Authorisation by a pharmacist who is absent or treated as absent – handing out checked and bagged prescriptions

Checklist of considerations 

Here are some considerations around authorising others to make the final supply of checked and bagged medicines.

1. Risk assessments – identify and manage potential risks (with appropriate safeguards in place) associated with authorising others to make the final supply of checked and bagged medicines. Review at regular intervals and, if necessary, revise or update risk assessments. 
   • See the section on roles and responsibilities for who could conduct risk assessments
   • You may find the Medicines, Ethics and Practice (MEP) helpful on how to risk assess (member login required to access).
2. SOPs – SOPs should be accessible to the pharmacy team and regularly reviewed, maintained and signed where needed. Review current SOPs around handing out medicines and, if necessary, revise or update them. 
   • See the section on roles and responsibilities for who could develop SOPs
   • See the section on SOPs for considerations around authorising others to make the final supply of checked and bagged medicines
3. Authorisation – the pharmacist is responsible for deciding if authorisation is appropriate, who to authorise (depending on risk assessment, professional judgment and skill mix) and whether to withdraw/amend authorisation if at any time risks arise. Review and outline expectations around authorisation in the SOPs. 
   • See the section on SOPs for considerations around authorisation
4. Pharmacist escalation or intervention – certain higher-risk medicines and scenarios may require pharmacist intervention or escalation before being handed out. Review and outline these in the SOPs with appropriate safeguards to manage them 
   • Nothing in the order prevents intervention by another pharmacist if needed or if risks arise. Another pharmacist can intervene or stop a transaction or supply of a medicine, regardless of authorisation. If they, in their clinical judgement, decide that a medicine is not safe or appropriate, a transaction or supply should not go ahead and should be discussed with the authorising pharmacist and prescriber as appropriate
   • You may find the sections on medicines that may require pharmacist escalation or intervention and scenarios that may require pharmacist escalation or intervention helpful.
5. Training – any member pharmacy team authorised to hand out checked and bagged medicines must have the appropriate training, competence, confidence and confirm they have the appropriate skills and qualifications to carry out such tasks and work within their scope of practice. Training should be covered in the SOPs, including demonstrating competence to perform specific tasks and regular reviews of individuals authorised to hand out checked and bagged medicines
   • For further information on training, see the GPhC requirements for the education and training of pharmacy support staff
   • You may find our consultation skills pharmacy guide and our consultation skills e-learning module helpful in developing confidence (member login required to access these resources).
6. Audit – regularly monitor, evaluate and improve the process and share learning in practice.
   • You may find our guides on clinical audit, service evaluation and quality improvement helpful (member login required to access these resources).
7. Communicate necessary information with pharmacy teams, patients and their representatives – including conditions/limitations for authorisation, changes in authorisations and how a pharmacist can be contacted during periods of absence to intervene and provide support if necessary and within a reasonable timeframe 
8. Roles and responsibilities – everyone in the pharmacy team needs to know their roles and responsibilities.

SOPs

It’s important to review and update your SOPs for handing out medicines and consider the following around authorising others to make the final supply of checked and bagged medicines: See the roles and responsibilities on who should develop SOPs. 

• How authorisation can be given and recorded – authorisation can be:
  • Given in writing or orally – record keeping concerning an authorisation should be defined in the SOPs
  • Given subject to conditions or restrictions
  • Varied or withdrawn by the pharmacist.
• Who can give authorisation to hand out checked and bagged medicines when a pharmacist is absent or treated as being absent
  • Only a pharmacist (it does not have to be the RP but it must be a pharmacist) can:
    • Authorise any member of the pharmacy team to hand out checked and bagged medicines in their absence
    • Decide if authorisation is appropriate and who can receive authorisation – this is optional and must be based on professional judgement, risk assessment and skill mix on the day
    • Withdraw or amend authorisation at any time if risks arise.
• Who can receive authorisation to hand out checked and bagged medicines when a pharmacist is absent or treated as being absent 
  • Authorisation can be given to a pharmacy technician or other suitably skilled or experienced member of the pharmacy team
  • Any pharmacy team members authorised to hand out checked and bagged medicines must have the appropriate training, competence, confidence and confirm they have the appropriate skills and qualifications to carry out such tasks and work within their scope of practice. 
• Withdrawing/amending authorisation – which could also cover any variation/change/removal to the authorisation, and scenarios when any other pharmacist can intervene or override 
  • Only the pharmacist who has given the authorisation can override, withdraw or amend the authorisation already given if, in their professional judgement, the change is necessary – consider who made the original authorisation and how long it was meant to remain in place
  • The pharmacist is responsible for communicating any changes to the authorisation effectively and in a timely way to members of the pharmacy team operating under the authorisation. Ensure they fully understand the change at the time it is made
  • Nothing in the order prevents intervention by another pharmacist if needed or risks arise. Another pharmacist can intervene or stop a transaction or supply of a medicine, regardless of authorisation. If they, in their clinical judgement, deem that a medicine is not safe or appropriate, a transaction or supply should not go ahead and should be discussed with the authorising pharmacist and prescriber as appropriate.
• Scope and duration of authorisation (how long they should stay in place) 
• Conditions and restrictions for authorisation 
• How to raise concerns if an authorisation is not professionally appropriate (by the pharmacy team member given authorisation or by the authorising pharmacist)
• Which types of prescription medicines may require intervention by the pharmacist before handing out to a patient or their representative – see the section on medicines that may require pharmacist escalation or intervention
• Which scenarios may require a pharmacist intervention or escalation before handing out to a patient or their representative – see the section on scenarios that may require pharmacist escalation or intervention
• Arrangements that apply during the absence of the authorising pharmacist including how to contact the pharmacist in an emergency, where intervention is required or where a patient wants to engage with the pharmacist, using technology or in person, within a reasonable timescale
• Roles and responsibilities – see the section on roles and responsibilities.

Medicines that may require pharmacist escalation or intervention 

Certain types of prescription medicines may require pharmacist intervention or escalation before being handed out. The SOP should clearly define these prescription medicines and outline appropriate safeguards to manage them – e.g., using visual indicators such as stickers to highlight items requiring additional attention. 

Examples of higher-risk prescription medicines may include:

• Newly prescribed medicines 
• Changes to medicine dose/strength/formulation where counselling may be required 
• Antibiotics for serious acute infections
• Emergency contraception
• Medicines supplied under a serious shortage protocol (SSP)
• Controlled drugs (CDs) – e.g., supervised consumption of methadone/buprenorphine and CDs with record-keeping requirements and CD balances 
• Fridge items – e.g., insulin 
• High-risk medicines with:
  • Narrow therapeutic index, e.g., lithium 
  • Serious adverse effects
  • Interactions
  • Withdrawal effects
  • Time critical 
  • Complex or unusual dosing
  • Monitoring or recording requirements, e.g., steroids and methotrexate.
• Medicines for vulnerable patients where specific advice regarding dosing may be needed, e.g., children, older people, or people with learning disabilities.  

This list is not exhaustive, and additional medicines may be included as appropriate. 

Scenarios that may require pharmacist escalation or intervention 

Certain scenarios may require pharmacist intervention or escalation before being handed out. The SOP should clearly define these scenarios and outline appropriate safeguards to manage them – e.g., asking the patient/representative to return to the pharmacy once the pharmacist is available or taking a telephone number so the pharmacist can call them at a convenient time. 

Examples of scenarios may include:

• Higher-risk medicines that may not be suitable for pharmacy team members to hand out in the absence of the pharmacist without appropriate intervention
• Where the pharmacy team identify that the involvement of a pharmacist is needed, e.g., if a patient or their representative has information that requires pharmacist intervention, if a patient has questions they can’t answer or complains of side effects/symptoms
• When the patient or their representative asks to speak to the pharmacist  
• When a pharmacist has indicated a need to speak to a patient. 

This list is not exhaustive, and additional scenarios and safeguards may be included as appropriate. 

Roles and responsibilities 

Everyone in the pharmacy team needs to know the roles and responsibilities of others and themselves around authorisation. 

Pharmacy teams should be prepared to explain to patients and their representatives the reasoning for different hand-out processes on different days.

It’s important to remember that the roles of the authorising pharmacist, RP and SP are legally distinct. A pharmacist who authorises is authorising as a pharmacist regardless of whether they are also working as an RP.

SP and pharmacy owner 

• Conduct risk assessments and audits (member login required to access) or appoint someone in the team to do so, e.g., RP/pharmacist/pharmacy technician
• Develop clear SOPs for authorisation and escalation, or appoint someone in the team to do so, e.g., RP/pharmacist/pharmacy technician 
• Provide training and refreshers to pharmacy team members (including locums) to ensure they are suitable for the task 
• Do not compromise the ability for pharmacists working in a community pharmacy to meet their professional obligations
• Consider how the process will impact the day-to-day operations, people who use your pharmacy services and pharmacy team 
  • Does the pharmacy team have any concerns or feedback? 

Authorising pharmacists (including RP, locums and relief pharmacists)

• Ensure you are confident working within a pharmacy that follows this process before accepting a role – whether employed or self-employed – by reviewing and signing the relevant SOPs
  • Any decision to deviate must be based on professional judgement, considering risks, patient safety and other relevant factors
  • In your professional judgement, if the SOP cannot be implemented safely or you have concerns, notify the SP or owner. This will allow them to review the concerns raised, make any necessary changes and share best practice 
• Decide whether to authorise pharmacy team members and who to give authorisation to
• Communicate clearly the conditions for authorisation to the pharmacy team and patients and stay contactable during periods of absence to intervene and provide support if necessary 
• Withdraw or amend authorisation at any time if risks arise 
  • The authorising pharmacist should communicate to the team any authorisation that is given or withdrawn effectively and in a timely way to ensure they fully understand the change at the time it is made.
• Remain professionally accountable for the safe and effective operation of the pharmacy during your responsibility as authorising pharmacist – only pharmacists can authorise and are accountable for authorisations
• Another pharmacist can intervene or stop a transaction or supply of a medicine, regardless of authorisation. If they, in their clinical judgement, deem that a medicine is not safe or appropriate, a transaction or supply should not go ahead and should be discussed with the authorising pharmacist and prescriber as appropriate
• Manage risks identified in the pharmacy and ensure they have been mitigated or minimised to maintain patient safety 
• You may find our professional judgement and locum guides (member login required to access) helpful.

Pharmacy technicians and the wider pharmacy team

• Read, sign and follow relevant internal SOPs 
• Complete appropriate training with regular refreshers as required to ensure ongoing confidence and competence 
  • Only hand out check and bagged medicines if you feel competent and confident – refuse tasks if you are not
• Know who the authorising pharmacist is on any given day and who is authorised to hand out checked and bagged medicines to a patient or their representative in the absence of a pharmacist – see internal SOPs
• Know when to escalate to the pharmacist for intervention – see internal SOPs 
• If you are a pharmacy technician responsible for writing the SOPs, see the section on SOPs.