The pharmacy profession is evolving globally. The International Pharmaceutical Federation (FIP), the apex professional world body of pharmacy is spearheading the change and providing the much needed leadership and guidance to harmonize the pharmacy profession as a health care profession. The FIP puts the focus firmly on the patient rather than the product as can be seen by the theme of the annual Congress which is about taking responsibility for patient outcomes. Other examples of recent themes include "From anecdote to evidence: Helping patients make the best use of medicines" (67th FIP Congress Beijing, China), "Reengineering pharmacy practice in a changing world" (68th FIP Congress Basel, Switzerland), and "Responsibility for patient outcomes - Are you ready?" (69th FIP Congress Istanbul, Turkey).
The paradigm shift from product to patient in recent years is due to alarming outcomes of unregulated use of medicines, which subsequently endangers patient safety. The FIP and World Health Organization (WHO) believe that patient safety can be ensured if the alliance for health care becomes the accepted norm of health care delivery, where doctors, nurses, and pharmacists work together in a team to optimise health care delivery. There is a need to revamp the health care system both in developed and developing countries by promoting nurses and pharmacists within the health care system more actively so that the health care needs of patient groups can be met more effectively. One world, one medicine and one universal system of medicine can harmonize the health care delivery.
This is the era of information and knowledge. All health care professions are over-brimming with knowledge and practice. It is time to abolish the old-fashioned mode of practice and to bring in an efficient, cost-effective, and safe system of health care. There is also a danger of misusing freely available health care information regarding drugs by some unscrupulous agencies. Community pharmacists are ideally placed to counter such misuse by providing the public with appropriate advice on the use of medicines when they are talking to patients who are mostly ignorant with regards to pharmaceutical matters. This poses a huge challenge to community pharmacy in the future. It is, therefore, necessary to learn from other countries and adopt these changes to suit our cultural background.
Good pharmacy practice and pharmaceutical care are the latest recommendations of the WHO and FIP to ensure the best possible outcomes for the patient regarding the safety and efficacy of medicines use.
System in Great Britain
By looking into the British system, ideas and useful aspects of how British community pharmacists ensure patient safety can be gained.
In Great Britain, community pharmacists constitute the largest group of pharmacists (75 per cent). There are also hospital, industrial, veterinary, and academic pharmacists. All pharmacists have to be registered with the Royal Pharmaceutical Society of Great Britain (RPSGB). The RPSGB is the regulatory and professional body for all pharmacists.
In the very near future these two functions are to be split, thereby creating two new bodies. This is in the interest of public safety. The regulatory body will ensure that all pharmacists practise in accordance with the law in the interest of public safety. It will take action against any pharmacist who does not do so. Membership will be mandatory. The professional body will concentrate on education, legal support, and other non-regulatory functions to ensure pharmacists are fit to practise, but membership will be voluntary.
The RPSGB provides professional standards and guidance documents, and the code of ethics for pharmacists and pharmacy technicians. The main objective of these documents is to ensure patient safety by making the patient's care the pharmacist's first concern.
In Great Britain most medicines are available from community pharmacies. Medicines are categorized: either they are on the General Sale List (GSL) or on the prescription-only medicines list (POM). Those medicines, which are not on any of those two lists are so-called Pharmacy medicines (P). These can only be sold over the counter to the public under the supervision of a pharmacist. Pharmacists have to use their discretion and professional judgement when selling these. A sale can also be refused and the patient be referred to their doctor. Pharmacy medicines requests by patients offer a good opportunity for community pharmacists to counsel and advice patients on the use of medicines and may prevent the patient from visiting the doctor or hospital for relatively minor complaints. Pharmacy medicines include stronger painkillers, decongestants, larger quantities of paracetamol, oral antifungals, etc.
In contrast, GSL medicines can be sold in small quantities at supermarkets, petrol stations and grocery stores. The lists ensure some level of protection of the public from potential harm caused if medicines are used incorrectly. GSL medicines cover most minor ailments like hyperacidity, headaches, diarrhoea, etc. and allow the public to self-treat. Prescription-only medicines can only be dispensed in accordance with a prescription written by a doctor, dentist, nurse prescriber, or pharmacist prescriber. These are medicines that can cause major harm if used incorrectly (antibiotics, parenterals, anticancer drugs, radiopharmaceuticals, large quantities of pharmacy medicines, etc.). Community pharmacists hand the dispensed medicines out to patients giving them another opportunity to check the understanding of the treatment with the patient and counsel patients accordingly on the best use of their medicines.
Pharmacists are legally obliged to clinically check all prescriptions in order to pick up any errors made by the prescriber (i.e., dose, quantity, frequency of administration, drug interactions, etc.).
Standard operating procedures are written protocols in every pharmacy to ensure the safe sale and dispensation of medicines. Pharmacists are supported by technicians (dispensers) and health care assistants. Technicians are either trained in-house or can opt to do national qualifications and, once qualified, register with the RPSGB. Pharmacy students and community pharmacists can support their learning about minor complaints and their treatment by reading books like "Symptoms in the Pharmacy" by Alison Blenkinsopp and Paul Paxton (Blackwell Science Publishing). It is also called the guide to the management of common (less serious) illness.
Community pharmacists not only dispense prescriptions and sell medicines, but also provide so-called pharmacy services. These services comprise a package of medicine supply with added pharmacist involvement. These services include supervised methadone administration, home oxygen therapy, home medication reviews, nicotine replacement therapy, sexual health counselling, weekly dispensing packs, and many more.
Looking at the system in Great Britain, there is a need to organise the community pharmacy and its function, which is vital for patient safety in our country also.
(The authors Anantha Naik Nagappa is professor at Manipal University and Ina Donat is community pharmacist at Boots UK, Edinburgh, Scotland, GB).