Ladies and gentlemen!  It’s a genuine pleasure to be hosting a blog from the brilliant & knowledgeable @cathrynjbrown…. 

Safe supply of pharmacy medicines

My thoughts on this have changed, it took a while, but I have been convinced that a total prohibition on open display is not the way to ensure safe supply of pharmacy medicines in the 21^st century.

A few things; this removal of the proscription on having pharmacy medicines on open display is part of a whole new suite of standards for pharmacy premises. They are a move away from strict rules which can act as a brake to innovation. The evidence on medicines on open supply is slight, but a total prohibition is not going to help the collection of such evidence. Some people are concerned about the nature of these standards, which are broad, but as professionals we should be able to work within grey areas.

The standard itself, and indeed the whole of principle 4, highlight the importance of treating medicines as special and not just ordinary items of commerce.  And none of these standards remove the necessity for pharmacy medicines to be sold or supplied under the supervision of a pharmacist.

4.3 Medicines and medical devices are:

• obtained from a reputable source
• safe and fit for purpose
• stored securely
• safeguarded from unauthorised access
• supplied to the patient safely
• disposed of safely and securely

We are in an internet age, for good or ill, and as such patients and customers have access to massive amounts of information about medicines and medical conditions compared with the past. They also have easy access to pharmacy medicines there; both from regulated and unregulated websites (don’t get me started…). Why then, once they come into a pharmacy do we treat them as children and not allow them to touch the box until we’ve decided it’s right for them? When I’ve spoken with members of the public about this, they are evenly split; with younger people wanting to make their own choices, versus older people who want to rely more on the judgement of a professional.

Some pharmacists are concerned about open display of drugs of abuse, I am concerned too, but hope that we can rely on the judgement of pharmacy superintendents, who are our fellow professionals, to store and display these safely such that members of the public won’t be harmed. I think that early adopters of any change will be closely monitored, both by the GPhC and by the pharmacy media to see that no harm comes to any patients who are able to choose their own medicines.

People are concerned about the quality of interaction between a patient who might have made a choice to buy something, and the pharmacist or staff member at the till. I know that the Which? report didn’t give us a shining review, but I believe we can train our staff such that they are able to help patients get the right treatment or referral. We also need to trust our staff to be able to do the right thing by our patients, and if we don’t feel able to do that, are we letting both our colleagues and patients down? If the presence of a physical barrier between a patient and a medicine is the only thing keeping them safe, I think we have more things to worry about than just where items are displayed.

This is most likely to work safely and effectively in pharmacies where the only tills are in the pharmacy area, or where every member of the team is trained as a medicines counter assistant or to a higher level. As such supermarkets are unlikely to be early adopters of this, pharmacy is only a small part of their business and the capital investment required is likely to put them off. Also, only small areas of supermarkets are registered, and the confusion around which tills can be used would not lead to good customer experiences. The same would apply in a lot of larger pharmacy premises, unless the areas are very proactively staffed.

A few final thoughts; yes, patients feel like it’s theirs once it’s in their hand, but we have to take it off them to scan it through the till anyway. If they refuse to give it to us, and plan on leaving the shop with it, that’s shoplifting and there are rules against that sort of thing. Yes, some patients can be aggressive, but we don’t have to serve everybody, if you are unhappy with a patient’s behaviour, ask them to leave, or call the police. Yes, patients lie, but they always have and will. Possibly beginning to treat them like adults when they are managing their own symptoms might start to reduce this.

I have worked in pharmacies where this could work and pharmacies where it definitely wouldn’t. My hope is that this leads to better interactions between patients and pharmacy staff, and hopefully more visibility of pharmacists.