Realising the potential of medicine counter assistants
Dr M C Watson
Department of General Practice and Primary Care, University of Aberdeen.
Tel: 01224 553785 Email: [email protected]
Medicine counter assistant (MCA):
“A person who has satisfactorily
completed or is undertaking a
certificated programme of training
for work in support of the sale of
non-prescription medicines and the
giving of advice on health matters”.
Consultation paper: Regulation of pharmacy support
staff. Pharm J 2002;268:888.
Currently, ….• MCAs comprise the largest proportion of the community
pharmacy workforce.
• MCAs are unregistered and unregulated.
• No official statistics regarding the number of MCAs employed in British pharmacies (estimates of 40-60,000).
• Estimated average: 3 to 4 MCAs/pharmacy
Who are MCAs?
• Female
• Mid 30s to 40s• ~ 10 years working in pharmacy sector (C&D survey)
• ~ 5 years working in current pharmacy (J&J survey)
• 14.5 OTC recommendations/day
Hourly rate of pay
No answer11%
<£3.6011%
£3.61-424%
£4.01-4.5022%
£4.51-514%
£5.01-5.5010%
£5.51+8%
British, adult minimum wage £5.05/hour
Source: Chemist & Druggist 2005
Reclassification and MCAs
• > 70 POMs reclassified since 1980s
• EU directive likely to lead to more reclassifications
• Self care = major health strategy in the UK
• MCAs are involved in 7 out of 10 consultations for these medicines
We have a problem?
• Evidence of inappropriate supply of NPMs
• Evidence of inappropriate use of NPMs
The “Thrush” Study
• Randomised controlled trial comparing two educational strategies to promote evidence based guidelines for the treatment of vaginal candidiasis.
• 60 community pharmacies in Grampian.• 38% consultations deemed “appropriate” i.e. guideline
compliant.
Family Practice 2002;19(5):529-536. Watson M, Bond C et al.
What are the barriers to the evidence based supply of NPMs?
• Training– Lack of regular, formal training for MCAs
• Communication– During consultations with customers– Within the pharmacy team
• Safety concerns– Focus on avoidance of harm
IJPP 2004;12:65-72. Watson MC & Bond CM
MCAs and Training
“pharmacists should ensure their staff are
trained and that their competence is maintained
through ongoing training and updating”
Framework S/NVQ2 Pharm J 2002
And, ….
“any assistant who is given delegated authority to
sell medicines under a protocol should have
undertaken, or be undertaking, an accredited
course relevant to their duties”
Code of Ethics, Part 2, Section 1.A, part (f). (RPSGB 2005)
Barriers to training
• Time
• Money
• Availability (geographical, frequency) of relevant courses
IJPP 2004;12(4):191-197. Smith SM, Watson MC.
Royal Pharmaceutical Society of Great Britain
Code of EthicsSection 10: Sales of pharmacy medicinesa. Advice on treatment: obtain sufficient informationb. Product request: provision of advicec. Pharmacist personal involvementd. Specific patient groups e.g. elderlye. Specific drug groups e.g. drugs of abuse/misuse
20% MCAs reported having read the RPSGB guidelines
WWHAM
Who is it for?
What are the symptoms?
How long have the symptoms been present?
Any other medication being taken?
Medication tried already?
90% MCAs reported using WWHAM, and that it was
important/very important.
Compliance with WWHAMVariation in total WWHAM score
WWHAM Score
5.004.003.002.001.00.00
Perc
enta
ge o
f consultations 40
30
20
10
0
Variation in WWHAM questions asked/information elicited
0
10
20
30
40
50
60
70
80
Who for? What symptoms? Duration ofsymptoms?
Any medicationtried?
Other medicationtaken?
WWHAM Component
Pe
rce
nta
ge
of
co
ns
ult
ati
on
s w
he
re
qu
es
tio
n a
sk
ed
/in
form
ati
on
eli
cit
ed
Compliance with WWHAM
The New ContractEssential Service: Support for self-care“The provision of advice and support by pharmacy staff to enable
people to derive maximum benefit”• Aims and intended service outcomes
– People, including carers, are provided with appropriate advice to help the selection and use of any appropriate medicines.
• Service outline– Pharmacy staff will provide advice ….with the treatment of minor
illness and long-term conditions.– Pharmacy staff will advise on the appropriate use of the wide range of
NPMs which can be used in the self-care of minor illness and long-term conditions.
Skill-mixMCAs …..
• comprise the largest proportion of the community pharmacy workforce
• manage the majority of consultations for OTC medicines on their own
• are the least trained and recognised member of community pharmacy staff
Realising the potential of MCAs (I)Policy-level• Consider whether basic MCA training meets current
needs• Identify methods for providing ongoing, formal, regular
training opportunities for MCAs • Raise public awareness of MCAs’ training and role• Raise public awareness regarding the need to provide
information during consultations to derive the maximum benefit
• Registration?????
Realising the potential of MCAs (II)Pharmacy level• Adopt a systematic approach to the supply of OTC
medicines– SOPs– Which medicines/patients/symptoms should be referred
• Identify/address MCA training needs to enable full development/involvement in the provision of self-care
• Make MCAs visible – identify them as MCAs “not just shop assistants”: use identity badges; display MCA certificates.
Realising the potential of MCAs (III)
MCA level
• Enhance motivation
• Regular identification of training needs
• WWHAM – consider its future and explore alternatives
Medicine Counter Assistants
• Important member of pharmacy staff
• Increasing role in the supply of NPMs and supporting self care
• Pharmacy profession needs to support MCAs to ensure the safe and effective supply of NPMs and to realise their potential with self care