Law 5

Question 1

What are the general Pharmaceutical Council guidance (7)

Answer 1

1. Consent
2. Sexual boundaries
3. Confidentiality
4. Raising concerns
5. Duty of candour
6. Pharmacy services affected by religious or moral beliefs
7. Responsible pharmacist

Question 2

What is consent (4)

Answer 2

1. ‘to express willingness, give permission, agree’. Basic right
2. Difference between explicit and implied consent
3. Valid consent = capacity + lack of outside pressure + sufficient information
4. Lack of capacity = Inability to make or communicate decisions because of “impairment or disturbance”.

Question 3

How do you assess capacity (2)

Answer 3

1. Specific at the time of decision.
2. Don’t make assumptions on age, disability, beliefs, condition, behaviour, drugs or alcohol consumption, not the “correct decision”

Question 4

How do you navigate through the withholding of consent (2)

Answer 4

1. Explain consequences and record.
2. Respect decision OR raise with others if you believe there is a serious risk of harm.

Question 5

What are Gillick’s competency and Fraser’s guidelines (5)

Answer 5

1. Used for those who work with children (under 16 years old)
2. ‘Meet Fraser guidelines’
3. Advice and/or treatment for contraception and sexual health
4. ‘Gillick competent’
5. Used more broadly to assess

Question 6

How are sexual boundaries breached (7)

Answer 6

1. Power imbalance
2. Sexualised behaviour. “Acts, words or behaviour designed to arouse or gratify sexual impulses or desires”
3. Breaching boundaries.
4. Revealing intimate personal details
5. Giving or accepting social invitations with sexual intent
6. Visiting a patient’s home without consent with sexual intent
7. Meeting patients outside normal practice with sexual intent

Question 7

How can sexual boundaries be enhanced (5)

Answer 7

1. Chaperones. For the patient’s and professional’s benefit
2. Cultural differences – personal values and beliefs, respect for views
3. Previous patients. It can still be inappropriate but consider all factors.
4. Raising concern. Must report suspicions of other healthcare professionals
5. Importance of records of possible suspect situations

Question 8

How can confidentiality be enhanced (6)

Answer 8

1. Protecting information.
2. secure storage
3. not discussing with others
4. social media policy
5. team responsibility
6. Disclosing confidential information. Decisions are complex but generally are not disclosed unless in special limited situations.

Question 9

How do you disclose information with consent (8)

Answer 9

1. Make sure the individual understands all aspects.
2. Consider coding or anonymising.
3. Only disclose information needed.
4. Indicate it is confidential.
5. Example for research purposes
6. Be prepared to justify any actions taken.
7. Record Details
8. Need explicit consent if for a purpose a patient would not reasonably expect

Question 10

How do you disclose information without consent (4)

Answer 10

1. Be satisfied the law requires disclosure or it is in the public interest.
2. Check the reason for the request if unsure.
3. Ask for a written request for disclosure.
4. Check with indemnity insurance provider, regulator, pharmacy support organisation or independent legal advisor if appropriate.

Question 11

What are disclosures required by law (7)

Answer 11

1. When a person or body asks for information under the law
2. The police or another enforcement, prosecuting or regulatory authority
3. Healthcare regulator, such as GPhC or the GMC
4. NHS counter-fraud investigation officer
5. Coroner or judge, or relevant court that orders that the information should be disclosed
6. No automatic right to all data. You should check for a legitimate reason.
7. Check with indemnity insurance provider, regulator, pharmacy support organisation or independent legal advisor if appropriate.

Question 12

What is considered in disclosures made in the public interest (7)

Answer 12

1. Balance patient and public interest.
2. Disclose if you think it is in the public interest to because of, for example.
3. Serious crime
4. Serious harm to a patient or third party
5. Serious risk to public health
6. Consider the harm of not disclosing.
7. Check with indemnity insurance provider, regulator, pharmacy support organisation or independent legal advisor if appropriate.

Question 13

What are the principles of raising concerns (whistleblowing) (10)

Answer 13

1. Professional responsibility to take action to protect the well-being of patients and the public
2. GPhC Standards for registered pharmacies – policy in place
3. Raising concerns about individual pharmacy professionals, the staff you work with (including trainees), employers and the environment you work in is a key part of this.
4. Includes pharmacy colleagues and other people responsible for the care of a patient, such as carers, care home staff or key workers.
5. It includes concerns about behaviours, competency, the working environment and any actions that may compromise patient safety.
6. Could be reluctant to raise concerns but have a professional duty and legal obligation under the Public Interest Disclosure Act 1998
7. Failure to report concern could call into question one’s fitness to practice.
8. Find out the employer’s policy.
9. Report without delay to the immediate supervisor, more senior manager or the appropriate regulator
10. Keep a record and maintain confidentiality.

Question 14

What is the duty of candour (5)

Answer 14

1. Openness and honesty, especially when things go wrong

Healthcare professionals must:

1. Tell the patient (or, where appropriate, the patient’s advocate, carer or family) when something has gone wrong.
2. Apologise to the patient (or, where appropriate, the patient’s advocate, carer or family)
3. Offer an appropriate remedy or support to put matters right (if possible)
4. Explain fully to the patient (or, where appropriate, the patient’s advocate, carer or family) the short and long-term effects of what has happened.

Question 15

How can pharmacy services be affected by religious or moral beliefs (8)

Answer 15

1. Beliefs may prevent some pharmacists from providing services, e.g. contraception, fertility, and substance misuse.
2. Ensure person-centred care is not affected – Priority.

Before employment:

1. Think about the provision of service in the locality.
2. If working on your own, can you direct to readily available service?
3. Inform employers of
4. If service is requested
5. Your responsibility to inform and direct the patient
6. The request should be handled sensitively and not discouraged from accessing the service.

Question 16

What are the roles of the responsible pharmacist concerning medicinal products (7)

Answer 16

Arrangements to secure medicinal products are:

1. ordered
2. stored
3. prepared
4. sold by retail
5. supplied in the circumstances corresponding to retail sale
6. delivered outside the pharmacy
7. disposed of

Question 17

What are the other roles of the responsible pharmacist (8)

Answer 17

1. The circumstances in which a member of the pharmacy staff who is not a pharmacist may give advice about medicinal products
2. The identification of members of pharmacy staff who are, in the view of the responsible pharmacist, competent to perform specified tasks relating to the pharmacy business
3. The keeping of records about arrangements to ensure medicinal products
4. Arrangements which are to apply during the absence of the responsible pharmacist from the premises
5. Steps to be taken when there is a change of responsible pharmacist at the premises
6. The procedure which is followed if a complaint is made about the pharmacy business
7. The procedure which is to be followed if an incident occurs which may indicate that the pharmacy business is not running in a safe and effective manner
8. How changes to the pharmacy procedures are to be notified to the staff.

Question 18

What are the hospital pharmacy services (4)

Answer 18

1. Pharmacists are employed by NHS Trusts.
2. NHS Foundation Trusts are independent legal entities with unique governance arrangements.
3. Use several Standard Operating Procedures and use Pharmacy Technicians for dispensing tasks
4. Pharmacists will contribute to many services. Medicine reconciliation, ward rounds, discharge planning, etc.

Question 19

What are the community pharmacy services (10)

Answer 19

1. Discharge Medicine Service
2. Dispensing of Appliances
3. Dispensing of Medicines
4. Disposal of unwanted medicines
5. Health Living Pharmacies
6. Public Health (Promotion of Healthy Lifestyles)
7. Repeat dispensing and eRD
8. Signposting
9. Support for Self-care
10. Monitoring may result in withholding of payment

Question 20

What are the community pharmacy advanced services (9)

Answer 20

1. Appliance Use Review
2. Flu Vaccination Service
3. Hypertension Case-Finding Service
4. LFD Service
5. New Medicine Service
6. Pharmacy Contraception
7. Pharmacy First Service
8. Smoking Cessation Service
9. Stoma Appliance Customisation

Question 21

What is the drug tariff (7)

Answer 21

1. Detail linked to pharmacy contract – payment for services
2. Tells pharmacists what the NHS will pay them for
3. Tells pharmacists how much the NHS will pay them
4. Tells pharmacist how to get their money
5. Details of circumstances in which certain medications can be supplied or items can be classed as medicines
6. Updated monthly as rules change
7. “Rules of the game”. Some players earn more. NHS set total

Question 22

How is misuse of GSL and Pharmacy medicines mitigated (1)

Answer 22

The sale of medicines protocol usually indicates how to recognise inappropriate requests. Large quantities or frequent purchases

Question 23

What are typical requests of misused GSL and P medicines (6)

Answer 23

1. Pseudoephedrine
2. Codeine linctus
3. Kaolin and morphine
4. laxatives
5. antihistamines
6. solvents

Question 24

What is the guidance for GSL and P medicine misuse (2)

Answer 24

1. MHRA guidance: distance selling of medications to the public
2. Professional responsibility to help the requester

Question 25

How can prescription-only medicine misuse be identified, and what can be done (7)

Answer 25

1. Use of Patient Medication Record (PMR)
2. Liaise with prescribers to help patients. Salbutamol inhaler, dihydrocodeine
3. Ensure emergency supply requests are conducted with the patient, and there is an immediate need.
4. Drug Tariff: Part XIVA: Reward scheme – Fraudulent prescriptions
5. Forgery: £70 reward
6. Prescribers self-medication or those with close personal relationships.
7. GPhC: “Pharmacist prescribers must not prescribe for themselves or for anyone with whom they have a close personal relationship (such as family members, friends or colleagues), other than in exceptional circumstances”

Question 26

How is controlled drug misuse mitigated (3)

Answer 26

1. Supervised Self-administration of Methadone and Buprenorphine. Service Level Agreement
2. Client/Pharmacist agreement form
3. Needle exchange: Paraphernalia, Citric acid, foil, and water for injection.