The revised standard requires pharmacists and other pharmacy professionals to ensure their beliefs do not compromise patient-centred care, meaning that they will not always have the option to refer a patient to another provider or service when offering certain treatments, such as emergency hormonal contraception, routine contraception or fertility medicines.
The consultation on the changes split the profession, generating 3,000 comments — the highest-ever number of responses to a GPhC public consultation. After the consultation, the GPhC made it clear that while there was a shift towards more patient-centricity, there were situations where pharmacists could still refer.
As many pharmacists said they were unclear on which situations allowed them to refer, the GPhC promised to produce further guidance.
This fuller guidance, ‘In practice: guidance on religion, personal values and beliefs’ published on 22 June 2017, does not contain specific examples of situations illustrating when it would be acceptable to refer or not, but describes the processes that pharmacists should go through to help them come to a decision about how to proceed themselves.
Phamacists must record thought processes
Hugh Simpson, director of strategy at the GPhC, said that a decision had been made not to include specific examples because of the complex legal issues involved, with so much depending on the particular circumstances of an individual case. “That makes it problematic in terms of trying to explain to somebody what they must or should do in certain situations,” he said.
The guidance says that pharmacists should ask themselves whether they have made care of the patient their first priority and if they decide that a referral is appropriate, make a record of that in their notes, including details of the process they went through to come to that decision.
However, Simpson highlighted that signposting to another pharmacy would not be sufficient, and that it would need to be “an active referral”, taking into account the location of the other pharmacy, its opening hours and whether it would be able to provide the service requested. It would also have to take account of factors relating to the patient, including mobility and how urgently the service needed to be provided.
“The law is quite complex,” he reiterated, “which is why the guidance does refer to the need to take advice and support either from a colleague or your employer, or in certain circumstances legal advice.”
Simpson warned that even if a colleague in the same pharmacy is available to provide the requested service immediately, referral to them will not always be an acceptable option under the revised standard.
“Referral may not be an option either because it is not in the patient’s interests or because the individual pharmacist doesn’t want to provide a service, not on the basis of personal values and beliefs, but on the basis that may be seen in the law as discriminatory,” he said. “A refusal to provide treatment because you don’t like the gender or the religion or the sexuality of someone who has come in for a service would be clearly discriminatory and so referral would not be an option in those situations.”