More than a year on from the Which? report that highlighted poor service from MCAs, has the root of the problem – and, better still, a solution – been found? 

It is accurate to hail medicines counter assistants (MCAs) as the public face of community pharmacy. Whenever someone walks into a pharmacy, chances are the first person they will see will be an MCA. This means that counter assistants are much more likely than their dispensary colleagues – including pharmacists – to be the people who deal with queries about OTC medicines. It is, after all, their job. It is what they trained for. And it is what they are good at.

Or is it? Last year the consumer association Which? published the results of its latest mystery shopping exercise, and stated that two-thirds of the visits handled solely by MCAs were unsatisfactory. While it might be tempting to dismiss the ensuing headlines as sensationalist (“Patients’ health is being put at risk” was what the Daily Mail went with), it is worth clarifying that Which? used the term “unsatisfactory” to mean that insufficient questions were asked in order to check patient safety. This is something that even the most ardent MCA enthusiast would find it difficult to argue against.

Certainly, the profession did not take this criticism lightly, particularly as a similar investigation conducted by Which? in 2008 found much the same. Although there was a sense that these findings didn’t necessarily represent the sector as a whole – after all, only 122 pharmacies were visited, which is less than one per cent of the total number – many organisations, including pharmacy’s regulatory and professional bodies, Which? and several multiples, announced plans to work together with the aim of investigating the reasons for this trend and addressing the issues raised.

Tackling training

One of the topics that has come up time and time again as a result of this collaborative work is MCA training, with questions asked about whether courses adequately prepare staff for the types of enquiries they will be required to handle once they are working on the medicines counter. Helga Mangion, a professional development manager for the National Pharmacy Association, asserts that Interact, the MCA development programme provided by her organisation, is “fit for purpose”. All courses of this type have to be accredited by the General Pharmaceutical Council (GPhC), she says, adding: “The course involves many assessments and if the student doesn’t pass, they don’t qualify.”

Given Helga’s comments, it makes sense to go further back in the process to the accrediting organisation. Joanne Martin, quality assurance manager (education) for the GPhC, explains: “Rather than having a syllabus, MCA courses must meet three of the national occupational standards set by the then sector skills council for health. These three standards are concerned with assisting in the sale of medicines and products, receiving prescriptions, and assisting in the issuing of prescribed items.”

It may sound straightforward, but in order to get a course accredited by the GPhC, training providers have to submit not only their course materials but also evidence that their offering fulfils the job it has been designed to do – for example, by explaining how the enrolment and assessment procedures work, and how students are supported. This is then scrutinised by an expert panel. Only once the training provider has met with the panel to discuss any concerns do they find out if their course has been approved. And it doesn’t end there. Accreditation only lasts three years, meaning that after two years or so, the training provider needs to start again from the beginning.

While the accreditation process is certainly rigorous and robust, criticisms have been levelled at the standards MCA courses are required to meet. But Joanne points out: “MCA courses have to remain current and up-to-date and this is part of an ongoing review of the standards.” Helga confirms that courses are regularly reviewed. This means, for example, that if a new OTC category or product is introduced, it has to be added to an MCA course with reasonable promptness.

Enriching knowledge

Once someone has qualified as an MCA, their learning journey doesn’t – or rather shouldn’t – stop. Continuing professional development (CPD) for MCAs is pretty much a given across community pharmacy nowadays, and can range from formal courses and events to on-the-job training and reading articles in trade magazines such as Training Matters. While some of this is initiated by MCAs themselves, pharmacy managers undoubtedly also have a role. However, this latter factor accounts for much of the variation that exists in support staff CPD, with some pharmacists claiming they are simply too busy keeping the business on track and meeting targets to spend time on staff training.

Royal Pharmaceutical Society president Ash Soni says that this attitude simply isn’t good enough: “Everyone should be able to dedicate a certain amount of time to learning and development within the pharmacy’s core hours. It doesn’t need to be much, even half an hour is fine, but it does need to be allocated and take place away from customers so the staff member isn’t trying to switch between, say, serving someone and then trying to read a CPD module.”

In an ideal world, pharmacists and their staff would get protected learning time in the same way that GPs and their staff do, Ash adds, though he is of the opinion that this won’t happen in a consistent way across pharmacy unless, or until, it is built into the contract. Another issue that has been raised is whether the public comprehends what an MCA actually does. Views such as “just a sales assistant with a badge and a tabard” are not unheard of on social media forums, and often stem from indignation at what is perceived as “being quizzed” when buying something like a head lice treatment. The fact that many of these affronted individuals would be equally outraged about “not enough questions being asked” under other circumstances – a young girl trying to access emergency contraception, for example – indicates how the role of frontline pharmacy staff is sometimes poorly understood.

In an ideal world, pharmacists and their staff would get protected learning time in the same way that GPs and their staff do

On promotion

Given the success of community pharmacy awareness drives such as “Ask Your Pharmacist” and “Dispensing Health”, would an initiative that aims to educate people on the roles of pharmacy staff be a good idea? Rob Darracott, chief executive of Pharmacy Voice, says: “Recent campaigns have tried to raise the profile of the sector as a whole because pharmacies provide services that the general public either don’t realise are there, or are much more involved than people recognise, as in the clinical and safety elements of medicines’ supply.”

Instead of homing in on MCAs as part of such initiatives, Rob thinks it is better to promote what the whole pharmacy team – pharmacists, pharmacy technicians, MCAs and newer focused roles such health champions – can offer in terms of helping the general public to improve their health. Perhaps, instead of awareness campaigns, a new role needs to be created within pharmacy. In the way that health champions have helped promote pharmacy services to the general public, maybe making someone in each pharmacy an OTC champion could be a way of highlighting exactly what MCAs do. However, the RPS’s Ash Soni has his reservations: “All frontline staff are OTC champions, so giving certain members of staff this title could lead to a situation in which the public undervalue what the rest of the team does, when in fact they have very similar skills and expertise.”

Instead, he suggests getting staff to wear name badges that state their job title. This would be a good start in defining to the public who does what in a community pharmacy, Ash says. It is clear that Which? has presented a problem that pharmacy needs to know about, but for which there is no easy solution. Public awareness of community pharmacy and the roles of different staff, the quality of courses that staff do to qualify as MCAs, and ongoing training are certainly all factors. But pharmacists also need to look to themselves.

As the NPA’s Helga puts it: “Ultimately, it is the supervising pharmacist who nominates an individual to become an MCA. They have to make sure they nominate the right person in the first place.”