| Standard not met | Reason | Action being taken by the Pharmacy | By when | Notification By Pharmacy Improvements Made |
|---|---|---|---|---|
| 1.3 | The team has been opening and running the pharmacy in the absence of the Responsible Pharmacist (RP). |
Reinforced the absence of RP SOP and again strictly reminded and enforced that the pharmacy should not be operating in the absence of the RP. Staff informed to notify the superintendent/Management team on any lateness and or absence immediately without any delay. Test phone calls made when RP was running late in morning, and covert inspection done to see if any activity occurs whilst RP absent. E-mail sent to all staff and pharmacy stating importance of adhering to RP rules. Individual face to face meetings with staff to stress importance of RP absence rules. Regular contact with staff and advised RP’s to contact superintendent pharmacist immediately if running late, via direct telephone number and/or SMS. Site visits as part of ongoing review along with i.e. random phone calls. |
27/05/2025 | 23/05/2025 |
| 1.2 | Staff including the regular, responsible pharmacist are not dealing with mistakes appropriately. They have not obtained, checked nor recorded all the relevant details when mistakes have taken place, and there is limited evidence of review, remedial activity or learning occurring in response. |
Reinforced training on incident recording – retrained staff. Evidence of near miss and incidents recorded by pharmacy. Any incidents informed to superintendent / Management have been actioned, reviewed and discussed with the pharmacy along with associated reports. Advised staff and pharmacists to re-visit SOPs for errors and dealing with complaints and information regarding errors clearly displayed in dispensary. Advised a member of staff to email the superintendent pharmacist the near miss log once weekly to review and give feedback. Staff allocation of time to read through SOPS again is being set up. |
27/05/2025 | 23/05/2025 |
| 1.6 | Pharmacists have not always maintained the RP record in accordance with legal requirements. They have not recorded any details about absences and consistently failed to record the time that their responsibility ceased. |
Reinforced with all branches via email, individual emails sent to regular RPs at Lydney pharmacy and discussed across the group (by telephone and/or site visits), the importance of following RP rules and maintaining records. Weekly RP record being sent to Superintendent/Management so that this can be audited and ensure compliance to maintaining records. Which will continue until satisfied that records are being maintained in line with regulation and then on an ad hoc basis. |
27/05/2025 | 23/05/2025 |
| 2.2 | The pharmacy is not meeting the GPhC's 'Requirements for the education and training of pharmacy support staff' as one member of the pharmacy team has been working at the pharmacy for longer than three months and is undertaking dispensing tasks without being enrolled on accredited training appropriate for this. |
In process of reviewing all staff training. One individual who was seen to have been carrying out dispensing activity by the area inspector, his job role was just to be on the counter only. We have contacted Buttercups training to transfer his course from counter assistant to Healthcare Assistant (HCA) which allows both counter and dispensing activity. |
27/05/2025 | 23/05/2025 |
Pharmacy inspections
Inspection reports and learning from inspections