UK pharmacist prescribers reportedly linked to deaths

Matt Woodley

22/11/2019 2:40:27 PM

Inappropriate prescribing and poor advice, underpinned by ‘an assumption of competence which was ill-founded’ are potential causes.

Pharmacist behind a desk.
Reports have linked some pharmacists with unsafe prescribing practices.

Patient deaths and other serious incidents linked to pharmacist prescribing have been highlighted by UK trade union Pharmacists’ Defence Association (PDA) in a bid to raise awareness of ‘unsafe practices.’
The PDA communique states that the union’s defence team has become ‘increasingly concerned’ about reports of unsafe practice that have emerged as the number of independent prescribers working in general practice clinics and in online pharmacies has risen in the UK.
‘We have seen a number of serious incidents recently and are currently in the early stages of dealing with cases where patient deaths have been reported,’ the PDA stated.
‘We raise as a root cause, the issue of competency once more – serious harm to patients causes untold distress to patients, their families and to the pharmacists involved.
‘Some of these recent cases are linked in some way to pharmacists prescribing inappropriately or offering poor advice, often underpinned by an assumption of competence which was ill-founded, and we cannot impress upon members strongly enough the importance of seriously considering their levels of experience and skill at all times before making a clinical decision and issuing a prescription.’
The RACGP has strongly opposed efforts to introduce independent pharmacy prescribing in Australia, and President Dr Harry Nespolon said the latest reports highlight the dangers of non-medical practitioner prescribing.
‘Pharmacists don’t have the necessary medical training to safely prescribe medications, irrespective of where they work. Anything beyond providing medicine management advice and dispensing is completely beyond their level of expertise and professional scope of practice,’ he said.
‘It’s vital we put the health needs of Australians ahead of the commercial imperatives of pharmacists keen to expand their scope and commercial reach. Otherwise we will see greater fragmentation of care and more medication errors, impacting on patient safety.
‘In the United Kingdom their pharmacy representative group is now dealing with cases where patient deaths have been reported.
‘Is this really a road we want to go down?’
Aside from independent prescribers working in general practices, the PDA also listed concerns about a rise in online pharmacies selling prescription-only medicines (POMs), as ‘the prescriber cannot see the patient or examine them directly’ and ‘will usually have no access to the patient’s clinical notes’.
‘In some cases we are aware that employers in online pharmacies may place expectations upon their pharmacist employees to prescribe high-risk POMs, such as controlled drugs or medicines for conditions that require regular monitoring, without any communication with the patient’s GP, either to check that a medicine has been prescribed before or to advise the GP of the supply made,’ it stated.
‘We would regard this as unsafe and unacceptable practice.’
The PDA warned all members that ‘significant levels of caution’ should be used when prescribing a medicine for the first time and highlighted the following as high-risk scenarios: 

  • Undertaking prescribing or providing clinical advice for patients who are not physically present
  • Undertaking prescribing for patients without reference to their clinical records
  • Undertaking prescribing for walk-in patients where a diagnosis may be required
  • Prescribing alternative medicines due to shortages – particularly where the medicine to be replaced is a member of a high-risk group such as opiates and/or the pharmacist is unfamiliar with the use of the chosen replacement. 
The PDA’s warnings have come shortly after an Australian pharmacy-led study recommended the creation of a minor ailments scheme that would expand pharmacists’ scope of practice and allow them to triage, manage and refer patients to doctors for common ailments, such as coughs and colds.
An RACGP position statement released in April broadly supports inclusion of the general practice-based pharmacists in a team-based model, but not independent prescribing.
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Dr Richard Mark Smith   26/11/2019 3:10:01 PM

This is no surprise to me :
1) a shop crammed with non-evidence based expensive vitamins and "remedies" raises concerns about quality prescribing
2) providing advice which result in a product sale is a conflict of interest
3) advice based on symptoms without examination nor exhaustive context is an error-prone guesstimate
4) pharmacists are not clinicians and will never be until they graduate as an MD

Let's improve the current system by cutting out the retailer !
Save costs
Improve distribution
Improve supply
Reduce duplication
Automate processes
Empower patients