Pharmacists working in general practice, online pharmacies and other settings should assess their fitness to practise risk, the Pharmacists’ Defence Association (PDA) has warned.

This follows an increase in incidents reported among pharmacist independent prescribers (PIPs) working in online pharmacies, as well as an ‘expected upturn in incidents linked to general practice work as the practice pharmacist workforce increases’, the PDA said.

Pharmacists should ensure that they record the training they have undertaken as well as participate in appropriate shadowing, supervised practice and peer review and mentorship, and be ready to describe and justify their prescribing and care choices, the PDA warned in an advisory letter to its members published yesterday (6 June).

It said that general practice PIPs had been involved in incidents where they had been working outside their scope of competence, resulting in misdiagnosis leading to life limiting illness, delay in identifying serious disease progression and death.

The PDA also said that general practice PIPs had been referred to and investigated by the General Pharmaceutical Council (GPhC) for providing high risk activities in triage, telephone triage and walk-in clinics without adequate experience and training, resulting in misdiagnosis and subsequent patient harm, including serious illness and death.

In some cases, general practice pharmacists had been referred to the GPhC by the Care Quality Commission (CQC) for working beyond competence without clinical supervision, while in other cases concerns had been raised about the pharmacist’s lack of competence and failure to carry out safe medication reviews and medicines reconciliation.

The PDA warned that GPhC ‘is taking harm and the potential for harm linked to pharmacists operating without the required level of competence extremely seriously’, and emphasised that ‘committee decisions and sanctions are starting to reflect this’.

It said that all pharmacists should reflect on whether their competence is sufficient for the work that they currently undertake, and seek additional training, mentorship and self-study if required.

And it specifically advised online pharmacists to ‘give serious consideration’ as to whether the setting they worked in had adequate policies and processes in place and whether they would be able to justify their prescribing choices to the GPhC if required.

In particular, the PDA said that not informing a patient’s GP about providing medications that could be harmful in overdose, cause dependence or possibly interact with other medications was ‘incompatible with patient safety’. It added that the ‘only professional choice’ would be to explain this to the patient and refuse to prescribe the medication unless the patient gave consent for the GP to be contacted.

The GPhC recently said that around 30% of its fitness to practise caseload involved online pharmacies, with many of these cases involving individuals operating outside their scope of practice.

It has previously warned that pharmacists should make sure they are meeting its standards for pharmacy professionals at all times, including for pharmacist prescribers, and said that pharmacy owners must ‘create and maintain the right environment and framework to deliver safe and effective pharmacy services’. 

And it added that pharmacies should not work with ‘online providers who try to circumvent the regulatory oversight put in place within the UK to ensure patient safety’.