Advance clinical checks could put patients and pharmacists at risk

Carrying out advance clinical checks for repeat prescriptions could put pharmacists and pharmacies at risk of investigation and pharmacists should not carry them out, the Pharmacists’ Defence Association (PDA) has warned.

The practice involves carrying out an initial clinical check once and applying it to future dispensing of a repeat prescription for a period of up to twelve months.

The PDA said that an increasing number of pharmacists have been asked to carry out advance clinical checks following the development of new standard operating practices (SOPs) and PMR systems ‘adopted by some pharmacy chains’, which appeared 'to be based on efficiency gains and productivity benefits, rather than optimising care and reducing risk'.

PDA members had expressed concerns that the practice of advance clinical checks could put patient safety at risk, since although the repeat medicine remains the same, the patient’s health and other material factors may have changed between the initial clinical check and dispensing the repeat prescription.

These concerns were shared by specialist legal opinion sought by the PDA, which warned that the practice could put pharmacists at risk of GPhC investigation.

‘It would not be unreasonable to expect the Council to investigate a concern which related to a failure, by a pharmacist, to carry out a suitable and sufficient clinical assessment prior to the supply of a medicinal product so as to ensure that that medicine is (or remains) appropriate for the patient,’ advised the legal counsel.

It also advised that undertaking an advance clinical check would put pharmacists at risk of personal liability if a court were to consider a civil claim against a pharmacist.

The PDA said that it was aware of significant patient safety incidents reported by members where repeat prescriptions not subject to a separate, fresh clinical check by a pharmacist had later been identified as clinically inappropriate for the patient.

The PDA also said that pharmacy owners and superintendent pharmacists could be considered were responsible to ensure that the services provided by them are safe and said that contractors could be in breach of their NHS contract if their pharmacists, including employees and locums, did not carry out a clinical check for each supply.

It urged pharmacists not to participate in processes where a single clinical check applies to future repeat supplies and said that they should raise any outstanding concerns with their Superintendent Pharmacist, while the PDA could assist members if there were any dispute or attempted enforcement of the procedures against the responsible pharmacist’s professional judgement.

Mark Pitt, PDA director of defence service, said: ‘Pharmacists prioritise patient safety and the PDA as a pharmacist led organisation also puts patients at the forefront of our advice. Our advice note on Advance Clinical Checks highlights how Regulatory Standards, Professional Practice Guidance and the NHS Community Pharmacy contractual framework are in place to maintain patient safety.

‘The specialist legal advice obtained by the PDA support the concerns expressed by members and so the advice note urges all pharmacists to ensure clinical checks are performed in line with established accepted professional practice.’