1. 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: m.c.watson@abdn.ac.uk

2. 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.

3. 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

4. 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

5. British, adult minimum wage £5.05/hour Source: Chemist & Druggist 2005

6. 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

7. We have a problem? Evidence of inappropriate supply of NPMs Evidence of inappropriate use of NPMs

8. 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.

9. 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

10. Public Perception? people think you’re just a shop assistant

11. MCA perception I am not qualified to tell somebody what they should be taking

12. 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

13. 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)

14. Barriers to training Time Money Availability (geographical, frequency) of relevant courses IJPP 2004;12(4):191-197. Smith SM, Watson MC.

15. MCAs and Communication

16. Royal Pharmaceutical Society of Great Britain Code of Ethics Section 10: Sales of pharmacy medicines a. Advice on treatment: obtain sufficient information b. Product request: provision of advice c. Pharmacist personal involvement d. Specific patient groups e.g. elderly e. Specific drug groups e.g. drugs of abuse/misuse 20% MCAs reported having read the RPSGB guidelines

17. 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.

18. Compliance with WWHAM

20. Reclassification, self care and the development of MCAs

21. Source: Public attitudes to self care. DoH, 2005.

22. The New Contract Essential 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.

23. Skill-mix MCAs ….. 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

24. 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?????

25. 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.

26. Realising the potential of MCAs (III) MCA level Enhance motivation Regular identification of training needs WWHAM – consider its future and explore alternatives

27. 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

28. Funded by the Medical Research Council (UK) and the Chief Scientist Office, Scottish Executive Health Department. Acknowledgements