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Three in 10 pharmacies not following safety guidelines, finds Which? investigation

You should be able to trust pharmacy staff to warn you about potential dangers of over-the-counter medicines, but our probe reveals this isn't always the case

An undercover Which? investigation has discovered that some pharmacies are failing to give important safety advice to customers buying over-the-counter medicines such as paracetamol and ibuprofen.

We sent undercover researchers into 78 independent and high street pharmacies – including Boots, Lloyds Pharmacy, Asda, Tesco and Morrisons – to see whether staff gave the necessary warnings about medicines that could cause harm if taken incorrectly.

The advice given in one of our two scenarios – where our shoppers tried to buy two medicines that shouldn’t be taken together – was rated ‘poor’ in 11 out of our 36 visits.

In a further scenario, we found that some pharmacies were selling large amounts of paracetamol without asking any questions or giving warnings. This is not illegal, but we’ve flagged the visits as needing improvement, as it’s not best practice.

Ben Clissit, Which? magazine editor, said:

“People will be alarmed that some pharmacists are missing out on asking their customers the basics, particularly in light of recent NHS advice to use pharmacies as the first point of call for minor illnesses.”

“Our advice would be to read the patient information leaflet on any medication you take and be proactive when seeking out your pharmacist’s advice by asking key questions, especially if you are taking more than one medication.”

Related: discover the best types of painkillers proven to help you feel better faster.

Crucial questions not asked

In the first scenario, our researchers bought two items: Sudafed Sinus Pressure & Pain, and ibuprofen. These shouldn’t be taken together due to a risk of ibuprofen overdose. And this type of Sudafed should also be sold with dosage advice, as it is a pharmacy-only medicine – which means that to buy it we had to ask a member of staff.

During the transaction, just half of our researchers were asked if they were taking any other medication, and only a quarter were asked if they’d had the medication before – two questions that our expert pharmacist highlighted as important. In a third of visits, our researchers were not warned about the risks of taking the two medicines together.

Our undercover researchers spoke to a mix of pharmacists and sales assistants – but you should be able to expect good advice from any member of staff who serves you in a pharmacy.

What is pharmacy-only medicine?

Two classes of medicines are available without prescription – general medicines that you pick up from the shelves, and pharmacy-only medicines. The latter are kept behind the counter, with sales supervised by a pharmacist. According to our expert pharmacist, the poor results were from pharmacies that made no effort to distinguish a pharmacy-only sale from a general one.

Pharmacies compared

Our table below shows what we found on each of our six visits to the pharmacies when trying to buy Sudafed Sinus Pressure & Pain with ibuprofen.

Paracetamol sales and multibuys

In our second undercover scenario, researchers tried to buy four 16-tablet packets of regular paracetamol at 42 pharmacies, supermarkets and discount stores. The aim was to see whether the Medicines & Healthcare Products Regulatory Agency (MHRA) best-practice guidelines limiting sales to two packets per transaction were being followed.

On 11 visits we were able to buy more than the recommended amount of paracetamol in one transaction, without any questions being asked. Paracetamol is the most common non-prescription drug associated with misuse deaths in the UK. The Royal Pharmaceutical Society (RPS) recommends that pharmacists use their discretion for sales of more than 32 tablets – ideally by asking questions or giving dosage warnings before selling more than that amount.

In our visits, Asda, Morrisons and Tesco successfully implemented a two-packet maximum. But it was a slightly different picture at some pharmacies, as a larger number of packets were sold without advice. We’ve rated these visits as needing improvement.

Worryingly, Poundland has a multibuy promotion, selling three 16-tablet packets of paracetamol for £1. Commenting on our findings, Ash Soni, president of the RPS called this ‘poor practice’.

What the pharmacies say

When we shared our results, Asda, Lloyds Pharmacy and Tesco committed to strengthening their pharmacy staff training. Boots told us it would take our findings on board to ensure a positive customer experience. Morrisons declined to comment. Poundland told us: ‘We sell most things for £1, which is why we sell three packets together.’

How to get the best from your pharmacy

Pharmacies are increasingly playing a part in helping us to manage our health to relieve pressure on GPs, and there are ways you can be proactive about getting the right advice:

  • Use the same pharmacy. It’s a good idea to use the same pharmacy regularly so that your pharmacist is more likely to be aware of your medical history, and it’s worth asking about options available for medication tracking and management, which involve structured consultations with your pharmacist.
  • Have a conversation. When buying pharmacy-only medicines, you should always be asked some basic questions, including whether the medicine is for you, whether you’ve taken it before, whether you’re on other medication – and to flag any particular concerns, such as interactions. Research shows that people can find these questions to be inconvenient, but they’re designed to help, not prevent you from getting your medicine. Ash Soni emphasises that you should think of them as a helpful conversation, rather than an interrogation.
  • Flag important information about your health. A lot of the visits we rated ‘poor’ were due to a lack of questioning, so be proactive in offering any information. Always tell the pharmacist about other medicines you take, including non-prescription or herbal. With 75% of you taking medication for more than one ailment, it’s important to be aware of how drugs might interact – and not solely for prescription drugs; they can also crop up for supplements and food.

Always double-check the label

Make sure you know what you’re buying. Many medicine ranges have similarly designed packaging but contain different active ingredients. For example, Piriton and Piriteze look and sound very similar, but the former is sedating and the latter isn’t.

Vital information can be lost in long lists of ingredients, and experts we spoke to highlighted multiple-ingredient cold and flu remedies as ones to watch out for. It’s easy when taking a combination of these products to take more paracetamol than recommended, even when you’re just taking ‘top-up’ doses that build up over time. Combination cold and flu medicines account for the most accidental overdoses involving over-the-counter medicines.

And it’s a good idea to read the patient information leaflet even if you’ve taken the medication before, as the information is regularly updated.

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