharmacist is not present or that some other pressing reason has arisen requiring the presence of a pharmacist somewhere other than where they were originally intended to be. Note that the NHS Pharmacy Contract does not allow any leeway on this matter - it requires the contractor i.e. the owner of the company owning a pharmacy - to provide NHS Pharmaceutical Services during their contractual hours. The regulations DO NOT STATE that if it costs a contractor more to secure the services of a locum than they might wish to pay, then they are allowed an exemption from this requirement.

Very often, it seems, that the people responsible for booking locums for companies are ignorant of the responsibility that goes with the job (If anyone is any doubt about the consequences of making just one mistake, consider Elizabeth Lee and her situation) and of the length of time required for us to train before we are allowed to practice.

For those that are jealous of what a locum can earn, I suggest they stop what they are doing and go back to school (at least 3 good "A" levels needed, usually two years study, then the pharmacy degree course, four years, then the year's pre-registration training before we can earn a living). Just think, in the seven years that will have passed by then (assuming that you pass all the exams and other hurdles), locum rates will be even more than they are now, and you too can become "a greedy locum". Of course, you won't, because you're not greedy, so you won't charge what the rest of us do, will you?

I am the one in ten

According to the PJ 1st August 2009, "One in 10 pharmacists is considering quitting" the profession, according to the workforce survey comissioned by the Royal Pharmaceutical Society. Commenting on this, Sue Ambler (Head of research and development at the Society) said; "The data will be utilised to help identify how both the General Pharmaceutical Council and the new leadership body can further and strengthen support for pharmacists".