A third of pharmacies give poor advice, survey finds

BMJ 2008; 337 doi: (Published 25 September 2008) Cite this as: BMJ 2008;337:a1847
  1. Zosia Kmietowicz
  1. 1London

    An undercover investigation has found that staff in UK pharmacies are giving unsuitable and potentially dangerous advice about some common illnesses and drugs. The problem is particularly bad in independently owned pharmacies, where half of the advice was judged to be poor.

    Recent years have seen pharmacists take on a wider public health role, with many giving advice on minor ailments and checking for health problems, says Which? (the consumer organisation). In May it sent undercover investigators into 101 pharmacies across the United Kingdom—including chains such as Boots and supermarkets—to test the competence of staff.

    The investigators acted out one of three different scenarios in each pharmacy, asking about emergency contraception, the migraine drug Imigran Recovery (a preparation of sumatriptan), or traveller’s diarrhoea. A panel of three pharmacists then graded the responses according to the advice given.

    Overall just a quarter of the responses (24%) were judged to be good, nearly half (44%) were satisfactory, and nearly a third (32%) were unsatisfactory. However, at the 23 independent pharmacies a much bigger proportion of the advice from staff was judged to be unsatisfactory (48%), and only 17% of their advice was rated as good.

    The survey found that 40% of sales assistants, when asked about Imigran Recovery, which until recently required a prescription, did not alert the pharmacist about the request, even though it should be sold only after questioning by a pharmacist. One in five assistants sold it without any questioning.

    Responses in only six of the 32 visits to pharmacies for advice about travellers’ diarrhoea were judged as good. Questions by staff should have led to the investigators being advised to see their GP, but this didn’t happen on 10 occasions. One pharmacy technician told an investigator that she may have irritable bowel syndrome, even though she told the assistant that she had been abroad.

    As part of the research one investigator also bought treatments from four online pharmacies accredited by the Royal Pharmaceutical Society of Great Britain and was sold 160 Solpadeine Plus tablets, which contain paracetamol and codeine, despite it being illegal to sell more than 100 tablets without a prescription. The case is to be investigated by the society, which has also pledged to support improvements in the industry by mystery shopping and training.

    However, some things had improved since Which? last investigated pharmacies in 2004, the survey found. In 34 requests for emergency contraception, only four investigators were not offered a private room or area to discuss the matter.

    Neil Fowler, editor of Which? magazine, said: “People are increasingly turning to pharmacies for the sort of advice they might have gone to their GP for in the past, but we’re concerned that in some cases they’re getting advice that is unsuitable and potentially unsafe.

    “With plans to expand the remit of pharmacists further, even allowing them to leave sales assistants in charge for periods of time, it’s vital that training improves and that meaningful action is taken against those that fail to deliver, so that consumers can trust the advice they receive.”


    • The article “A test of your own medicine” appears in the October 2008 issue of Which? magazine. To find out more see

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