Why did you study pharmacy? Were there any alternatives you considered?
Yes, I had several offers to do medicine, but I didn’t get the required grades in my final year at school. I actually got into pharmacy through clearing. Due to my impatient nature I chose not to repeat my A-Levels. It’s funny how things work out.
In retrospect are you glad you studied it?
Yes, I’m glad. There are now many opportunities for pharmacists: the ability to practice as independent prescribers has opened the door to many avenues of practice beyond the recent traditional supply role. The ball is firmly in the court of pharmacists to adapt and carve out important new roles.
Is there anyone in pharmacy you aspire to be like? Or anyone outwith pharmacy?
Robert Noonan was a writer who had to write under the name of Robert Tressell for fear that his views got him into trouble. His courage in the face of adversity resonates as strongly with me today as it did then, especially in the context of the significant pharmacy cuts in England. He inspired me not to write anonymously, but instead to stand up for the things in which I believe. I believe that pharmacy is a worthy profession and especially community practice is worth fighting to protect.
What do you spend most of your time doing day-to-day in the pharmacy?
I am involved in the day-to-day running of the pharmacy. Half a day per week I am now involved in running asthma clinics in collaboration with my local practice. I also support the surgery with polypharmacy medication reviews that are targeted at frail elderly patients.
What do you enjoy about pharmacy?
The people. My team, patients and the community.
The thing I love about my job is interacting with, and supporting the various people with who I come into contact. The professional privilege that comes with running a rural community pharmacy presents a lot of opportunities to care for many people. Sometimes I can have a significantly positive impact on the health of my patients.
I enjoy the fact that I have now worked in the same pharmacy for six years, and although not always the most lucrative, I think to be a good community pharmacist, time, rapport and solid relationships with patients are very important. Now that there are fewer owner-managers, this is less common than it used to be. I feel that living in the community where you practice is also important.
I love when the pharmacy is extremely busy. I have an absolutely awesome team, and I love being part of them stepping up through the gears to look after our patients. This makes me happiest.
What do you not enjoy?
I am an optimist. Necessity is always the mother of invention with me, so if I come up against a barrier I will try my best to get around it and succeed. That said, community pharmacy is becoming an ever tougher place to reside, especially for coal-face pharmacists. Contractors have been experiencing real terms erosion of profit for quite a few years now, and this does have an effect on the ground. The real value in community pharmacy lies not always in going quicker, cheaper or achieving more volume, but instead in the skill, intuition, care and professionalism community pharmacists can provide to patients.
What is the likely future for pharmacy?
Dispensing volumes will continue to increase in line with the ageing demographics. Supply will be centralised and the term ‘click and collect’ will normalise in discussions about drug supply. I do, however, worry that a key public health function of the community pharmacy could be lost with serious negative consequences if somehow the supply function is completely taken away. The community pharmacy network is still an untapped NHS gem. With regret, I think there will be fewer community pharmacies in the future.
Drugs will become more targeted and I think identification of, and manipulation of rogue genes will become ever more important in the future.
I also think as patients become more comfortable with allowing their data to be used for clinical benefit, then new technology, particularly wearables, will progress.
What needs to change?
Pharmacists need to regain professional autonomy. Simple.
What about the prescription volume?
As I mentioned I think volume will continue to grow but supply methods will rationalise in response. The days of making easy money through supply only are long gone.
You are an independent prescriber – did you enjoy the course?
Yes I loved it. It actually took me back to basics and reminded me how much it means to be a pharmacist, prescriber or not. Pharmacists that achieve the qualification deserve great credit and support, because the complexity and level of responsibility associated are significant. It is early days in terms of practicing in community pharmacy, but my view remains the same that prescribing by pharmacists in the community setting present a great opportunity for the profession as well as for patients.
What do you do with the qualification?
I work closely with my local practice to manage asthmatic patients and we have developed new referral pathways and innovative ways to communicate. Our collective interest is to act on the findings of the National Review of Asthma Deaths 2014, and in doing so identify high risk asthmatics by engaging with them in the community pharmacy. There is no specific precedent for what we are doing, as far as I know, so we are proceeding slowly. It is a concept that I truly believe in, and also the model is one that could easily be adapted to help community pharmacists manage patients with other long term conditions like diabetes. I am passionate about making the specific clinical case to keep the community pharmacy network, because quite simply this model would not work without community pharmacy input.
Are you able to make full use of the qualification?
My GP friend and colleague, Dr. Steven Henderson and practice manager Linda Barron, have been so supportive in my integration into the practice team. It is a new way of working, so it’s a work in progress. It has already been worth the effort, because I have been able to make many interventions that I otherwise would not have made. My increased understanding of my own practice has significantly improved for my asthmatic patients and others. I am sure this will only continue to develop and improve.
You also recently completed the clinical skills course. What did that involve?
The course involved learning about basic monitoring of vital signs and tuition on how to take a blood pressure, take a peak flow and do a complete examination of the body.
Have you been able to apply that learning?
Yes, I have used them quite a bit. I have listened to chest sounds in the community pharmacy and have made a number of important referrals as a result. Overall the course opened my eyes to the issues surrounding patient examination. Typically, pharmacists do not touch patients, preferring instead to deal with their medicines or medicine records. Incorporating this new set of clinical skills into my practice has complemented the knowledge and experience I have gained to date.
What can be done to encourage or help all pharmacists to become independent prescribers?
The Royal Pharmaceutical Society (RPS) is helping here and NHS Education for Scotland is already doing great work. The thing about being an independent pharmacist prescriber, especially in community, is that pharmacists are still quite professionally isolated. Without the support and guidance of my great colleagues in my local GP practice I am not sure if I would have achieved what I have.
What would be your ideal job?
I’m too busy to look for an ideal job! It is a cliché but being a Dad is a pretty cool job. My kids teach me more about the world than they know.
What do you think about the RPS and the Faculty?
Since the RPS divested the regulatory role and the General Pharmaceutical Council (GPhC) took over, the professional body in my view has gone from strength-to-strength. Dr. Catherine Duggan and many others in the RPS have done a fantastic job of promoting the Faculty. It was actually my new years resolution to make a submission. The Faculty has clearly inspired many to greater engagement with their own development, with fellow professionals and also with the profession.