Letby case: ‘Lessons need to be learned’ in community pharmacy

The Pharmacists’ Defence Association (PDA) ‘routinely’ receives reports about managers overruling the clinical judgement of registered pharmacists, potentially impacting patient safety, it has said.

And it raised ‘significant concerns’ about the power of non-clinical managers in community pharmacies, especially those operated by large private companies.

The comments follow the conclusion of the sentencing of neonatal nurse Lucy Letby, who was this month given a full life sentence for the murder and attempted murder of several babies at the Countess of Chester Hospital.

In wake of the case, the PDA has urged that lessons ‘still need to be learned around the role of leadership, management and candour when clinical harm occurs’ and repeated calls made in 2015 and 2022 for the regulation of non-registered managers, to ensure better accountability.

A government-ordered inquiry is set to try and identify systemic failures which meant that concerns raised by clinicians were dismissed by non-clinical managers during Letby’s crimes.

The PDA said that within the Letby case, ‘the threat of a referral to their regulator was left hanging over the heads of the clinicians’ and suggested that non-clinical managers should also be held accountable for their actions through a regulatory body.

‘Without the appropriate regulatory traction, their decision-making and influence, which has direct impact on patient safety, might never be called into question,’ the PDA said in a statement.

It added: ‘It should not take a further public inquiry and/or more patient deaths to recognise that the regulation of those in management posts is essential to ensure that they do not disregard concerns that are raised about the actions of individuals, patient safety, and the risk of harm.’

The PDA shared examples of the risks within a community pharmacy setting of non-registered managers influencing clinical decisions and operations based on commercial or reputational factors.

For example, it said it had heard of a non-pharmacist manager selling a patient a medication which the pharmacist deemed inappropriate and unsafe; demands to deliver a higher number of vaccinations than can be safely supervised; as well as the ‘temporary closure of pharmacies for purely commercial reasons depriving patients of access to vital medication’.

‘Whilst these episodes and many more do not receive national headline attention, they nevertheless impact patients and corrode the ability of pharmacists to protect the interests of the public by maintaining safety,’ the PDA said.