This was a community pharmacy close to a GP practice in a town with a population of 50,000 of which the pharmacy served around 10,000. It had recently had a complete refit and was dispensing around 12,000 NHS items each month. The NHS items included supply to around 350 patients in monitored dose devices. Dispensing was highly automated using 2 robots. Other NHS services provided were the standard Scottish pharmacy contract services – CMS, eMAS, smoking cessation and the gluten free food prescribing service. A substance misuse service was provided An extensive range of other services were delivered including independent prescribing for respiratory conditions, pain management common clinical conditions.
- 2.2 - Staff have the appropriate skills, qualifications and competence for their role and the tasks they carry out, or are working under the supervision of another person while they are in training
- 2.3 - Staff can comply with their own professional and legal obligations and are empowered to exercise their professional judgement in the best interests of patients and the public
- 2.4 - There is a culture of openness, honesty and learning
- 2.5 - Staff are empowered to provide feedback and raise concerns about meeting these standards and other aspects of pharmacy services
Why this is notable practice
This is a team of highly qualified individuals with an emphasis on delivering good quality outcome focused pharmaceutical care to patients. To this end, appropriate training and development are in place and embedded into the working week. Highly trained and skilled individuals are assigned to high risk activities. Communication is good with all opinions valued.
How the pharmacy did this
Staff roles and responsibilities were recorded on individual SOPs. They were stored on easy to use racks on the dispensary bench and in other areas of the pharmacy for ease of use – these were very much working documents. Staff could easily look through them for reference. They had been updated to reflect changes in processes following the refit and the introduction of the large robot, with all members of the team empowered to make suggestions as some of the processes were still developing.
Staff members could describe their roles and accurately explain which activities could not be undertaken in the absence of the pharmacist. There was clarity among the team of ownership of different tasks and who could deputise. The allocation of tasks each morning with revisiting this during the day ensured that individuals did not become bored or complacent and all were involved in several processes.
All staff members were medicines’ counter trained. Schedules were used to ensure that all activities were covered and there were several individuals competent to undertake all tasks. The front dispensary was always staffed with 2 dispensers on the reception area, one other dispenser dispensing on the bench behind, and a pharmacist. The rear dispensary was staffed with 2 teams of 2 – 2 dispensers labelling and dispensing, and a pharmacist checking. A dispenser with a degree in pharmaceutical sciences and an accuracy checking qualification managed the compliance aid dispensing, acknowledging the potential high level of risk in this process and the desire for highly skilled staff.
There had been a recent review of staff levels, skills mix and competence with contracts and job descriptions all reviewed and revisited. The refit and automation had changed processes and workload, including increased numbers of prescriptions for compliance aids. Each member of staff had a training folder containing the staff handbook, health and safety handbook, contract of employment, disclosure forms as appropriate, training material and records of training undertaken and the pharmacist was monitoring and appraising this. Several staff members were first aid trained. Protected time was allocated to undertake accredited courses and other training. Development planning was in place with one accuracy checking dispenser and one training accuracy checking dispenser planning to embark on NVQ 3 training to ‘up-skill’ to accuracy checking technicians.
Meetings were held each morning with the superintendent pharmacist sharing any relevant information, distributing tasks for the day and giving staff members an opportunity to raise any issues. Any patient safety issues were discussed including any changes that had been implemented to improve safety. There was a whistleblowing policy and all staff opinion and feedback was welcomed. Examples were described of individuals being consulted during the refit process and discussions amongst the team about staffing levels had resulted in an additional full-time dispenser being recruited.
What difference this made to patients
Staff have been supported to enhance their skills and the services they can provide.
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: