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Pharmacy inspections

Inspection reports and learning from inspections

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Patients’ feedback about their experience of pharmacy’s services not acted upon and patient confidentiality, privacy and dignity not protected

Pharmacy type

Community

Pharmacy context

The pharmacy is located on a main road close to other retail shops and the town centre. It dispenses approximately 3,000 NHS prescription items and 1 private item per month. The services provided include prescription collection and delivery, substance misuse for 10 supervised and 5 unsupervised patients, medicines use reviews (MUR), new medicine service (NMS), medicine dosage system (MDS) for approximately 30-35 community patients, needle exchange, blood pressure monitoring and minor ailments.

Relevant standards

  • 1.4 - Feedback and concerns about the pharmacy, services and staff can be raised by individuals and organizations, and these are taken into account and action taken where appropriate

Why this is poor practice

The pharmacy is not receptive to customer feedback about the services it provides and there is no information advising customers how to give feedback or make a complaint.

What the shortcomings are

The customer complaint system was described in the SOPs, but there was no complaints procedure on display or in a practice leaflet to advise customers how to raise a concern or make a complaint. Staff were aware that there was a complaints procedure but could not describe it. They said they would refer any complaint to the pharmacy manager. The pharmacy manager showed an electronic system to record complaints but none had been recorded. A patient receiving supervised methadone complained because he was not offered the use of the consultation room and NHS England became involved and stressed the importance of using the consultation room for supervised methadone. Despite this the pharmacy did not routinely use the consultation room for supervised consumption and clients were supervised at the end of the counter. This was not in line with the SOP. There was an assumption that the clients would not like to use the room and it was not used as some of the pharmacists felt uncomfortable in the consultation room with clients.

What improvements are required

All patients should be treated with dignity and respect and offered the use of a consultation room, with appropriate risk assessments made to address any concerns that staff may have about their personal safety.

Highlighted standards

We have identified the standards most likely and least likely to be met in inspections, and highlighted examples of notable practice for each of these standards; to help everyone learn from others and to support continuous improvement:

  1. 1.1 Risk management
  2. 1.2 Reviewing and monitoring the safety of services
  3. 4.2 Safe and effective service delivery
  4. 4.3 Sourcing and safe, secure management of medicines and devices
  5. 2.2 Staff skills and qualifications