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A safe service does not mean it is a good service

“Surely pharmacists should have been consulted?” writes Graham Phillips (2014;293:85) in his blog about the new General Pharmaceutical Council (GPhC) inspection model for community pharmacies. He considers it unjustified to conclude that only 1 in 30 pharmacies in the UK is “good”. In fact, pharmacists were consulted. I was on the GPhC sounding board in Wales and contributed to the discussion around the development of the inspection model. And why should we expect more than 1 in 30 pharmacies to be good?

The problem lies not in the inspection process, but rather in the words used to calibrate the findings of the inspection. As Mr Phillips will know, there will be a “normal distribution” of the quality of standards presented by pharmacies. At the lower end of the distribution, there will be poor pharmacies. However, by definition, most will be average. Fewer will be better than average and fewer still will be much better than average. These words could be changed, but would that produce a change in the inspection process? I think not.

We should resist the temptation to compare the scoring process used by the GPhC with that used by, for example, the Food Standards Agency, when assessing hygiene standards in cafés and restaurants.

The brutal truth is that although most community pharmacies most of the time will deliver a safe service, standards are not as high as they might be. Average drivers get home safely most of the time. Advanced drivers get home safely most of the time, too. It is just that advanced drivers apply strategies that make it more likely that they will get home safely more often.  And it is also the case that most drivers over-estimate the standard of their driving skill.

The May 2013 Which? report on pharmacy certainly did not come to the view that most pharmacists are “advanced drivers”. For the calibration of its findings, Which? used the terms “unsatisfactory”, “satisfactory” and “good”. I have to say that the findings of that Which? report were not inconsistent with my own experiences when working as a locum community pharmacist.

A further brutal truth, at least in my view, is that standards in a community pharmacy are a reflection of the quality of training provided to the regular pharmacist and, in turn, a reflection of the quality of training provided by the pharmacist to the regular dispensary and medicines counter support staff (PJ 2013;291:374).

This boils down to the inappropriate but widespread reliance by those responsible for training on only requiring trainees to read written materials rather than providing interactive face-to-face training sessions with (good) trainers who can explain how a job is to be done and, more importantly, why. 

I believe that the “good” pharmacies are those in which there is a “good” pharmacist who has successfully explained verbally what “good” looks like to his or her support staff. However, this process requires that both pharmacists and support staff buy in to the idea that we should all strive every day to find ways of improving the quality of the service we provide. This is, we can be sure, what the GPhC is seeking to encourage. And that is why the GPhC cannot yet tell us what “excellent” looks like.

I think “excellent” pharmacies will be those carrying out research on aspects of the good service they are already providing, and using the findings of that research to introduce even better and safer ways of working.

Richard J Schmidt

Penarth, Vale of Glamorgan

Citation: The Pharmaceutical Journal URI: 20066040

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