Learning from inspections
We commissioned independent research from Solutions for Public Health (SPH) to identify the key patterns, trends and themes in pharmacy inspection reports from November 2013 to August 2018.
The analysis involved a quantitative analysis of 14,650 reports and a qualitative analysis of a sample of 249 inspection reports.
We also undertook further internal analysis to gain insight into the reasons why particular standards have not been met.
What we have learnt will help inform our approach to regulating and inspecting pharmacies. We are also urging pharmacy owners and pharmacy teams to use the findings of the report to help them to improve their pharmacy’s performance against the standards, which will benefit patients and the public using their services.
- The vast majority (85.2%) of pharmacies inspected between November 2013 and August 2018 met all of the standards for registered pharmacies.
- 1,322 pharmacies were inspected twice between 2013 and 2018; 70.7% maintained their rating and 21.8% improved their rating in their second inspection.
- The analysis identified which principles and standards were the biggest drivers of overall performance - so when these were rated good or poor, the pharmacy was also more likely to be rated good or poor overall.
- Principle 1 (governance) was consistently demonstrated to be the principle with the strongest influence on good and poor overall pharmacy performance, followed by Principle 4 (services). In addition, pharmacies rated good on Principle 2 (staff) were frequency found to be rated good overall.
- The above findings suggest Principles 1 (governance) and 4 (services) are drivers of both good and poor overall performance whereas Principle 2 (staff) is a driver of good overall performance only.
Figure 1: Standards that drive a pharmacy’s performance
- The analysis identified that pharmacies with particular characteristics, including being in a hospital, being part of a larger pharmacy chain or being in a rural location were more commonly rated as good. Community pharmacies, and particularly single independent pharmacies or ones that were part of a small chain, were more commonly in the smaller group of pharmacies that did not meet one or more standards and were rated as poor or satisfactory with an improvement action plan.
- However, all six pharmacies with an overall rating of excellent were community pharmacies, and four of the six were single independent pharmacies or part of a chain of between 2 to 5 branches. Although the numbers are too low to be statistically significant, this indicates that smaller community pharmacies are also able to demonstrate excellent performance.
- Internal analysis identified the top five standards rated as good. Standards relating to staff skills, monitoring safety and quality of services, managing risks, culture and safe and effective delivery of services were most commonly rated good.
- The analysis also identified the top five standards that were not met and the most common reasons why each standard was not met, to help pharmacies understand potential failings in these areas. Standards relating to managing medicines and devices, managing risks, monitoring safety and quality of services, keeping records and safe and effective delivery of services were most commonly found to be not met.
- The analysis identified seven emergent themes which were associated with good and/or poor performance:
- A proactive approach
- Efficient processes
- Customer and patient focus
- Added value
- Lack of key knowledge and a failure to learn
- The analysis also looked at three themes identified in advance; leadership, innovation and demonstrating outcomes, and found that they also appear to play a part in influencing pharmacy performance.
- The quality of pharmacy staff was found to underpin the themes that were associated with good and poor performance and can therefore be seen to play an important role in the pharmacy’s performance overall.
Key insights from the research:
- Pharmacies that put the people using their services at the heart of what they do and respond proactively to people’s needs are more likely to perform well against the standards.
- Struggling pharmacies should begin by focussing on governance and service delivery, as these are the key areas associated with poor performance.
- Pharmacies that invest in improving the quality of their staff will perform better overall.
- The vast majority of pharmacies met the standards around equipment, facilities and premises.
- The research found that for pharmacies that had undergone more than one inspection, it was more common for the inspection rating to have improved rather than to have deteriorated.
- Pharmacies will only perform well against the standards if pharmacy owners have made sure that their pharmacies have the right governance, systems and culture in place, and are investing in their staff. Once these elements are in place, the pharmacy staff are then able to deliver good or even excellent practice. Strong leadership may be associated with having these in place.
- Struggling pharmacies should ensure that not only do they reflect on their performance and learn from their mistakes but that they also share knowledge and learning amongst the pharmacy team.
- Providing added value in the range and quality of services offered is associated with good performance. This can be driven by local needs, developed and delivered in partnership with other organisations or through use of innovation.
We are using what we have learnt from this analysis to inform our future work, including:
- using our online ‘knowledge hub’ on our new pharmacy inspections publications site to highlight examples of excellent, good and poor practice for the key themes identified in this report, as well as examples for the standards that have a key role in driving performance and the standards that are most commonly found to be not met
- sharing our findings with key organisations with a role in supporting pharmacy owners or pharmacy professionals, so they can provide further support and resources to their members on the key themes and standards identified through the analysis
- the learnings from this report will help to inform our approach to inspections, including in relation to what standards we will pay particular attention to in intelligence-led inspections and pre-registration visits for pharmacies, and in how we schedule routine inspections
- considering the learnings in relation to wider work, for example our future fitness to practise strategy
Standards which play a key part in a pharmacy’s overall performance:
Standards found to drive both good and poor overall performance:
- Standard 1.1 (risk identification and management)
- Standard 1.2 (reviewing and monitoring the safety and quality of services)
- Standard 4.2 (safe and effective service delivery)
Standards found to drive good overall performance:
- Standard 2.2 (staff skills and qualifications)
- Standard 2.4 (culture of openness, honesty and learning)
Standards found to drive poor overall performance:
- Standard 4.3 (sourcing and safe, secure management of medicines and devices)
View the reports
What we have learnt will help inform our approach to regulating and inspecting pharmacies
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