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

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

Public Perception?

people think you’re just a shop

assistant

MCA perception

I am not qualified to tell somebody what they

should be taking

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.

MCAs and Communication

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

Reclassification, self care and the development of MCAs

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

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

Funded by the Medical Research Council (UK)

and the Chief Scientist Office, Scottish

Executive Health Department.

Acknowledgements