People in Lithuania have placed lit candles outside community pharmacies to symbolise mourning, after parliamentarians voted to allow remote supervision – a move that campaigners fear would spell the death of the pharmacist profession.

On Tuesday 25 April 2023, 64 members of the Seimas (Lithuanian parliament) voted to allow pharmacy technicians who qualified before 2006 to continue to work alone, with pharmacists being allowed to remotely supervise up to three pharmacy technicians per pharmacist. There were 25 votes against this move and 32 abstentions.

Campaigners fear this will spell the end of investment in training pharmacists, amid an ongoing shortage within the profession.

And in response, members of the public have been invited to place a candle outside a pharmacy to symbolise the ‘funeral of the pharmacist profession’ and share photographs on social media using the hashtag #vaistamen – ‘for medicines’.

The situation in Lithuania

Before Lithuania joined the EU in 2004, the physical supervision of a pharmacist was not necessary – and in the 18 years since then, the EU directive that requires pharmacy technicians to work under the supervision of a pharmacist physically present in the pharmacy has not been implemented.

The Lithuanian Pharmaceutical Association (LFS) presented a letter to the members of the Seimas of the Republic of Lithuania, the Ministry of Health and the advisors of the Prime Minister, calling for the implementation of the EU directive 2005/36/EC and its supplementing directive 2013/55/EU from July 1 2023.

But the draft amendment to the country’s Law on Pharmacy seeks to allow pharmacy technicians to continue working in pharmacies alone, remotely assisting pharmacists.

Professor Dr Habil Ona Ragažinskienė, president of the Lithuanian Pharmaceutical Association, said the proposed amendment was ‘inappropriate’ and told The Pharmacist she was concerned the recent vote in parliament would postpone the implementation of the EU directive ‘indefinitely’.

Parliamentarians are due to hold a second vote on the issue.

‘It would harm the development of pharmaceutical services necessary for Lithuanian society, promote the irrational use of drugs, increase the separation of regions and worsen the quality of patient service – thus the health interests of Lithuanian citizens would be violated,’ said Professor Dr Ragažinskienė.

Meanwhile, Neringa Smalstiene, a pharmacist who trained in Lithuania and now works in the UK, said the issue was likely to affect the quality of access in rural areas where it was difficult to recruit and retain pharmacists.

Community pharmacies have always been a ‘unique setting’ where ‘anyone who turns up to the doorstep’ can expect ‘qualified, clinical advice, without making any appointment with a healthcare professional’, she told The Pharmacist. ‘As a pharmacist, I fear I could not provide that equally effective care supervising multiple pharmacies at the same time,’ she added.

Remote supervision has ‘always been deemed as a practice with increased risk to patient safety’, said Ms Smalstiene, adding that while pharmacy technicians were ‘highly qualified specialists’, changes to supervision regulations could lead to a ‘postcode lottery’ affecting quality of care in different areas.

‘Patients and the public should expect equally safe and effective care from any pharmacy [wherever] they go,’ she added.

She also raised concerns that in a sector already experiencing shortages of pharmacists, the move could risk the ‘extinction’ of the profession, as fewer community pharmacists would be needed and therefore trained. She explained that the candles outside pharmacies in Lithuania were to raise awareness of the impending possible loss of the profession.

Lithuania ES LV Presidents

Prof. Dr. Ragažinskienė with Tanel Kuusmann, President of the Pharmaceutical Society of Estonia and Dace Ķikute, President of the Pharmacists' Society of Latvia

Could it happen in the UK?

Ms Smalstiene’s partner, Dr Dean Eggitt, a GP, told The Pharmacist that pharmacists in Lithuania are ‘independently run, highly skilled, highly trained, help you through your medical problems and usually stop escalation to anywhere else in the health system’.

‘But they’re a dying breed. There aren’t many of them anymore and they’re expensive,’ he added.

He said: ‘The challenges we have here are actually global challenges, and many countries across the world are looking at solutions to tackle the same problems that we have here [in the UK].

‘So, [a] lack of pharmacists, lack of doctors, lack of money to pay for the healthcare system. And everyone is looking to technology as a potential solution.’

Debates around remote supervision in the UK are ongoing.

The Department of Health and Social Care (DHSC) is planning to reform legislation relating to supervision this year, and a cross-sector group has been set up to co-produce a report along with a set of recommendations to inform the DHSC and health ministers.

The group has said that any changes to supervision legislation and guidance ‘must benefit patients through greater access to care and services and enable the profession to thrive within a future health and care system that enables pharmacy to deliver a holistic range of patient care and support’.