The NHS terms of service for community pharmacies in England changed this month. The revised terms of service say that if a pharmacy owner has access to the summary care record (SCR) of a patient, then the record must be accessed if – in the clinical judgement of the pharmacy’s owner – this is in the patient’s best interest.
While it is encouraging to see that the regulations depend on the exercise of clinical judgment, it is odd that the responsibility for exercising this judgment is not placed on the responsible pharmacist, or the pharmacist who makes or supervises the supply, but on the owner – which may be a company.
If we assume that it is a pharmacist who exercises clinical judgement, then when must the SCR be accessed? This may be important in potential situations where a patient is harmed because the prescriber made a mistake that might have been picked up in the pharmacy.
I know of a case in which a patient died because a pharmacist supplied 100mg of morphine sulphate tablets (MST), when the PMR showed that the patient had previously only received 10mg. The pharmacist in that case had to appear before a fitness-to-practise committee.
Royal Pharmaceutical Society guidance on using the SCR says there is no need to refer back to the record every time a repeat prescription is dispensed. Instead, it recommends that the record should be checked:
- for drug allergies
- when the patient is new
- if there are any queries or concerns
Although wrongly failing to consult the SCR could lead to a compensation claim or a fitness-to-practise hearing, it will not be a criminal offence in itself. This highlights how daft it is that giving out the wrong medication is currently still an offence. Even the partial decriminalisation of inadvertent dispensing errors – proposed for later this year – will still leave pharmacists and others at risk of criminal prosecution if the wrong item is given out.