Pharmacists' Defence Association

Aims

The stated aims of the PDA are to:

Elizabeth Lee

Elizabeth Lee was a pharmacist who was given a 3-month suspended prison sentence for an inadvertent dispensing error at a Tesco pharmacy in 2007, reduced to a £300 fine on appeal in 2010. Her case received national media attention and was the catalyst of a substantial national effort in the UK to decriminalize inadvertent dispensing errors. She was defended by the Pharmacists' Defence Association between 2007 and 2010. The case has been used since that time in pharmacy education as an aid to explain the legislation applicable to the supply of medicines by pharmacists in the UK.

Road Map

‘Road Map’ is the PDA's strategic proposal and vision for pharmacy in the community in the UK. The PDA published a version for Scotland in July 2012 and a version for England in October 2013, which were submitted to the respective governments. It was based on the concept of 'pharmaceutical care' (as opposed to 'medicines management'), defined as “a patient-centred practice in which the practitioner assumes responsibility for a patient’s medicines-related needs and is held accountable for this commitment.”

Road Map was designed to strengthen the role of pharmacists as clinical practitioners, supported by a structured career framework, enhanced access to patient medical records and patients registering directly with the pharmacist or pharmacy. At present (2016), community pharmacies (not pharmacists) are paid based on the volume of prescription items dispensed and the volume of other pharmacy services provided; pharmacists may have to deliver the work associated with this contract under pressure to meet profit targets set by the company they work for.

Under the proposals, pharmacists would work as either a ‘clinic pharmacist' or ‘patient facing pharmacist' (conceptually). ‘Clinic pharmacists' would commission pharmaceutical care services directly to the NHS and deliver them either from existing pharmacies (making use of existing consultation rooms), GP surgeries, care homes, patients’ homes or elsewhere. They would manage medicines prescribing for caseloads of patients, referred to them by GPs once the diagnosis had been made (e.g. for patients with long-term health conditions), resulting in much closer working between pharmacists and GPs. It was proposed that the 'clinic pharmacist' contract would be held between pharmacists and the NHS, working independently or as group practices of pharmacists. The contract may also be operated (again through a contract between the NHS and named pharmacist(s)) by pharmacists working for existing pharmacist contractors, a specialist provider or a franchise or social enterprise. ‘Patient facing pharmacists' would work in patient-facing roles in ‘bricks and mortar’ community pharmacy premises, focusing on clinical interventions, health promotion and proactive and reactive advice when patients presented prescriptions for dispensing.

The proposals cited a ruling from the European Court of Justice (ECJ) on whether the ownership of pharmacies should be restricted solely to pharmacists. The ECJ invited member states to conclude that with non-pharmacist employers "there is a risk that legislative rules protecting the professional independence of pharmacists will not be observed or will be circumvented in practice". It was therefore proposed that contracts for pharmaceutical care services "should rest either with individuals who are pharmacists – some of whom may also be the owners of pharmacies – or with vehicles that are independent of the retailing culture that currently prevails within community pharmacy."

Payment would be based on patient outcomes rather than volume of services / profit delivered, through a quality and outcomes framework (QOF) similar to that used by GPs.

‘Bricks and mortar’ pharmacist community pharmacy contractors would have the option to provide one or both contracts (the ‘patient facing’ prescription items-based contract and optionally the clinic-based services contract). A dedicated pharmacist was proposed for the ‘clinic pharmacist' services, meaning that if a ‘bricks and mortar’ pharmacy wanted to provide both the prescription items-based contract and the clinical services-based contract, two pharmacists would need to be present at the same time. This was designed to allow the ‘clinic’ pharmacist to increase the range of services offered and to enhance the clinical relationship between pharmacists and patients. The increased costs for doing so were more than offset by significant overall savings to the NHS, outlined in the proposals.

The overall strategy was designed to increase integration and collaborative working between pharmacists (as experts in medicines) and GPs (as experts in diagnosis), other areas of primary care and hospitals, allow pharmacists to focus solely on clinical service delivery, increase pharmacists' professional autonomy and reduce the pressure on pharmacists to balance the delivery of both clinical services and prescription dispensing at the same time, in the context of commercial imperatives and often as the sole pharmacist.

The proposals include a cost benefit to the NHS through increased GP capacity, a reduction in adverse drug reactions, reduced A&E admissions, reduced medicines wastage and improved health outcomes.

Workplace Pressure

In 2016, the Association conducted a survey of its members in which pharmacists reported that they were pressurised by Boots UK into conducting unnecessary medicine use reviews, each of which attracts a fee of £28 from the NHS. In April 2016, The Guardian stated that the General Pharmaceutical Council was poised to investigate.