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GPs go forth

PDA issues urgent warning to GP-based pharmacists after serious incidents

Urgent guidelines have been issued to GP-based pharmacists after patient deaths were reported to the pharmacists’ union.

The Pharmacists’ Defence Association (PDA) said it has become increasingly concerned about ‘unsafe practice’ which has emerged since the number of independent prescribers working in GP practices has risen.

It confirmed it has seen a number of ‘serious incidents’ recently and is in the ‘early stages of dealing with cases where patient deaths have been reported’.

The incidents relate to GP practice-based pharmacists and those working in online pharmacies.

Alima Batchelor, head of policy at the PDA, said they would be raising concerns with the relevant government departments and pharmacy bodies.

’The decision to bring such matters openly to the attention of all pharmacists is always a difficult one, but we were sufficiently concerned to feel that making a public statement was necessary.'

She added: ‘We will be using information from relevant cases in future safety and risk management presentations, training and guidance material for pharmacists.'

The guidance, issued to all pharmacists, said the recent cases were linked to pharmacists prescribing inappropriately or offering poor advice because they had an ‘ill-founded’ assumption of competence.

This potentially causes serious harm and distress to patients, their families and the pharmacists involved, warned the guidance.

A PDA statement said: ‘We cannot impress upon members strongly enough the importance of seriously considering their levels of experience and skill at all times before making a clinical decision and issuing a prescription.'

The guidance also acknowledged the rise in online pharmacies selling prescription only medicines (POMs) and the risks involved due to a lack of access to examine the patient or review their clinical notes.

The statement said: ‘In some cases, we are aware that employers in online pharmacies may place expectations upon their pharmacist employees to prescribe high-risk POMs, such as controlled drugs or medicines for conditions that require regular monitoring, without any communication with the patient’s GP. We would regard this as unsafe and unacceptable practice.'

A Pulse investigation last year highlighted fears among GPs that patients were too easily able to access medicines inappropriately online.

In April 2019, the pharmacy regulator the General Pharmaceutical Council issued new rules for online pharmacies in response to these growing concerns.

And earlier this month a new set of practice guidelines for remote consultation and prescribing online was agreed and released by the GMC, CQC and Academy of Medical Royal Colleges.


Readers' comments (10)

  • What do we have here. Get non GPs to do a gps work and people die?? Who knew?

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  • Suprised anyone?
    It is the large professional blackhole where "you don't know what you you don't know" that can happen with any clinician, but with the race to give out autonomous prescribing rights to almost anyone after relatively minimal training it becomes a bigger and bigger concern.You need to know where your professional competence ends. I realise more and more what I don't know after practicing over 20 years, and actually I am far more cautious than I used to be. Worried. I welcome the mandatory prescribing audit with GP registrars now.

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  • So knowledge and experience are useful in medicine, maybe GPs are not as useless as the Daily Fascist (and The Facist on Sunday) would have us all believe.
    You never miss your water......

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  • The GPs have all warned you. You get what you pay for. Getting non doctors to do a doctor's work and people either die or run into problems.
    The beginning of the end for PCNs. Practicing medicine without being medically qualified or licensed is a criminal offence.
    I can see some Gross Negligence Manslaughter charges coming up!

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  • dear health department. told you so but you didn't listen and patients have died. 3 years of a pharmacy degree in a narrow focused subject is not the same as 10 years plus training to be a GP who train in pretty much everything and take responsibility for all of their actions regardless of whether its their fault or not. That's why you pay us more and that's why we are cost effective. You are losing us at risk to your own survival. madness.

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  • Let’s not be too hard on them. There are a few pharmacists maybe 1 in 10 who are aware of their limitations and total lack of training in patient care.
    They have been pushed into these Noctor jobs by the idiots in charge of the system and the results are as predicted.
    Stop it now and get all the doctors on CCG’s and PCNs and CQC, and deaneries etc etc back on the front line.

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  • Can you hear the establishment train coming off the tracks.

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  • I am a Gp Registrar and an Independent Pharmacist Prescriber and have taught Pharmacists wanting to become Independent Prescribers and warned them about prescribing in areas they are unfamiliar with. The vast majority heed that warning. Having done both degrees I realise that there is no substitute for the clinical knowledge you must first acquire before considering prescribing other than the ability to prescribe. It's a shame that my Pharmacist colleagues have fallen foul of this assumption to be able to prescribe is all that is needed. Even as a GP registrar I have to double check myself to make sure that I know what is right and what could be dangerous, weigh that against clinical judgement and then prescribe. The idea was great but the course is very short to become prescribers and there are even shorter courses for accelerated accreditation in as little as 3 months. 10 years minimum against 3 months seems a little disproportionate and perhaps they should be asked to complete areas of physiology and human disease before being allowed to attend a course in prescribing.

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  • The issue with non medical prescribing is that it is give you almost full prescribing rights akin to a doctor.

    What is needed is limited prescribing roles whereby non doctors can prescribe on pre agreed protocols , bit like PGDs , in very narrow scope, with regular audit and review.

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  • I have provided mentoring for 3 practitioners in the last 3 years, for "prescribing status". Whilst the clinicians involved were dedicated, hardworking and keen to learn, I realised that the syllabus has many short cuts and assumptions and there is some collusion between th professional and academic bodies involved to "get this pushed thru". In their own words, the clinicians involved (senior Practice Nurses and a very motivated Pharmacist) repeatedly expressed their concern that prescribing is just part of doing a clinical assessment and that a knowledge of the BNF in a chosen field is NOT the same as hours in face to face consultations with peer review. I admire and value their contribution but there is a rush to "release them into the wild" and they and their patients are perhaps more vulnerable than they should be as a result. In my practice(s) I always build in review time and impress that being "immediately interruptable" is part of the evolving role of a GP in our new PCN/ Multidisciplinary world. Practices who employ such staff need to prove in the Job description and to the CQC that these Practitioners are not to be shoved in a Consulting Room and expected to "get on with it regardless" of their knowledge gaps. I still have some of my own gaps after 30 years. It's about HOW these clinicians are employed and how much support they are given day after day.

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