Another year almost over already and like us you may be wondering how it went so quickly! We’re sure many of you will be eagerly looking forward to some time off over summer. We most wish to acknowledge the dedication of pharmacists who provide high quality care to patients, especially when faced with the challenges of high workloads and expanding pharmacy services in our ever-changing health sector. We would also like to take this opportunity to thank Council and team members for their commitment and contribution to our mahi. 

Reflecting on 2023, there are a number of achievements we can be proud of. We have continued to provide a robust regulatory framework to fulfil our statutory role to protect the health and safety of New Zealanders, focused on ensuring pharmacists remain fit and competent to practise. Our Business-As-Usual – which makes up the vast majority of our work – has included maintaining our registration database, renewing 4,000 plus Annual Practising Certificates, overseeing compliance and assessing notifications of pharmacists’ competence, and completing two Assessment Centres. Complementing our BAU, we have advanced key projects including the publication of competence standards to set the foundational requirements for pharmacists practising in Aotearoa New Zealand in terms of competencies, knowledge, and skills. In preparing the new professional standards, we appreciated the engagement from consultation and the strong buy-in and ownership from the profession for these standards. As we move towards these standards taking effect from April 2024, Council continues to encourage professional associations to proactively assist pharmacists to practise to the new standards and for pharmacists to also reach out to their associations for their support.

We also published accreditation standards which sets a high bar for pharmacy education providers to align with the new competence standards (these also come into effect from April 2024).

We have made pleasing progress on our cultural journey to become a stronger Te Tiriti focused, culturally safe organisation. This will enable us to better influence and guide the profession’s cultural safety knowledge and competencies. We have taken time to honestly reflect on our own Māori values, the biases we may have, as well as learning more about Te Ao Māori (Māori world view) and Te Reo Māori. As frontline health professionals, arguably the most accessible in our health sector, supporting pharmacists to practise greater cultural safety will help the profession to be an integral part of improving Māori health equity across the motu.

We also recently completed a review of MyRecert portfolios, which you can read more about in this newsletter.  The review was to check that the profession is engaging in ongoing professional development and is recording it to provide the necessary assurance of pharmacists’ fitness and competence.

Again, we thank those who have supported Council’s work in 2023 benefitting patients, community health and the profession. We hope that you can take a break during the festive season to rest, recharge and enjoy time with whānau and friends. We look forward to reconnecting with you in the New Year.

Ngā mihi
Arthur Bauld (Chair) and Michael Pead (CE)

Council has reviewed a random selection of MyRecert portfolios for the 2022-23 practising year. CE Michael Pead says the review aimed to gain assurance that pharmacists are strongly engaging in professional development to maintain their competence.

Each anonymised portfolio was reviewed against the six main requirements of MyRecert: plan/goals, reflection, cultural safety, peer group meetings, keeping up-to-date and verifier sign off.

Outcomes were grouped into three categories: those that engaged effectively overall, engaged well (some improvements possible) and those that did not engage, engaged poorly or provided insufficient information (just 7 per cent of the sample).

The key themes we noted to improve engagement with MyRecert include:

Professional development goals and learning cycle

• Need to create ‘SMART’ goals (Specific, Measurable, Achievable, Relevant and Time-Bound).
• Clearly demonstrate full learning cycles i.e., each goal is SMART, well documented and shows planning, learning, and evaluating the learning and reflecting how it impacts practice.

Reflection

• Reflecting critically on the competency or experience/incident chosen.
• Description of an incident/experience must be followed with an adequate reflection. The reflective aspect should be the focus.
• Clearly identify/document insights gained and the actions resulting from a new perspective within your reflection.

Cultural safety

• Recognise the difference in cultural competency and cultural safety. Aside from acknowledging differences and disparities, take that next step to reflect personally on any power imbalance, racism, your own biases, thoughts, and behaviours in this context.
• Document clearly the ‘action’ taken towards cultural safety and give a narrative on how it connects to culturally safe practice or working towards this.
• Be explicit about the learning and how this is/will be reflected in your practice.

Peer group

• Ensure peer group notes are sufficient with required number of meetings including number and type of participants involved (and recorded adequately to demonstrate this).
• Team meetings/dispensary meetings and discussion of operational matters are not peer group meetings.
• Group chats (WhatsApp) or webinars/trainings without discussion or reflection on clinical practice don’t qualify.

Documentation

• Provide enough information to demonstrate effective engagement and completion of requirements.
• Ensure documents are clear, legible, complete and up to date.

Verifier

• Your verifier must go into your portfolio to check each item and complete the sign off.

Dispensing of incorrect dosage of medication
In its report the HDC found two pharmacists breached the Code of Health and Disability Services Consumers’ Rights (the Code) following a dispensing error where the incorrect strength of venlafaxine was dispensed.

Case description
The patient was prescribed venlafaxine 37.5mg capsules at a dose of one capsule daily for one week, increasing to two capsules daily after one week if tolerating the medication. Due to the patient’s mental state, they did not feel comfortable having large quantities of medicine in their possession, so the treatment plan called for fortnightly dispensing.

Three pharmacists were included in the dispensing process; one pharmacist correctly entered the prescription and generated dispensing labels, one incorrectly dispensed 21 150mg venlafaxine capsules, and one pharmacist did not identify the incorrect strength in their final check. This led to the vulnerable patient receiving an inappropriate dose and quantity of medicine that was potentially dangerous for them. At the time of the error there was a particularly high dispensary workload.

HDC action
In dispensing the incorrect strength of venlafaxine, the HDC found that both the dispensing pharmacist and the checking pharmacist breached Right 4(2) of the Code: “Every consumer has the right to have services provided that comply with legal, professional, ethical, and other relevant standards.”

Key lessons for pharmacists to note from this investigation include:

• Ensuring that their final check process verifies the prescription details, match label details, and the contents of dispensing containers.
• Undertaking their professional responsibility to maintain safe provision of pharmacist services within what is reasonable and within their authority even when external factors are challenging.
• Raising concerns/recommending practicable improvements when workplace factors (e.g., workflow, staffing) could be improved to reduce risk.
• Each pharmacy having robust SOPs that reflect actual practice and that all relevant team members are familiar with and practise. Ideally these team members should be involved in formulating and reviewing the SOPs.
• Pharmacies having a process for managing particularly busy periods to maintain order and safety of services, and the wellbeing of team members. This could include increasing wait times, triaging prescriptions, and/or temporarily deferring/referring non-core or non-urgent services.

We recommend all pharmacists who dispense medicines periodically review their processes based on incidents (including, but not limited to, near misses, dispensing errors, and miscommunications) that they have been personally involved in; that have occurred in their workplace; been discussed at peer meetings; and/or that are published publicly.

Taking the time now to review your dispensing process may prevent a future error. This is especially important to do as the holiday period approaches, demand for other pharmacist services grows, and whilst there is a shortage of pharmacists.

The Health Practitioners Disciplinary Tribunal (HPDT) holds disciplinary proceedings against health practitioners — including pharmacists — who are alleged to have breached standards of practice. 

Read the precis of two recent HPDT decisions that we have published on our website

Each year we attempt to contact pharmacists who have not updated their registration status. This is a final attempt to make contact before removing them from the register. If you would like to stay on the register or know someone who may want to maintain their registered status, please check the list of pharmacists.

Council is consulting on proposed changes to the policy on naming pharmacists who are the subject of an order (e.g. imposing conditions on scope of practice or suspending registration or practising certificate) or direction (“Naming Policy”). The Council consulted on this Policy in December 2019, which has been in place since February 2020. The 2019 consultation document explained the framework that Council applies to decide whether to name a pharmacist under such an order.  

Since 2020, the Council has published an order on two occasions and named the pharmacists involved. Both orders were for interim suspension of practising certificates, and the orders for the pharmacists were published because Council was concerned the pharmacists might continue practising despite the order. 

The proposed changes to the current Naming Policy are minor technical and legal changes, aimed to improve clarity and transparency for application of the Policy. We also include the possibility of naming pharmacists if they do not respond to Council and acknowledge that an order has been made.  

Council invites feedback on the proposed updated Naming Policy and plans to finalise the reviewed Naming Policy in 2024.  

Submissions are welcomed and close on 5pm, 26 January 2024 and can be emailed to [email protected] 

In June 2023 the Pharmacy Council of New Zealand published the Aotearoa New Zealand Accreditation Standards for Pharmacy Programmes. We are now seeking Expressions of Interest from local and international applicants with the necessary experience to serve as a member of Council’s Accreditation Advisory Group (AAG).  We would also appreciate you passing this information onto others who you think may be interested.

The AAG will comprise up to six independent expert members, and will meet at least bi-annually to:

• monitor pharmacy education programmes (Bachelor of Pharmacy, graduate entry Master of Pharmacy, intern training and pharmacist prescribing programmes)
• advise Council on accreditation
• support the appointment of Programme Accreditation Teams (PAT)
• advise PAT and Council on key areas for assessment
• make accreditation recommendations to Council based on PAT findings.

The ideal candidate will have experience on decision making/advisory groups and proven expertise in at least one of the following key areas:

• senior leader in pharmacy academia
• accreditation of pharmacy education programmes, including undergraduate, graduate entry, intern training and prescribing programmes)
• accreditation of other health or education programmes (e.g., medicine, nursing, dentistry)
• accreditation of other education programmes
• pharmacy practice (including community, hospital, or primary care)
• Te Tiriti, health equity and cultural safety.

A copy of our Terms of Reference can be found on our website

For further information on the role, please contact Trish Farrelly, Manager Registration and Competence Assurance, Pharmacy Council of New Zealand [email protected] or 04 495 0336.

Council sent out its proposal to pharmacists and professional associations on the draft 2024/25 budget, and APC fees and Disciplinary levy in November 2023.  Submissions closed on Monday 11 December 2023. The consultation paper provided detailed information on the costs of delivering Council’s statutory regulatory functions, the work we have undertaken, as well as our forecast deficit and reserves position.

Thank you to everyone who submitted and considered the proposal. Council members will meet before Christmas to consider all submissions and feedback. The Council will inform registrants and stakeholders of its decision in January 2024 and give effect to any change in APC fees and disciplinary levies by placing a notice in the New Zealand Gazette.

Our 2023 annual workforce demographic report will soon be released, which provides a comprehensive overview of pharmacy practitioners in Aotearoa New Zealand.

The report covers the latest data in the year from 1 July 2022 to 30 June 2023. Key highlights include:

• in 2022 we reported growth of 1.4 percent of practising pharmacists and commented that this was less than the long-term average of 2.2 percent per annum growth observed previously. This year’s result continues the deviation from historic trend, and the average growth over the last five years is now 2.0 percent per annum.
• the growth in the number of practising pharmacists has not kept pace with the growth of our national population. As such, the ‘density’ of practising pharmacists has declined from 8.04 to 7.93 practising pharmacists per 10,000 population.
• the more urban regions (Auckland, Wellington, Canterbury) have broadly maintained their pharmacist density, while ‘rural’ regions (Northland, Southland, Gisborne) have reduced density compared to last year.
• the ratio of male to female pharmacists remains at about 1:2.
• younger pharmacists tend to identify as ‘Asian’, while older members of the profession are more likely to identify as European.
• although down on the previous year, 4 percent of pharmacists reported practising in excess of 1.0 FTE over the APC year 1 April 2022 to 31 March 2023.

Of the 230 interns who attended the Assessment Centre (AC) on 14 November 2023 we are pleased to report that 86 percent passed and are now ready to practise to register in the Pharmacist scope of practice and work as a pharmacist unsupervised.

A big congratulations to the interns who were successful and can now contribute to supporting patients in our communities as safe and competent pharmacists.

The 86 percent pass rate is a return to more normal levels. The ACs were conjointly held across two centres in Auckland and Wellington and completed to the usual robust standard. The 10-station examination (an Objective Structured Clinical Examination) aims to simulate real life scenarios.

Thank you to all who contributed to the smooth running of the ACs and to all those pharmacists who have supported interns to practise to a high standard throughout the year.

To ensure we understand the competency standards we expect of the pharmacy profession and to develop a strong foundation for this knowledge, the Council team has been making progress on its own cultural capability learning journey. A key part of this journey has been our speaker series which has covered a diversity of themes.

Senior Advisor, Māori and Health Equity Natalia Taurima-Hinton says that we need to begin by thinking broadly, rather than in silos. “Understanding cultural safety, hauora Māori and Te Tiriti can only be achieved when we begin piecing together how each of the topics, as featured in our speaker series, interweave together. Culturally safe practice is achieved when we have a better understanding of racism, our biases, and how these behaviours contribute to health inequities for Māori.”

From left: Nate Rowe, Natalia Taurima-Hinton Pharmacy Council Senior Advisor, Māori and Health Equity, Alishia Moeahu, Dame Rangimārie Naida Glavish DNZM JP, Michael Pead Pharmacy Council CE, Jennifer Ward-Lealand, Jeffrey Galt Pharmacy Council Independent Advisor and Dental Council CE Marie MacKay.

Speaker series 2023 has included:

• Mr John Whaanga – Director Māori Health, Ministry of Health, and Mr Pat Snedden.  John and Pat spoke on the Ao Mai Te Rā – Anti Racism Kaupapa. Pat spoke from a tangata Tiriti perspective and his journey in the anti-racism movement.
• Judge Michael Doogan – Māori Land Court and Waitangi Tribunal member and Ms Kerri Nuku –CEO, NZ Nurses Organisation presented to us on the role of the Waitangi Tribunal and the recommendations from WAI2575.  Judge Doogan is tangata Tiriti and Kerri is of Ngāti Kahungunu whakapapa.
• Jo Wailling – Restorative Practice, Diana Unwin Chair, Victoria University and Mr Mike Hinton –CEO, He Herenga Kura presented on Restorative practice and Hohou te Rongo in the health sector and what restorative practice is.  Jo is tangata Tiriti and Mike is Te Āti Awa, Taranaki Whanui and Ngāti Raukawa whakapapa.
• Dr Dianne Wepa – Associate Professor AUT and Darwin University. Dianne presented on kawa Whakaruruhau and cultural safety.  Dianne is of Ngāti Kahungunu whakapapa.
• Dame Rāngimarie Naida Glavish – Iwi Co-Chair, Chief Advisor Tikanga Auckland and Waitemata DHB presented on the Revitalisation of Te Reo Māori and Jennifer Ward-Lealand spoke from her own journey learning Te Reo Māori as a Pākeha.

Sophia Haynes
Senior Advisor, Pharmacy Practice and Policy

Sophia is an experienced registered pharmacist with over 20 years in pharmacy, specialising in primary care, commissioning, regulation and policy. She joined the Council in early October, making the move from her previous advisory role at Te Whatu Ora, Health New Zealand. Her key responsibilities at the Council are to provide leadership and support to operationalise organisational systems and processes, evidence-informed policy analysis and development. Sophia is a lifelong learner who has continued her postgraduate journey with two postgraduate diplomas under her belt, in Clinical Pharmacy and Public Health.

Sophia says that as the health professionals we see most often, “pharmacists can contribute to better health outcomes for all New Zealanders, through their expertise in medicines, patient-centred care and safe practice.”