Why did pharmacy complaints spike?

A jump in complaints about NSW pharmacists was driven not by a growth in professional misconduct, but in Health Ministry activity

The Review of the Health Care Complaints Commission 2019-20 annual report, which was tabled in Parliament this week, singled out an increase in complaints about pharmacies and pharmacists for particular attention.

It noted a 30.9% increase in the number of complaints about NSW pharmacists over the reporting period.

“There were 356 complaints received in 2019-20, compared to 272 in 2018-19,” the Review noted. “We also noted a 78.5% increase in complaints about pharmacies, with 116 in 2019-20, compared to 65 received in the previous year.”

Pharmacists, numbering 10,335 during the 2019-20 reporting period, comprised around 4.5% of all registered health practitioners in NSW.

Before this period, around 5% of total complaints received about practitioners concerned pharmacists; however during 2019-20, these complaints jumped to 6.9% of the total, up from 5.7% in 2018-19.

“Additionally, we heard 20% of the complaints about pharmacists were referred for investigation,” the Committee noted in its review.

“These complaints were serious in nature as they were about illegal practices, breaches of guidelines and laws, or dispensing issues.

“As a group, the proportion of pharmacist-related complaints referred for investigation is the highest across all health practitioners: over four times higher than medical practitioners.”

The Committee said it was also concerned about complaints relating to S8s, including the Opioid Treatment Program, and improper or illegal compounding.

It asked the HCCC to provide more detail on the profile and analysis of these complaints, especially regarding S8s.

“In response, the Commission said the increase in complaints is ‘overwhelmingly’ being driven by the work of the Pharmaceutical Regulatory Unit (PRU), and not because there has been an uptick in professional misconduct,” the review states.

“The Commission told us that 28.6% of complaints that resulted in investigations were related to breaches of legislation governing Schedule 8 drugs and Schedule 4D restricted substances.

“A further 19.5% related to provision of OTP services and noncompliance with the NSW OTP protocol.

Regarding compounding, of the total number of complaints about pharmacists that were formally investigated, 6.5% related to the compounding of medicines without a TGA license or using imported products that are not approved for use in Australia.

“The Commission told us that more than half of these complaints were received from the NSW Pharmacy Council, and a quarter resulted from proactive work done by the Pharmaceutical Regulatory Unit,” the review states.

From early 2019, the PRU has had a focus on auditing pharmacies registered as OTP dosing point sites, it highlights.

“We heard that these audits resulted in an increased number of complaints referred to the Commission.

“There were 868 pharmacies registered as dosing points in 2019-20, which is 85% of NSW’s dosing

“The PRU audited 80 of these during the reporting period. One-third were then referred for further investigation by the Pharmacy Council and/or the Commission.”

While the Committee noted in its review that this proportion is “significant,” it also highlighted that the PRU “applies a risk-based approach to its work”.

“This means those who are deemed more likely to be at risk of compliance breaches are, in turn, more likely to be audited. We heard that these audits are more likely to generate complaints.”

Over all the registered professions, the Commission received 7.6% more complaints in 2019-20 compared to 2018-19, noted review chair Gurmesh Singh MP, Member for Coffs Harbour.

He said this “follows a long-term trend of year-on-year increases in overall health care complaints”.

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1 Comment

  1. Sean G

    Interesting that the PRU’s main strategy for reducing breaches going forward is to focus on education for professional pharmacists and pharmacy students. Unfortunately, only 27% of community pharmacists receive paid leave to complete training, and only 17% have the cost of their CPD covered by their employers (PPA Remuneration Report 2019-20). I suspect that unreasonable workloads might be a significant factor in many compliance breaches, and creating additional training requirements for already-overworked pharmacists to complete in their free (unpaid) time doesn’t address the underlying problem of workloads and employer-employee relations.

    Two significant problems I see with pharmacy legislation and compliance are:
    1. Legislation is quite fragmented between state and federal levels. This leads to seemingly arbitrary variations between state laws that create confusion when communicating with prescribers and patients from different areas. This problem is most apparent in border areas, but it also can make it quite confusing for pharmacists who move to practice in a different state to where they trained. It can also make it difficult to know exactly which piece of legislation applies to the situation one finds themselves in.
    2. Pharmacists often find themselves unprepared for uncommon situations when they arise, and rifling through arcane legal documents while queues are forming is a high-pressure situation that doesn’t lend itself to good decision making. Many patients already perceive pharmacists as “computer says no” bureaucrats who capriciously reject prescriptions for inconsequential reasons, and unfortunately they’re often right. When faced with an unfamiliar situation in a busy environment, I would be inclined to simply reject a prescription rather than risking my registration to keep a customer satisfied with my boss’ business. Obviously this is not ideal for the patient or myself, but these are the tradeoffs that have to be made in very busy environments. If these situations arise when it’s quiet I’d make the effort to find the relevant legislation, but Murphy’s law dictates…

    Obviously every pharmacist has a personal responsibility to keep up to date with the legislation, but lets not ignore the environmental factors that contribute to breaches. 100% of pharmacists should have paid leave for training, legislation should be rationalised on a national level, and work environments need to be modified to allow pharmacists the necessary time to ensure legal compliance.

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