General advice for pharmacist colleagues considering making a competence referral to the Council

If you are concerned about a pharmacist’s competence, you may be considering whether to refer him or her to the Council, so it can decide whether an assessment of that pharmacist’s competence is required.

• Is there a one-off incident that concerns you, or does there appear to be a pattern of conduct emerging? (e.g. has the pharmacist made a dispensing error on one occasion in the last three months, or on three or four separate occasions?)
• Have you discussed this with the pharmacist?
• If it was a one-off incident:
  • was it a serious departure from accepted standards?
  • did the pharmacist have an adequate explanation for this departure?
  • Has there been a recent change in the pharmacist’s behaviour or ability?

If so, you may want to consider whether there is a possible health issue impacting on the pharmacist’s ability to perform.

Note: Under section 45 of the Health Practitioners Competence Assurance Act 2003 (HPCAA) pharmacists and pharmacist’s employers are required to advise Council if they have reason to believe that the pharmacist is unable to perform the functions required due to a mental or physical condition.

• Are you comfortable discussing your concerns with the pharmacist? If so, the pharmacist is likely to appreciate your frankness, and this may be an appropriate first step.
• It is helpful if you have:
  • specific incidents or cases to discuss with the pharmacist
  • particular issues in those cases that concern you, and
  • some suggestions on steps the pharmacist could take
• You may wish to advise the pharmacist that you are considering making a referral to Council.

Advice for pharmacist employers regarding competence issues of pharmacist employees

Are you satisfied that the pharmacist is practising pharmacy safely?

If not, the Council would suggest that you put immediate measures in place to ensure patients are not at risk and contact the Council for further advice.

Appropriate measures depend on the seriousness of your concerns, and may include:

• notifying the pharmacist of your concerns
• placing the pharmacist under supervision by a senior peer
• asking the pharmacist to cease practice while the concerns are investigated

Note: Under the HPCAA, if a pharmacist resigns or is dismissed for reasons relating to competence, his or her employer must notify the Council of the reasons for the resignation or dismissal.

How will the Council generally determine whether a competence review is required?

Each case is different, but when deciding whether a pharmacist should undergo a competence review, the Council will usually consider the following:

• is a pattern of conduct emerging that may indicate wider competence issues?
• was a particular incident a serious departure from accepted standards?
• has the pharmacist since put in place systems or undertaken education to prevent a similar occurrence in the future?

Was there a distracting influence in the pharmacist’s life at the time of the incident? This may include health, financial or personal issues, leading to increased stress, and impacting on the pharmacist’s ability to perform at his or her usual standard.

Notification of a belief of a pharmacist posing a risk of harm or a risk of serious harm

Council sets the following guidelines to be used to determine when pharmacists should notify the Council of situations involving the practice of a pharmacist posing a risk of harm:

• A serious event that is a significant departure from accepted standards
• Pattern of conduct over a period of time that is below the required standard of competence
• Criminal offending
• Professional isolation with declining standards
• Recognised poor performance where local intervention has

Council recognises that a risk of serious harm to the public may be indicated by:

• A patient being seriously harmed
• The pharmacist may pose a threat to more than one patient and as such the harm is collectively considered serious
• There is sufficient evidence to suggest that the alleged criminal offending is of such a nature that the pharmacist poses a risk of serious harm to one or more patients
• The inability of the pharmacist to perform the functions of his or her position due to a mental or physical

If the Council has reasonable grounds for believing a pharmacist poses a risk of serious harm to the public by practising below the standard of competence it may consider action under section 39, which is

• Suspend; or
• Impose conditions on the pharmacist’s scope, pending or following a review of the pharmacist’s competence.