This is the rather bold title of the latest Which Report looking at the mystery shopper investigation in community pharmacy. They used three scenarios, travellers’ diarrhoea asking for relief, migraine asking for sumatriptan and heartburn requesting Pantoprazole. The results, on the surface, look poor, but very similar to the last time that this was investigated and the time before.
I was looking at the scenarios and thinking what I would do:
- Travellers’ diarrhoea – I appreciate that the customer has been on holiday to South Asia, but they are in the shop and the NHS Clinical Knowledge Summary would suggest recommending fluid to prevent dehydration, perhaps with oral hydration salts and other medication to patients with mild to moderate diarrhoea. Certainly if their diarrhoea was persistent, moderate to severe or not resolving, then I would probably refer. I always think you know the ones to refer by the ‘pasty’ look of their face.
- Migraine – I would always try to establish if the customer had migraine, before supporting sumatriptan, but customers often have an accurate diagnosis from their GPs and have searched the internet before visiting the pharmacy.
- Heartburn – I would probably have tried to persuade them to take an alginate first – but if they specifically asked for pantoprazole I would have agreed. Other medications? Yes I would have probably asked, but pantoprazole is often on formularies because there are not many interactions of importance other than HIV medicines and methotrexate. The warfarin interaction has always been a doubtful one – not demonstrated within pharmacokinetic studies, but popping up in post-marketing surveillance. Would I have sold pantoprazole knowing the patient was taking warfarin – well I will have to wait for my turn?
I suppose in summary I might have failed one or two myself.
There would, however, seem to be some important indications:
- On some occasions the product was taken from the shelf and sold without any questions asked.
- On some occasions the counter assistant did not refer the customer to the pharmacist
- The pharmacist performed significantly better than the counter assistant
- Some multiple chains, performed better than independents
I am going to a joint meeting between the RPS and the GPhC to discuss the report and perhaps consider a way forward. I am looking forward to the meeting, just because I am unsure of the direction. Is this a professional matter or a regulatory matter? All the more interesting when self-selection will enable the customers to get hold of their chosen medicines more easily.
It will be a fascinating discussion, where many community pharmacists are under huge pressure to supervise dispensing, deliver MUR and NMS and other services, while income is at best stagnant. The outcome must be better trained counter assistants and more availability of the pharmacist at the front of the shop.
Now is this the job of the membership and professional representative bodies? And where does the PDA and regulators fit into the mix?