Supervision in a community pharmacy “should no longer be interpreted to mean [a pharmacist] supervising individual transactions”, the government has been told, following the publication of a report by a cross-sector group.
The Supervision Practice Group, made up of seven community pharmacy sector organisations — the Association of Independent Multiple Pharmacies (AIMp), the Association of Pharmacy Technicians UK (APTUK), the Company Chemists’ Association (CCA), the National Pharmacy Association (NPA), the Pharmacists’ Defence Association (PDA), Pharmacy Forum Northern Ireland (PFNI) and the Royal Pharmaceutical Society (RPS) — has submitted its report to the Department of Health and Social Care (DHSC), with the group suggesting that the DHSC could “draft specifically worded revisions to legislation and regulatory rules and standards” that would be “subject to a full consultation process”.
In the report — ‘Supervision in community pharmacy’, published on 1 August 2023 — all parties agreed that supervision meant that a pharmacist should be present in the pharmacy and accessible to patients and it recommended that public, primary and secondary legislation should be “clarified” and “updated” to reflect this.
“Current references to ‘supervision’ in legislation, regulatory rules and standards, and professional standards and guidance alongside the NHS contractual frameworks need to be reviewed and aligned in the context of future practice,” it said.
The group noted that because supervision was not defined in legislation, this had led to legal test cases effectively providing the current interpretation of the term, which it said was “no longer suitable for modern practice”.
“A clarifying statement or direction in legislation or regulatory rules and standards to remove the case law precedent would be a helpful step forward,” the report recommended.
While all parties agreed that the definition of supervision should mean that a pharmacist be present in the pharmacy, there was disagreement on how this should be set out.
The NPA, PDA, PFNI and RPS argued that primary legislation should be amended, which would “not only deal with the outdated concept of supervision and remove the previous case law precedent but importantly make it clear to all pharmacists, employers and patients that the community pharmacy is the place in which a pharmacist should be found”.
“Secondary legislation and regulatory rules and standards would continue to have the agility to be reviewed and respond to changes in practice and define the exceptions to primary legislation,” they argued.
However, the CCA, APTUK, and AIMp said: “Including the concept of [pharmacist] physical presence in either secondary legislation, regulatory rules and standards and/or professional standards and guidance would be more appropriate to enable future innovation.”
The group, which met for nine workshop-style discussions beginning in January 2023, also agreed that the default expectation should be that a responsible pharmacist should be present to ensure that a pharmacy is operating safely and effectively, but that “certain activities should be allowed to continue for the duration of [the responsible pharmacist’s] absence”.
These activities should be decided on by the responsible pharmacist in “a two-way conversation” with members of staff remaining in the pharmacy.
The group also agreed that aspects of the preparation, assembly, sale and supply of medicines could be delegated in defined circumstances from the responsible pharmacist to any member of the pharmacy team, but “it must be clear who has the power to delegate and to whom they can delegate” and that a person accepting the delegation must be “confident, competent and willing to do so”.
Group chair Michael Twigg, associate professor of primary care pharmacy at the University of East Anglia and head of research design and evaluation at NHS Norfolk and Waveney, said: “This report is a major step forward for community pharmacy and will enable the sector to work in new ways to support their patients and communities.
“It is a report that values the contribution of all members of the pharmacy team and provides a platform for the development of a more holistic model of care.”
Commenting on the report, Nick Kaye, chair of the NPA, said: “We are pleased to have reached a common position on pharmacy supervision, after months of working collaboratively to understand, respect and accommodate each other’s stance on this important matter.
“There is consensus that the physical presence of a pharmacist in the pharmacy is a defining characteristic of community pharmacy — a principle which has been an anchor point for the NPA throughout these talks.
“We also all agree that changes to current arrangements are necessary to improve access and help pharmacists have the capacity to deliver more face-to-face clinical services. This report means that when the government proceeds to a full consultation on this matter it will have a clear sense of where the consensus sits within the sector.”