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We need to talk about Leela

By Outsider

‘Five year community pharmacy contractual framework’ is not a phrase that rolls off the tongue, we need a better name for it. I’m going to future gaze this month, so in the spirit of Matt Groening’s better, but less famous cartoon, I’m going rename it Leela.

The advantage of Leela is that she gives us a route map of where we need to be at the end of her term. Right now, in pharmacies up and down England, contractors are struggling to make sure they’re completing the appropriate audits, sign-ups, SOPs and all the rest that comes with the rapid change of pace introduced by Leela. It is, however, worthwhile pausing and looking forward to what needs to be in place by 2023/24.

Walk in to most community pharmacies today and you’ll invariably find the pharmacist in the dispensary, supervising the sale and supply of medicines and doing a mixture of clinical checking and accuracy checking. If you’re really unlucky as a patient, when you walk up to the counter, the pharmacist will be delivering an MUR or some other consultation in the (most likely only) consultation room. 

Contrast this with any other primary healthcare contractors (doctors, dentists, opticians) who provide patient care on a one-to-one basis for most of the day. Instead, as pharmacists we seem to have an obsession with supervising or checking what other members of staff do, rather than providing care.

Leela demands that we change this approach. If the Community Pharmacist Consultation Service creates the demand Government and PSNC hope it will, pharmacists will inevitably find themselves providing consultations akin to the other healthcare colleagues.

People don't like change, and that's especially true of pharmacists, however, change we must

It’s not going to be that easy though. As a profession, we’re incredibly risk averse. The first lecture in any pharmacy law and ethics course invariably starts with Regulation 214, essentially teaching us that we will break the law unless we comply with every dotted ‘i’ and crossed ‘t’ that follows. That fear of risk tends to stay with pharmacists throughout life. It’s also our most convenient excuse not to do something difficult. People don’t like change, and that’s especially true of pharmacists, however, change we must.

First, let’s stop playing out the parody of our own profession with such sincerity. Supervision doesn’t need to mean standing over colleagues’ shoulders, or eavesdropping on every OTC sale. The continued failure to define supervision in statute is one of the things that reinforces this over-cautious approach by pharmacists, but let’s think differently and use that lack of definition to our advantage.

When you visit a licensed bar or public house, the licensee is responsible for supervising the safe and legal consumption of alcohol on the premises. They don’t do that by standing in the bar checking on each individual sale. The responsible person in a wholesaler doesn’t check each individual stock movement. Instead they supervise by robust processes, training and audit that gives them the assurance they need to comply with their relevant legal duties.

See that big folder of SOPs on the bookshelf? What’s the point in having them if they’re not actually used by the pharmacist as an assurance tool? Also, they’re ‘standard’ operating procedures, not ‘dictated’ operating procedures. 

GPs are able to digitally sign repeat prescriptions using their clinical system in the consultation room, managing their workflow as they see fit. Why can’t we digitally sign off the clinical check in the same way? If 70 per cent of your items are repeat prescriptions and of those 85 per cent don’t change month to month, why on earth are you still clinically checking them every time? 

Leela challenges us to adapt and behave differently. In her brave new world there is no place for pharmacists in the assembly process, or loitering to overhear what counter staff are doing. If you can’t trust your team then you need to ask yourself why. 

In Futurama, the protagonist, Fry, has an off and on again relationship with Leela, much like our relationship with previous contractual frameworks. We can’t afford that anymore. Leela is challenging and ambitious, only heading in one direction. Will you embrace her?

Outsider is a community pharmacist

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Thanks, Matt