From Mr M. Borson, MRPharmS
The Which? survey (PJ, 27 September 2008, p349) is a shocker for the independent pharmacy sector. One of the most serious issues is about the sale of large quantities of Solpadeine Plus online by Asset Chemists. I hope this is dealt with severely because it reveals how internet pharmacy can lead to the opportunistic sale of medicines.
No one benefits from internet sales of pharmacy-only medicines, and the development of online pharmacies has made everyone losers:
- The public: restrictive access to medicines and the supervision of sales is dramatically reduced, therefore putting people’s health in danger as per the Which? report. There is no such thing as “direct pharmacy prices” so medicines are not cheaper. The prices that internet pharmacies sell at can be found in any pharmacy, especially independents.
- Online pharmacies themselves: small businesses tend to operate and sell their goods at low margin. Ultimately, most will operate at break-even or loss with the hope that one day it will all be worthwhile.
- Bricks-and-mortar pharmacies: they lose vital sales of over-the-counter products and prescriptions at a time when they need it. The profits they would have made can no longer be ploughed back into community-based NHS services.
Whoever decided to allow control-of-entry exemption for internet pharmacies should be red-faced right now. The only way these hopeful businesses could make money is by doing what Asset Chemists has done. It could be argued that they have been forced into it. Only a desperate pharmacy would sell large volumes of paracetamol-containing tablets to an unknown customer.
I would also like to know how many internet pharmacies carry out enhanced or advanced services, such as medicines use reviews or chlamydia screening and treatment?
The Royal Pharmaceutical Society should accept some of the responsibility. Until recently, it had not addressed the issue of internet pharmacy. It should have protected community pharmacists from unlicensed premises selling online and should have monitored pharmacists selling online more closely.
I cannot imagine any patient group that requires large volumes of painkillers to be ordered at a distance, because prescribers can write long-term prescriptions for these patients or they can buy small quantities frequently from well supervised pharmacies. I cannot understand why the Society allows painkillers to be sold online.
I would like to see the Government and the Society take action now and react in the following way:
- Amend the Medicines Act to restrict mail order or online pharmacies from selling pharmacy-only medicines direct to the public.
- Amend the code of ethics so that it would be unlawful to sell pharmacy-only medicines outside a physical pharmacy.
- Create a Society taskforce that would identify any unlawful sales through the internet, be it on a stand-alone site or via an auction site, such as eBay. They should lobby search engine providers to restrict international retailers targeting the British consumer.
For those that think this is an excessive reaction, several years ago, a boy died after ordering a medicine online in the US. The banks reacted by banning credit card merchant account holders from selling prescription medicines online, due to the chance that they could be associated with the manslaughter of a teenager.
Look at the policy of eBay and Google: they also state that pharmacies cannot use their sites to sell prescription medicines.
Independents and corporate pharmacies should unite to put an end to one of the biggest threats to our professionalism and public relations. Ban pharmacy-only medicines sales from internet sites and distance sellers.
Marc Borson
Manchester
Pharmacists must follow the questionnaire process with sumatript
From Mr J. Hallatt
I am writing following the recent news regarding the Which? report on pharmacy advice to consumers (PJ, 27 September 2008, p349). The report found that many pharmacists were giving incorrect advice, although this was a small sample size and, therefore, not necessarily a true reflection of the industry.
Part of the research included independent investigators asking pharmacists for advice on Imigran Recovery (sumatriptan) for migraine relief. GlaxoSmithKline launched Imigran Recovery in June 2006 and conducted extensive training for pharmacists on advising consumers. This included a training manual supplied to all pharmacists via The Pharmaceutical Journal, face-to-face training workshops, distance learning and online learning via MyPharmAssist.co.uk.
Use and completion of a migraine questionnaire for consumers was part of this training because this was a requirement of the Commission on Human Medicines when sumatriptan was switched from a prescription-only to a pharmacy medicine. GlaxoSmithKline supplied and continues to supply pharmacists with questionnaire pads for their use.
Following the findings that 13 out of 35 visits to buy the product were ranked unsatisfactory, we would like to take the opportunity to remind pharmacists that it is extremely important to follow the questionnaire process to safeguard customers and ensure they are true migraine sufferers.
I urge pharmacists to go online to MyPharmaAssist.co.uk or imigranrecovery.co.uk for refresher e-learning or call 0800 783 3927 to obtain further copies of the questionnaire pad.
James Hallatt
General Manager
GlaxoSmithKline Consumer Healthcare UK
Which? on the witch-hunt again
From Mr N. Shah, MRPharmS
While I should be concerned if the Which? report on the quality of patient advice offered by pharmacy staff (PJ, 27 September 2008, p349) was a representative finding, I have to say this is a witch-hunt again.
Any statistician will tell you that a survey with a sample size of less than 1 per cent does not yield results with required confidence levels.
When one considers that only a third of the 1 per cent sample was tested on each scenario, confidence limits are further narrowed.
It is also interesting to note that any creditworthy findings have been left out of mention, such as the many extra services that trained pharmacists are now competently providing.
Nitin Shah
Pinner, Middlesex
Medicines counter assistants contribute to negative Which? repor
From Mr H. S. Badwal, MRPharmS
I was not at all surprised when I read the article (PJ, 27 September 2008, p349) concerning the criticism of pharmacy staff by Which?. In fact, I am shocked it has taken so long for anyone to realise the poor advice coming from the medicines counter.
Working as a locum, I work with many medicines counter assistants (MCAs) and I have to agree with Which? in saying that practices can be unsatisfactory and often dangerous. I am confident that no member of the general public expects much in terms of clinical knowledge from MCAs but they seldom know when to refer to the pharmacist and, despite their prominently displayed certificates of achievement, rarely give any sound, evidence-based advice.
I have often had the fortune to prevent a dangerous sale but will have to live with those that slip through the safety net. Only the other day, I heard an MCA recommend that a patient rub her wedding band on her eye to cure an itchy stye and have heard of a pharmacist being asked if the patient can have two packets of tablets containing pseudoephedrine, despite the training that he gave with regards to new legislation.
My fellow pharmacists often comment on how we are negatively perceived by the public. I put the blame squarely on the first people that the patient interacts with when visiting a community pharmacy — the MCAs.
Hardeep Badwal
Derby
Internet pharmacies follow professional standards too
From Mr D. M. Lee, MRPharmS
I was disappointed by Marc Borson’s letter (PJ, 4 October 2008, p386) tarnishing all internet pharmacies after the investigation by Which? into how well internet pharmacies work and the unhelpful comments in the Leading article (PJ, 4 October 2008, p376) in support of this.
Using Mr Borson’s logic, all independent pharmacies should be stopped from selling medicines because 48 per cent of independent pharmacies gave unsatisfactory advice to the Which? investigators. Of course, I am not suggesting this.
The Which? investigation visited four internet pharmacies, including Pharmacy2U. Readers will note from the investigation that Pharmacy2U questioned the investigator satisfactorily and sold the correct quantities of pain relief products.
Since its inception in 1999, Pharmacy2U has always tried to ensure appropriate professional standards in the supply of pharmacy only medicines through distance selling mechanisms.
We have created specific online questionnaires that allow our pharmacists to check the suitability and appropriateness of an order before supply. We also harness the use of technology and restrict orders of certain products if quantities are in excess of current legislation. If a pharmacist requires more information to authorise an order, the customer can be contacted either by telephone or by e-mail.
Crucially, all these stages in the sales order process are captured and a verifiable audit trail is established for each and every pharmacy order. We capture and hold much more information than some community pharmacies. Perhaps community pharmacy could benefit from this increased use of technology?
Of course, there are many beneficiaries from the development of internet pharmacy, not least allowing patients better access to services as enshrined in the “Pharmacy in the future” White Paper in 2000. The challenge is not to hark back to the past when pharmacies had a local monopoly but how we can raise the standard of all our pharmacy businesses whether it is internet, bricks and mortar or a combination of both. Increased competition, which Mr Borson is fearful of, is one way of achieving this.
An alternative way is through regulation and the Royal Pharmaceutical Society should be applauded for the implementation and audit of the accredited logo for bona fide internet pharmacies.
Daniel Lee
Superintendent Pharmacist
Managing Director
Pharmacy2U Ltd
Entrapment by Which?
From Mr A. M. F. O. El-Dabbagh, MRPharmS
The main objective of Which? magazine is entrapment. It aims to get publicity to increase its sales rather than reflecting on the importance of the service provided in pharmacy. I think it is irresponsible of Which? to use the words “potentially dangerous” in their comment.
It creates unfounded fear and anxiety among people who use pharmacies. It is more dangerous for the public not to trust and use pharmacies than to acknowledge some mistakes that unfortunately took place.
The services pharmacists supply to patients are abundant and increasing. To reduce this to Imigran Recovery, travellers diarrhoea and sexually transmitted disease advice is unjustified.
Instead of only focusing on the negative, Which? should also give emphasis on the satisfactory or good advice given by some of the pharmacies surveyed.
Ahmed M. El-Dabbagh
Wickford, Essex
Do not blame internet pharmacies
From Mr E. J. Newell, MRPharmS
Marc Borson’s tirade against internet pharmacies (PJ, 4 October 2008, p386) cannot go unanswered and, as superintendent pharmacist of an internet pharmacy, I feel qualified to reply.
Mr Borson makes his comments following the adverse Which? report and although I cannot defend any pharmacy that sells large quantities of painkillers, I also cannot defend any pharmacist that does not fulfil his professional responsibility. The Which? investigation found serious failings in bricks-and-mortar pharmacies too.
Internet pharmacies are regulated by the Royal Pharmaceutical Society and those pharmacies that meet its standards may use the Society’s internet logo to reassure customers that they are using an accredited UK pharmacy. We have a registered address and a defined pharmacy. This may be closed to the public but that does not make it any less than a bricks-and-mortar site.
The Society’s inspectorate is equally active (in my experience, it is more active against internet pharmacies than high street pharmacies) and, as well as inspecting standard operating procedures, it also looks at the computer protocols to ensure patient information on the internet is secure.
Mr Borson also makes sweeping statements about the profitability of online pharmacies. I suspect that his views are more of a gut feeling rather than a critical appraisal of all internet pharmacy businesses.
It may be true that some businesses run their online sales at a loss but we are a dedicated internet-only site and have to make a profit from our internet business to survive.
Before I joined my present employer, I ran a community pharmacy for nearly 30 years. At the time I sold my business, I was chairman of the local pharmaceutical committee. From experience, there is no substitute for a well-run community pharmacy with well-trained staff operating in modern, professional looking premises.
Competition on price of medicines comes from other retail sources and not only internet pharmacies. Customers will be prepared to pay a premium for their medicines if they are confident they are getting a superior service.
There are unlicensed internet sites selling all types of medicines. These may not be UK based and, therefore, difficult for the Society to police. It is equally annoying for our business to be told that customers have bought medicines online before without needing a prescription.
There are many reasons why people choose to purchase any item from an internet business. Price is one factor but is not the only reason. Convenience and confidentiality are also important factors.
The Which? survey also found that consulting rooms were not always used to counsel patients, even when they were asking for personal items. Surely, there can be no excuse for this because most pharmacies will have a consultation room available to undertake services, such as medicine use reviews.
Many community pharmacists are working under pressure — whether they are owners of independent pharmacies or employees of a company. Ideally, we would all like to offer a professional service but, inevitably, some standards may have to be compromised due to the sheer volume of work that a pharmacist is expected to undertake on a daily basis. Some lapses in standards are inevitable and errors may result.
This will be true of a pharmacist in any work environment and it is not reasonable to point the finger of blame for the problems facing community pharmacies on the comparatively small volume of business taken by internet pharmacies.
I am confident that the Society will investigate all instances of poor professional standards regardless of the source of business. It is up to all pharmacists to look at their operating procedures and make a judgement on whether these are fit for purpose and suitable for the business in which they work with the ability of the staff available.
Eddie Newell
Superintendent Pharmacist
Stratford Pharmacy Ltd
Profit is the ultimate goal
From Mr M. Goldin, MRPharmS
How interesting that so few letters have appeared in The Journal following the Which? investigation into pharmacy staff competence (PJ, 27 September 2008, p347).
What the general public does not realise is that retail pharmacy (or community pharmacy as it now likes to be called) is increasingly run and owned by businessmen. Many of them are not pharmacists and they know little about the action and uses of medicines and have poor diagnostic skills.
The pursuit of profit is the ultimate goal of the merchant class. Maximise profit by cutting overheads. Where better than by employing inferior staff at inferior wages?
Monty Goldin
London
Stop blaming internet pharmacies
From Mr A. D. Cohen, MRPharmS
I am writing about the findings of the recently published Which? report (PJ, 27 September 2008, p349).
I find it ludicrous that we should put the sole blame on internet pharmacies (PJ, 4 October 2008, p386), sample size (PJ, 4 October 2008, p386), medicines counter assistant’s technical ability (PJ, 4 October 2008, p387) or any other single reason.
The report is there to give feedback on the results, inform the profession and ensure that, as a profession, we continue to strive to improve standards and levels of care.
We should embrace the recommendations and those pharmacies that implement good standard operating procedures and adequate levels of training for staff will have nothing to fear.
Ashley D. Cohen
Managing Director
Pharm-Assist (Healthcare) Ltd
Good pharmacy staff are out there
From Mrs F. J. Bunney, RegPharmTech
As an accredited checking technician, I was deeply saddened by the recent Which? report on the quality of advice given by pharmacy staff (PJ, 27 September 2008, p349).
I have worked in independent pharmacy for 15 years, starting out as a counter assistant, gradually working my way up through various levels of training, which has included medicines counter and dispensing assistant, drug interaction, National Vocational Qualification 3, and, finally, accuracy in dispensing.
This has been hard work but well worth it. I am confident that I can offer correct advice to customers that come into the pharmacy but also know my own level of knowledge on some subjects, and would not hesitate to involve the pharmacist at any time.
The training, however, does not stop. It is an ongoing process, keeping up-to-date with current issues and new procedures.
I believe that we should not all be tarred by the same brush because there are some good pharmacy staff out there.
Fiona Bunney
Beverley, East Yorkshire
Which? should send “mystery patients” to doctor’s surgeries
From Mr P. J. Francis, MRPharmS
I am waiting for Which? to send a “mystery patient” into a doctor’s surgery in the same way it sends “mystery shoppers” into pharmacies (PJ, 27 September 2008, p349).
Then we will hear from Which? that some doctors do not carry out basic health checks when issuing repeat prescriptions for some medicines.
Which? can then get on its high horse about the medical profession and question whether it should have the monopoly to prescribe.
Paul Francis
Brisbane, Australia