Council has published its 2024 annual workforce demographic report on pharmacy practitioners in Aotearoa New Zealand (1 July 2023 to 30 June 2024). 
 
The report, which compiles data provided by practitioners when they apply for their annual registration, is reliable and comprehensive says Council Chief Executive Michael Pead. “It’s a sound basis from which the sector can consider and make any changes needed to ensure pharmacists can achieve the best possible health outcomes for consumers.” 

Key findings from the report: 

• a 2.46 percent increase in the number of practising pharmacists, which is higher than the long-term average of 2.1 percent. In 2023 there was a 0.6 percent increase and in 2022 a 1.4 percent increase. 

• the increase in the number of practising pharmacists has not kept pace with the growth of our national population. The ‘density’ of practising pharmacists has only increased from 7.93 per 10,000 people in 2023 to 7.95 per 10,000 people in 2024. 

• although lower than in the previous year, 36 percent of pharmacists reported practising in excess of 1.0 FTE over the APC year 1 April 2023 to 31 March 2024. The percentage of pharmacists reporting part-time work has increased from 30 percent in 2023 to 32.9 percent in 2024. 

• the ratio of male to female pharmacists remains at about 1:2. 

• most pharmacists aged under 44 identify as Asian while most pharmacists aged over 45 identify as European. 

• the number of registered pharmacist prescribers continues to increase, with 74 practising pharmacist prescribers in 2024 compared to 51 in 2023. 

• the number of overseas pharmacists registering in New Zealand has shown an increase in 2024 and is comparable to what we were seeing prior to the Covid pandemic. 

• a noticeable increase in the number of New Zealand pharmacists returning to practice after being away from New Zealand practice for eight or more years. 
• 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 full report can be read here

Look-alike and sound-alike dispensing error (22HDC01295) 
 
The HDC has found that a pharmacist missed multiple checkpoints to intervene and made a dispensing error with look-alike and sound-alike medicine.  

Case description  

Mrs A had been prescribed clomiphen (clomifene citrate) tablets by a fertility clinic. The prescription called for 10 tablets of clomiphen 50mg, one tablet to be taken daily for five days, starting on day three of Mrs A’s menstrual cycle. Unfortunately, the pharmacist misread the prescription, processed and dispensed clomipramine (an antidepressant), instead of clomiphen  which is used to treat infertility by stimulating ovulation. 

The pharmacist did not pick up on the error and proceeded to adjust the dosage instructions and change the quantity of the tablets from 10 clomiphen tablets to 20 clomipramine tablets (as clomipramine came in only 25mg tablets, and the prescription required a 50mg dose). 

The pharmacist’s lack of thorough checking meant that he did not identify the dispensing error at several stages of the dispensing process, despite various checkpoints set out in the pharmacy’s standard operating procedures (albeit out-of-date). The pharmacist also did not provide counselling or have a discussion with the patient, which was a lost opportunity where the error may have been discovered. 

The need for more clinical reasoning and promptly addressing uncertainties 

The pharmacist missed several warning flags during the dispensing process:  

• the unusual instructions and short course (one tablet to be taken daily for five days, starting on day three of menstrual cycle)  

• the prescription was from a fertility clinic (it is unlikely a fertility clinic would prescribe an antidepressant) 

• the dose form availability and subsequent quantity change (clomipramine only came in 25mg tablet and the prescription required a 50mg dosage). 

The Pharmacy Accuracy Checking Technician had also noticed that the clomipramine label was different from the prescription but wrongly assumed that clomipramine was a new brand name for clomiphen. The technician should have double checked any uncertainties against drug formulary when in doubt, rather than continuing with the dispensing process.  

Clinical reasoning should have been applied during the checking process as there were many warning flags that should have prompted the pharmacist to re-check. Another lost opportunity to prevent errors was for the technician to query the different names against the label and prescription and to double check against reference resources. 

Look-alike, sound-alike (LASA) medicines common cause of errors 

Look-alike, sound-alike (LASA) medicines are a well-recognised cause of medication errors due to orthographic (look-alike) and phonetic (sound-alike) similarities between medicines. Confusion can occur between brand-brand, brand-generic or generic-generic names.  

We recommend pharmacists, pharmacist managers and/or owners review and implement strategies to manage LASA medicines. This can involve (not an exhaustive list): 

• storing those medicines that have similar names and packaging separately  

• Health Quality and Safety Commission’s Tall Man Lettering 

• Having alert/highlight stickers on the shelves 

• patient counselling (e.g. prevent potential dispensing errors by finding out more clinical information and the intended purpose of the prescribed medicine) 

• having a logical and thorough dispensing process. This should include ensuring the accuracy of medication being dispensed by checking against the prescription. This is a fundamental step in the patient safety and quality assurance process.   

 
Relevant Standards can be read in Competence Standards for Aotearoa New Zealand Pharmacy Profession 

Assesses prescriptions, including applies knowledge in undertaking a clinical assessment of the prescription… (Competency 6.1) considered together with Person-centred Care and Medicines Management (Domain 5). 

Follows a logical, safe, and methodical procedure to dispense therapeutic products (Behaviour 6.2.1) 

Monitors the dispensing process for potential errors and acts promptly to mitigate them (Behaviour 6.2.2). 

A joint set of prescribing principles to ensure consistent, safe prescribing across Aotearoa New Zealand have been developed collaboratively by seven Responsible Authorities (RAs) that regulate health practitioners who prescribe. 

Pharmacy Council Chief Executive Michael Pead says that Council was proud to lead the collaboration of RAs to develop the Principles for quality and safe prescribing practice which provide guidance on expected behaviours for prescribing for all prescribers, irrespective of professional background or practice setting.   

“The principles will be an invaluable resource for those doctors, dentists/dental specialists, pharmacists, dieticians, nurses, midwives and optometrists who are authorised to prescribe.   

They are intended to be used by authorised prescribers alongside the standards and guidance documents published by each prescriber’s Responsible Authority.” 

Pharmacists should refer to the principles alongside Council’s competence standards and pharmacist prescriber standards. 
 
“The principles complement our standards as we worked to ensure they were strongly aligned to the competence standards to provide optimal guidance of best practice prescribing for prescribing pharmacists,” says Michael. 
 
The principles will be applicable to the vast majority of cases, however, there may be some variation in applying these principles to reflect the differences of each prescribing workforce and the specific circumstances of each case. 

The principles were informed and influenced by overseas competence frameworks, the Medical Council of New Zealand’s Statement on Good Prescribing Practice, and extensive consultation with the prescribing professions and the public.  

MyRecert email sent in error 
Council wrote to some pharmacists earlier this month to advise them the email they had received about MyRecert portfolios expiring was sent in error due to a system setting. We assured pharmacists that portfolios were not expiring. The system setting was put in place for Council to avoid holding pharmacists’ data for a long time, as this incurs financial costs. Unfortunately having this setting in place led to unintended consequences. We can unequivocally assure you that there was no security breach, and no data was lost or compromised.  

Among the questions we received in response to our email was: is the Pharmacy Council itself competent? Council CE Michael Pead says that Council holds itself to a high standard and is accountable for its actions. We are undertaking a thorough review with our supplier, our technology provider, and operational team to investigate the issue. This review includes assessing how we managed the situation, reviewing our current system settings and putting measures in place to prevent any similar issues in future.  Following the review, Council will complete a report of its findings and the process improvements it is putting in place.  

Another question Council was asked is whether the error would cause us to put up our fees. The answer is no. Council’s proposed rise in the APC fee and disciplinary levy for the new recertification year, which we informed the profession of last week in our APC communications series, is based on three key factors: a rise in the number and complexity of notifications we are receiving regarding pharmacists’ conduct and competence to practice, the need to replenish our general and disciplinary reserves, the government’s programme of legislative review and general inflationary pressures. 

MyRecert portfolio review  
Council appreciated the time and effort of pharmacists who applied to be considered as reviewers of 2023/24 MyRecert portfolios. Eight reviewers were appointed and have now reviewed randomly selected portfolios against the six main MyRecert requirements: plan/goals, reflection, cultural safety, peer group meetings, keeping up-to-date and verifier sign off. Manager, Registration and Competence Assurance, Trish Farrelly says that the review aims to provide assurance to Council that pharmacists are strongly engaging in professional development to maintain their competence. Council is finalising the review findings and will soon be providing feedback to those whose portfolios were reviewed. A summary of the results will be released next month for all pharmacists.  

Council hosted its regular hui with the professional associations earlier this month. We provided an update of our work programme, including the joint prescribing principles we developed with six other Responsible Authorities, and the MyRecert portfolio review (both items are covered in this newsletter). We also summarised Council’s consultation and communications approach on the proposed new APC fee and disciplinary levy, which began with our communications series last week. We welcomed opportunities to attend events run by the professional associations to engage with their members on the APC fee and disciplinary levy, or any other issues.  

There was a discussion on workforce issues including workforce shortages, funding, and the need to support pharmacists’ wellbeing to assist workforce retention and to reduce the risk of harm to patients. Both the Pharmaceutical Society of New Zealand and the Independent Pharmacists of New Zealand shared information about the key results from recent member surveys they had undertaken to support their workforce advocacy. Thank you to all the professional associations for such constructive and informative dialogue.  

Last week Council launched the first in its series of communications to the profession ahead of releasing the APC fee and disciplinary levy consultation document in late October. Our series aims to enhance your understanding of our work as set out in the Health Practitioners Competence Assurance Act 2003, the challenges we face in meeting our costs, and the rationale for our proposal to raise the fee and levy to just over $1,000 (versus $925 this year). Our communications will cover a range of topics, including the rise in the number and complexity of notifications we are receiving about pharmacists’ conduct and/or competence and fitness to practice, our approach in addressing these notifications, and the impact of increased notifications on Council workload and costs.  

In a world-first, the medicine Maviret that treats hepatitis C, can now be prescribed through specially trained nurses and pharmacists without the need for a doctor’s prescription. This collaborative hepatitis C treatment model involves pharmacists and nurses working together to increase access to treatment. The pharmacist will work with an authorised nurse to help oversee clinical records, blood test results, referral to secondary care where needed and patient centred care. Information about reclassification. models of supply and training is on the Health NZ Te Whatu Ora website.  
 
Council’s requirements and expectations for pharmacists providing hepatitis C medication without prescription are on our website here.  
 
The changes are part of the Government’s aim to work towards the World Health Organisation’s goal to eliminate viral hepatitis by 2030.  A hepatitis C point-of-care (finger-prick) test can be accessed at various places throughout the country including mobile clinics, some pharmacies, kaupapa Māori health providers and needle exchanges.  

Ming-chun Wu is the Pharmacy Council’s current Deputy Chair and will be in the role until March 2025.  A Chartered Director with the Institute of Directors, she has over 17 years’ experience in transforming and improving organisations.  Appointed to the Council in 2019, she is one of two laypeople who serve on Council, along with six pharmacists.  

Ming-chun has broad governance experience, having served on advisory, regulatory, volunteer, professional and commercial boards. She is passionate about good governance and making a difference for all New Zealanders through her governance work.  She has held senior strategy and policy roles in large public sector organisations and has in-depth knowledge of governing legislation such as the Health Practitioners Competence Assurance Act 2003.  She is also on the Responsible Authority Board of the Chinese Medicine Council of New Zealand.  
  
Ming-chun is currently a Trustee for the Wellington Community Fund, a Board Member of the Plumbers, Gasfitters and Drainlayers’ Board, and a Board Director for Network for Learning Limited.  

You’ve said that you’re passionate about good governance. What are some of the key factors of good governance? How can this make a positive difference to a Responsible Authority such as the Pharmacy Council and the public it serves? 
Good governance is built on transparency, accountability, strategic foresight, and inclusiveness.  For Council, good governance ensures decisions are made in a fair, evidence-based, and ethical manner, prioritising public safety and trust.  By maintaining clear communication and being responsive to stakeholders, the Council can uphold standards and promote the integrity of the pharmacy profession.  This, in turn, benefits the public by ensuring that they receive safe and competent care from registered professionals. 

As a layperson serving on Council, what are some of the impressions you’ve formed of the pharmacy profession? 
I’ve been impressed by the deep commitment within the profession to patient care and safety.  Pharmacists play a critical role in the healthcare system, often being the most accessible healthcare providers.  They demonstrate a strong dedication to continuous learning and adapting to changes, whether from advancements in medicine, technology, or evolving public health needs.  The profession’s proactive approach to patient care and its adaptability to regulatory standards are commendable. 

In the five years you’ve served on Council, what is one achievement that stands out to you most? 
It is hard to pick a standout!  At the governance level, it was the release of our governance charter last year which outlined our commitment to working together with the profession and the wider sector through authentic partnership with Māori as prescribed in Te Tiriti o Waitangi.  Throughout my tenure on the Council, we have been implementing this approach and it’s gratifying to be working together as an organisation to strive towards enhancing the pharmacy sector’s high standards. 

Looking to the future, what will be the top challenges for Council and regulation more generally? 
One of the primary challenges for the Council and regulatory bodies will be navigating the rapid pace of technological advancements and their implications on the profession.  From digital health innovations to changes in pharmacy practice models, there is a need to continuously adapt our regulatory frameworks to keep pace.  Additionally, addressing workforce pressures, such as burnout and the need for greater diversity and inclusion, will be crucial to maintain the resilience and integrity of the profession. 

For someone contemplating or new to a governance role, what advice would you give? 
I’d emphasise the importance of understanding the principles of good governance: transparency, accountability, and strategic focus.  Be curious and ask questions, as your fresh perspective is invaluable.  Take the time to learn about the organisation’s mission, values, its stakeholders, and the context in which it operates.  Effective governance requires a balance of providing oversight and support while challenging the status quo when necessary to drive continuous improvement. 

What are three words that best describe you? 
Resilient, strategic, and collaborative.