The nurse who chose the pharmacy path

 

Could you tell us a little bit about your background and how you came to study pharmacy?

 

I have been a qualified nurse since 2002. I have worked mainly in critical care areas and, for 7 years prior to starting my MPharm, I was a clinical nurse specialist in pain management. I completed my non-medical prescribing course in 2013 and became interested in how drugs work. I enjoyed counselling patients on how to take their medications to achieve the best outcome for them so decided to take the plunge and study pharmacy. Having lived and worked in other parts of the UK and overseas for many years, I wanted to study in Scotland to be closer to my family. I got an unconditional offer from The Robert Gordon University (RGU) in Aberdeen and the rest is history.

 

Congratulations on your recent award. Could you tell us what you did to achieve this accolade?

 

Thank you! I honestly have no idea how I achieved the award. I was nominated for the volunteering I did at RGU, peer teaching and my work as a nurse during the pandemic while still studying for my MPharm. I was the academic rep for my year in 2nd year and am currently one of the two Student School Officers for the School of Pharmacy and Life Sciences. I feel honoured to have been nominated and over the moon to have won but basically, I just try to work hard, help others, be organised and lead by example.

 

How has the pandemic had an impact on you and your friends as pharmacy students?

 

The pandemic has impacted us as pharmacy students a lot. Everything is online now and most of us have not been on campus since March last year. We miss the social side of being at university and seeing our friends. It can be hard to motivate ourselves when we’re staring at a screen all day. I’ve been lucky and could still attend my experiential learning placement last year but many others couldn’t due to the travel restrictions.

 

What changes has the university made to your learning experience?

 

The university has been fantastic. All of the staff have worked so hard to ensure that our learning experience is the same high quality as it was before the pandemic. Everything is online now but the staff at RGU have gone over and above to make the transition to online learning as good as it can be. All of the support services at university are still available and the staff themselves have been exceptionally supportive.

 

What have you enjoyed so far in the undergraduate course?

 

I have enjoyed learning so many new things and making new friends up in Aberdeen. The placements I have had have been great and have given me an insight into many different aspects of the pharmacy profession.

 

The pandemic has in many ways been devastating for the UK but taking an optimistic stance do you see any benefits for pharmacy students and the profession more widely as a result?

 

The fact that we’ve all had to adapt the way we work (in uni, pharmacy roles or both), deal with the impact of all the restrictions and work a lot harder means that we’ve developed coping mechanisms that we perhaps didn’t have before and we’ve become more resilient. It’s been lovely to see how people have pulled together and I believe, in the vast majority of cases, it’s brought out the best in society.

 

Have you decided what pharmacy sector you would like to go into and why that area?

 

I honestly don’t know what sector I would like to go into yet. I have worked with so many inspirational pharmacists in many different places over the years. I started the course I thought that I’d become a hospital pharmacist as all of my nursing career has been in hospitals, then I got a community pharmacy job and did a summer placement with a great independent pharmacy chain. I’ve yet to have a placement in primary care so that may confuse matters even more.

 

Have you got any words of advice for pharmacy students coming behind you in years to come?

 

Make writing a to-do list a habit, start assignments and studying for exams early, and ask for advice if you need it. Help each other and share your knowledge and experience. I have lots of clinical experience that I use to help others yet I’m not the best at chemistry. Luckily, one of my best friends in my year is great at chemistry.

 

 

Career spotlight: Independent pharmacist prescriber Sarah Cameron

 

Sarah Cameron is an independent pharmacist prescriber and Director of Propharm Services and Superintendent Pharmacist at My Pharmacy 365. She took some time out to talk to us about her career progression, achievements and future plans.

 

How long have you been a pharmacist?

 

16 years

 

Why did you choose to become a pharmacist?

 

I wanted to interact with people and directly impact the application of science and medicine to patients. Even 20 years ago, the prospects and career development potential seemed exciting.

 

Where did you work on your first day as a pharmacist?

 

I worked as a rotational basic grade pharmacist in Princess Alexandra Hospital in Harlow, Essex. It was a great department, with pro-active staff who invested resources into technology and bringing care to the patient bedside.

 

What does your current role involve?

 

As an independent pharmacist prescriber, I manage acute prescription requests, which often involves (at the moment) telephone appointments with patients. I am a member of the diabetes management team within one GP Practice, undertaking annual reviews of patients living with diabetes. I have had fantastic clinician support to enable the development of this role, including undertaking clinical assessments. Working within primary care enables me to autonomously manage a wide variety of patients living with long term conditions and implement medication changes or clinical assessment and follow up. I try to minimise the need for further unnecessary practitioner appointments, including being able to take blood at the point of consultation. As a vaccinator, I administer annual influenza vaccines on an ad-hoc or sessional basis and have recently undertaken Covid-19 vaccination training.

 

In the current unprecedented circumstances, it is vital to continually strive to expand clinical experience and abilities. This enables our front-line clinicians to direct their time and skillset where they are most needed.

 

What do you love about your job?

 

Building relationships with patients and instilling confidence in the pharmacist as one of their clinical care providers. Being a consistent part of the patient journey and liaising with other services to manage any disease changes or progression creates a very person-centred approach and supports cross-sector communication.

 

Any aspects you dislike?

 

Like most healthcare workers, time and resource limitations can be frustrating, but I generally find that individuals within the health care sector strive as far as possible to do their best for their patients.

 

What previous roles have you undertaken as a pharmacist?

 

I have worked previously as a community pharmacist which has given me an insight into the pressures the sector faces.

 

As a locum hospital pharmacist for a number of years, I had fantastic learning opportunities working within hospital dispensaries, respiratory wards, cardiovascular care, emergency medicine, surgical admissions, paediatric speciality wards and oncology.

 

Looking to build my future as an experienced clinician, I took every opportunity to become involved in direct patient care to continually develop my knowledge base and learn from experienced practitioners.

 

Which role did you find most challenging and why?

 

Within emergency medical admissions wards, the pace and urgency of care could be a challenge. Adapting work planning, care plans and complex medication calculations to a changing clinical picture at any given time provided me with resilience and the ability to access resources and evidence quickly and efficiently. This is a skill I still use on a daily basis.

 

Do you think all pharmacists should be independent prescribers?

 

I think that all pharmacists should have the opportunity to access training and support to become independent prescribers. For some, their career pathway does not include the need to prescribe medication, and resources may be better directed to provide training in other areas to support career development. However, the independent prescriber training curriculum provides a valuable perspective on the realistic application of medicine. This can greatly influence how we work with our prescribing colleagues and clinicians.

 

What was the toughest lesson you had to learn as a pharmacist?

 

My own limitations, and as an independent practitioner, having the confidence and knowledge to be responsible for your own decisions. Once you expect to be working with patients to manage conditions, you have to be prepared to be accountable.

 

Has the pharmacists working in general practice initiative been a success in recent years?

 

I do think it is a success, but only where we integrate as part of the General Practice team and are provided with GP support to develop the role. In Scotland, the pharmacotherapy aspect of the GP contract provides clear direction for the general practice pharmacist role, and the ongoing developments in training and accreditation will serve to strengthen this.

 

Are you optimistic about the future of pharmacy?

 

Absolutely! As a workforce, we have shown that we can step up and develop our skills as necessary. Registered pharmacy technicians are now routinely undertaking tasks that were traditionally performed by pharmacists; as a profession, we are striding forward with career development. By continuing to undertake our work and improve communication we can enable other medical professionals to understand the support we can provide.

 

What’s next for you?

 

Imminently, participating in the national COVID vaccination scheme.

 

Within Propharm Services, we are currently working to provide further GP practices with the opportunity to obtain sessional pharmacist support. Many prescribing pharmacists are flexible, adaptable and keen to provide a few hours or a few days to practices, enabling effective bespoke resource management for GP practices. We are always looking to build our pharmacist team across the Central Belt.

 

Sarah has teamed up with Pharmacy in Practice to conduct a survey to find out how the working lives of pharmacists across the UK had been impacted on throughout the pandemic and explore the support that they may need this year and beyond. 

 

Click here to take part in the survey

 

You can contact Sarah by email here.

 

Working remotely as a prescribing pharmacist during a pandemic

 

As pharmacists, there are many roles to choose from after qualifying. From the more traditional positions in community pharmacies and hospitals to work in GP surgeries and medical centres, or even going into research.

 

There are plenty of options. And with each passing year, it seems like those horizons expand further.

 

Though 2020 has come with plenty of challenges, it has also provided some new avenues – or widened avenues that already existed. One of those comes with the increase in demand for telemedicine services.

 

GP appointments are increasingly moving online, and telephone consultations have become the new normal. The transformation was already underway before 2020 but it has accelerated exponentially as a result of the Covid-19 pandemic. This change will inevitably affect how some pharmacist’s work.

 

To find out more about the subject, and how pharmacists interested in moving into digital healthcare might go about it, I spoke to friend and colleague Mahira Hanid-Awan.

 

Mahira and I talk regularly to motivate each other. In our most recent conversation, we focused on her career journey, to try to shed some light on the new opportunities available to people in our profession.

 

Mahira studied pharmacy at Liverpool John Moore’s University before completing her pre-registration year in community pharmacy with Boots. She has since worked in community pharmacy and in a GP surgery, where she completed her Independent Prescriber qualification.

 

Most recently, though, she has joined telemedicine provider Doctor Care Anywhere (‘DCA’) as Clinical Operations Manager for Medicines Management. For those who do not know, Doctor Care Anywhere is a digital healthcare service that allows patients to speak with a doctor over the phone or video anytime they like, anywhere in the world.

 

Before moving into her current role, Mahira told me, she “managed two stores with Boots and one with Rowlands Pharmacy”, where she “enjoyed the daily interaction with customers and ensuring their medication was being taken in the most optimum way”.

 

Following that, Mahira spent three and a half years working in a GP practice, commuting 85 miles a day to and from work. It was, she said, a key period in her professional development: “In GP surgery I challenged myself to study further and completed the independent prescribing course and became one of the first Senior Clinical Pharmacists in my local area.

 

“By completing my Independent Prescribing (‘IP’) course I was able to develop myself further and have a deeper knowledge of my patients. I was able to follow their patient journey to ensure that they were receiving the best patient care whilst managing long-term conditions. Studying for the IP qualification gave me the confidence to go on to achieve more and opened more doors. I feel that as a result, I am able to consult with my patients better and more holistically.”

 

Mahira specialised in type 2 diabetes for her IP and, she said, “I felt a sense of achievement when I could see the HbA1C levels of my patients improving.” But that was far from all she accomplished. “I was consulting with patients for medication reviews which involved interpretation of blood tests. I was also consulting for long-term disease management clinics and in minor illness clinics.

 

“As a clinical pharmacist, I would conduct annual reviews for patients with long-term diseases, which included conducting mental health reviews, asthma reviews and in-depth diabetes reviews.

 

“Education of patients was another aspect of my work in the primary care sector I enjoyed. I was able to work on my consultation skills and try to find motivating factors to enable and arm my patients.

 

“I was also given the opportunity to study and obtain a certificate to enable me to conduct substance misuse clinics on my own – this was my biggest achievement as these were remote clinics off-site from the GP surgery. I had very supportive mentors who were at the end of a phone call and felt supported throughout all of my learning. To my teachers at Farnham Road Practice, I will always be grateful for the opportunities they gave me.”

 

In early 2020, Mahira decided to give up the commute and start doing locum work more locally. But with the arrival of the coronavirus in the UK in March causing many GP surgeries to close their doors, she was forced into a rethink. Mahira applied for a job with a digital healthcare company that was serving NHS patients and was successful.

 

Yet after three months, the company decided to withdraw from the UK. “We were in lockdown and locuming was not an option,” she told me. “As a result, I came across Doctor Care Anywhere and applied for the role. In September of 2020, I was onboarded as Clinical Operations Manager for Medicines Management.”

 

The new role, she said, is a challenge. But it is one she is enjoying; “We are a fast-paced, quickly growing business and no two days are the same.

 

“My day starts early at 8 am with a check of emails and the calendar to see what meetings are on the agenda for the day. I start by looking at escalated prescribing data from the day before and reviewing any cases where prescribing may require feedback to the GP. At DCA, patient safety is paramount.

 

“At 10 a.m. we have a clinical team meeting with clinicians responsible for different parts of the business to update on different projects being run simultaneously. Part of my responsibility is to ensure that we can safely prescribe for patients utilising DCA, which can mean international consultations and prescribing.

 

“Later during the day, I meet with external pharmacy partners to discuss the previous month’s prescriptions and discuss any learnings that arise from the process. This can relate to either technical issues which need resolving or problems encountered by patients.

 

Mahira told me that her previous experience as an Independent Prescriber has stood her in good stead to thrive in her new role. “As head of medicines management part of my role is to audit prescribing data and the development of policies and protocols whilst prescribing on the platform. It is, therefore, important to be able to understand the nuances applicable to consulting with patients on a digital platform.”

 

Mahira also praised her colleagues for their openness, despite not yet having met them face-to-face. “Everyone has been very welcoming. I have been allowed to make this role my own. I have to ensure that medicine management is considered as part of the patient management on the platform. It is exciting to work for a company which is growing.”

 

“I am keen to show how the profession can offer diversity and challenges. It is important that pharmacists remain at the forefront of future developments in the digital healthcare space, ensuring that as subject matter experts we can continue helping to deliver excellent medical care.”

 

Mahira told me that, in the NHS, she foresees “pharmacists taking over the management of long-term disease conditions” and believes that in the private and public sectors “digital healthcare is the way of the future”. She said: “by prescribing and including pharmacists in consultations with the patient where we have their attention for 12 to 15 minutes, we can add a lot of value. We can help educate and empower the patient to be able to improve their condition where possible. We can inform the patient on possible side-effects, and in some cases de-prescribe medications to improve outcomes for them.”

 

So, what advice would she give to someone in our profession looking to move into the world of digital health? “I would advise you to apply,” she said. “Your skills as a pharmacist are transferrable and all that you have knowledge of can be utilised in digital healthcare. Digital healthcare is developing rapidly, and the opportunities are limitless. Pharmacists should embrace that we are an allied healthcare professional and we can provide another vital dimension to patient care. Digital healthcare is growing rapidly and its geographical boundaries are blurring. We can see patients located in different cities and even different countries. We can use this opportunity to display our diligence and ensure that we are always seen by the patient as the face for medication-related issues even virtually. If you are looking for support do look me up via LinkedIn; I would be happy to speak with any pharmacist wanting to enter the digital space.”

 

You can get in touch with Mahira by clicking here.

 

Reece Samani is a pharmacist. He is also the founder of Signature Pharmacy and The Locum App.

 

 

Have your say. Do you think pharmacists working from home as independent prescribers is the future?

 

We'll use your email address only to get back in touch with you after filling in this form.
We welcome all contributions and personal opinions are encouraged but please do make sure you back up any claims with suitable references.

 

 

Why I left Scotland to become a pharmacist in the USA

 

Where did you study?

 

I studied at the University of Strathclyde and graduated in 2010.

 

What additional qualifications have you achieved post-qualification?

 

I completed the Pharmacist Independent Prescribing course at Strathclyde in 2016, and of course, I have now achieved my California Pharmacist licence.

 

You were a locum in Scotland for some years. What were the pros and cons of this role in your experience?

 

Being a locum was great for getting experience in a wide range of settings, meeting lots of new people and learning how to adapt quickly to new situations. It also allowed me flexibility in choosing my own working days. On the other hand, sometimes there might not be much work available, and the resources for professional development such as training and networking might be more limited when you aren’t employed by a single company.

 

Could you describe the highlights of working for NHS Scotland?

 

I worked in three different NHS Scotland roles – as a Pharmacy Advisor for NHS 24, a Prescribing Support Pharmacist and General Practice Clinical Pharmacist for NHS Lanarkshire and as a hospital Clinical Pharmacist, also with NHS Lanarkshire. Although these positions were different from each other in many ways, they all allowed me to feel the satisfaction of using my experience and training to help patients. Being a welcomed part of a multidisciplinary team was always a highlight, and I enjoyed learning from my colleagues in other professions and demonstrating the value that I could bring as a pharmacist. At NHS 24 I had the challenge of assessing and advising patients from all over Scotland by telephone. It was always a highlight when I could help a patient to understand their medication, provide reassurance to a worried caller, or recognise a high urgency situation and get the appropriate help in time. In primary care, I was able to review patients’ medicines and make sure they were getting the most from their treatment. Getting patients engaged with their medication, making clinical decisions based on risk and benefit and coming to a mutual agreement on the treatment plan were highlights for me. In the hospital, I saw patients admitted while seriously unwell, participated in their care throughout their journey until they improved and saw them go home looking like a new person. To see the difference I can make as a pharmacist is the greatest highlight of all.

 

During the course of your work in Scotland did you manage to apply your independent prescribing qualification?

 

I did. I used it as a General Practice Clinical Pharmacist to prescribe for patients requesting acute prescriptions, then even more extensively as a Clinical Pharmacist on the surgical wards at University Hospital Wishaw.

 

Why did you decide to move to the USA to practise as a pharmacist?

 

My wife is from Los Angeles and was offered a great job opportunity back in the US. We decided to move over and so my journey began.

 

Could you describe the registration requirements and process for pharmacists who may wish to work in the US?

 

The first requirement for working here is employment authorization from US immigration. I am able to work here as the spouse of a US citizen, but it would otherwise be very unlikely that a US company would successfully sponsor a work visa for a foreign pharmacist.

 

The next requirement was the Foreign Pharmacy Graduate Examination Committee (FPGEC) Certification. This program evaluated my Scottish degree to certify that it is equivalent to a US pharmacy degree. The requirement for graduates after 2003 is a 5-year pharmacy program, but they consider Highers/Advanced Highers equivalent to a year of US undergraduate study, so my 4-year Scottish MPharm was accepted. Once my SQA Certificate, MPharm transcripts, GPhC letter and other supporting documents were sent in and I passed the Test of English as a Foreign Language (required even as a native speaker), I could sit the Foreign Pharmacy Graduate Equivalency Exam (FPGEE). This is held every October in test centres across the US, comprises 200 questions over 4.5 hours and tests all the knowledge from your pharmacy degree from organic chemistry to biostats to pharmacokinetics and therapeutics. After passing I received my FPGEC certificate and could move on to the next stage.

 

Pharmacy in the US is regulated by the individual states rather than nationally, so I then applied to the California Board of pharmacy for a license to complete the required intern hours (similar to a pre-reg). The intern hours required vary from state to state, but in California, I had to complete 1500. I was fortunate to find a paid hospital pharmacy position quickly after arriving, but it can be very challenging to get an internship as a foreign grad. Once my intern hours were complete, I then had to pass the national clinical exam sat by all pharmacy graduates – the NAPLEX – and the California exam testing further clinical knowledge, state pharmacy law and practice standards – the CPJE. Other states use a different exam for state law – the MPJE. This was the final step in a long process to gaining my California pharmacist license, and I would certainly advise anyone making the move to start gathering the required documents for FPGEC as soon as possible, as this was the longest part of the process and unexplained delays in processing are frequent.

 

Could you describe your current role and perhaps what a typical day working in the US as a pharmacist is like?

 

I work as a Clinical Pharmacist in a community hospital, which is similar in many ways to hospital pharmacy in Scotland. Some duties include medication reconciliation, therapeutic drug monitoring, TPN formulation, advising medical and nursing colleagues, and ensuring safe medicines use. One significant difference when compared to Scotland is that non-emergency inpatient medicines must be screened and approved by a pharmacist before the first dose can be given, so this is a significant part of our role. Dispensing discharge prescriptions is not done by our pharmacy department; patients going home instead receive a prescription to be filled by a community pharmacy. We do however check medicines filled for inpatients, which are supplied in single unit-dose packages and labelled for a specific patient. Even the liquids come packaged as single doses in little cups (which look more like dipping sauce than medicine). Unit doses are often stocked in automated dispensing cabinets on the ward, so we also check the medicines for the cabinet refill. Almost all IV infusions are made in the aseptic room by pharmacy rather than by the nurses, so pharmacists must also check these before they are sent to the ward. These are all tasks that might all be done in any one shift, but at the core of it the purpose is the same in both countries, to make sure medicines are being used in the best way to benefit patients.

 

What do you now recognise to be the key differences in pharmacy practice in Scotland versus the US?

 

The biggest difference here is the insurance system. In Scotland, we have universal healthcare which is free at the point of use. Prescriptions are free, hospital treatment is free, GP visits are free. In the United States, healthcare is expensive and the cost can be a barrier to care. Patients are covered by a wide range of insurance plans with different costs and coverages and can easily be surprised with bills for thousands of dollars if part of their care wasn’t fully covered. As a hospital pharmacist, my interaction with insurance is minimal, but a lot of community pharmacists’ time is taken up by trying to navigate the system.

 

A difference in hospital is that all but the smallest hospital pharmacies tend to be 24 hours a day, 7 days a week, so there is always a pharmacist on site. Another difference is that the IT systems here are a lot more integrated; all of the prescribing, clinical notes, lab tests, outside medical history, pharmacy dispensing records and previous admissions are contained in a single system at my hospital. This means that more tasks can be carried out without being physically located in the ward. Pharmacist independent prescribing does not exist in California, but prescribing responsibility is often delegated to hospital pharmacists for certain drugs. For example, when a hospital doctor orders a drug like vancomycin or warfarin, they will often prescribe “per pharmacy”. The pharmacist then assumes responsibility for monitoring and adjusting the dose without requiring the prescriber to sign off each dose. This is in contrast to Scotland where a practitioner with prescribing authority is required to sign every time. There are differences in pharmacy education too here. Pharmacy is a 4-year doctorate program which generally requires an undergraduate degree for admission, so it takes 8 years at university (and a few hundred thousand dollars) to become a pharmacist. Clinical rotations are a lot more established as part of the pharmacy degree and students spend a significant proportion of their time on placements. I’m sure I could keep thinking of differences but this answer would soon turn into an essay!

 

Would you recommend the move to the US to others considering it and if so why?

 

It’s a long, difficult and expensive process, and opportunities here are often contingent on knowing the right people. However, I have learned so much through this process. I had to go back to basics and revise everything from university, but now with the practice experience to put it into context. I have seen new ways of working, been forced out of my comfort zone and confronted with different perspectives. I have met some amazing people and learned from them. If there was any experience in my career so far to make me a better and stronger pharmacist, this was it.

 

As I previously mentioned, getting a work visa through sponsorship here is basically impossible and there are other countries where it is much easier to do so. But if you are authorized to work in the United States, have the means to do it and the motivating reason I did, then it is possible.

 

What does the future hold for you now?

 

If there’s one thing this year has taught us, it’s that we can never predict the future! COVID-19 has reduced staffing and hiring at many hospitals due to elective procedures being cancelled and patient numbers decreasing. I’m currently working on a part-time as-needed basis but I’m hoping for the chance to increase my hours either at my current job or by taking on a second position once hiring picks up. I’m also looking at becoming a Board Certified Pharmacotherapy Specialist, which is a clinical pharmacy certification often sought by employers.

 

 

Dr Emily Kennedy on why Scottish pharmacy remains world leading

Senior prescribing support pharmacist Dr Emily Kennedy

 

Dr Emily Kennedy has worked as a prescribing support pharmacist in primary care in NHS Dumfries and Galloway for 16 years and now supervises 17 pharmacists working across general practice. Her varied and very successful career so far has involved education, research and work in community pharmacy.

 

I was interested to discuss various aspects to her current and previous roles. In particular, I was interested to hear more about Emily’s current role and how she has seen things change in pharmacy over the years.

 

We discussed the current state of play in primary care pharmacy in Scotland and touched on education, training, supervision, competence and also the need for pharmacists to have confidence in their own ability.

 

Scottish pharmacy has evolved dramatically over recent years and Emily has really been part of that evolution. We discussed how pharmacists’ expectations have changed and how her work now involves

 

During the COVID-19 crisis, Emily has been involved with her local COVID-19 hub in Dumfries and Galloway. I was interested to hear her insights around being involved here.

 

 

If you prefer to never miss an episode you can subscribe on your preferred podcast platform. Just click on the links below to get going.

 

AnchoriTunesGoogle PodcastsSpotifyBreakerOvercastPocketCastsRadio PublicPodbeanStitcher

 

The career path to become President of the College of Mental Health Pharmacy

Ciara Ni Dhubhlaing, Specialist mental health pharmacist, President of the College of Mental Health Pharmacy

 

Why did you become a pharmacist?

 

I have wanted to be a pharmacist since I started thinking about career options at around age 15. I’m not sure what influenced me really, but I enjoyed science and I wanted to be involved in direct patient care. Medicine wasn’t for me – too many negatives with the duration of the study and working hours and too much ‘icky stuff’!

 

Could you describe your career pathway so far?

 

I was offered a place on the Pharmacy course at Aston University but deferred it for a year to do first-year Science at Trinity College Dublin. Here I got to learn more about physics (which I hadn’t studied in school) and thoroughly enjoy fresher life without the worry of exams at the end. Studying at Aston ignited my interest in mental health and my preregistration year, split between City Hospital in Birmingham and Murray’s Pharmacies, a small independent chain in Cumbria, cemented it. It is an area in which clinicians have the opportunity to really engage with and think about the patient as an individual and what treatment would suit their needs best rather than which slot they fit into in a guideline. Working in palliative care was plan B for the same reason.

 

I initially worked as a relief pharmacist in community whilst completing the Aston Certificate in Psychiatric Pharmacy before obtaining a mental health post in Morecambe Bay Primary Care Trust (later Lancashire Care Trust) in 2004. There I was able to work on hospital wards including Acute Assessment Units for Adult, Elderly, and Dementia patients, a PICU, a Forensic Low Secure Unit, an Alcohol Detoxification Unit, and a Tier 4 CAMHS unit. I also worked with Supported Housing, Adult and Elderly CMHTs, CRHT, AOT and EIS Teams. Whilst in Cumbria/Lancashire I attended College of Mental Health Pharmacy (CMHP) Psych 1 and 2, completed my Postgraduate Diploma, and obtained my non-medical prescribing qualification.

 

On my route back home to Dublin, I took a minor detour into physical health working on a respiratory ward in Derry for nine months. It was a great boost to my confidence to realise my skills as a pharmacist were universal and I could still be useful on a physical health ward. Some people think working in MH is disheartening, but I found it more difficult to deal with the comparatively frequent deaths from lung cancer, pulmonary embolisms, cystic fibrosis, infections etc. that occurred on the respiratory ward.  In October of that year I finally returned home to work in St John of Gods and then St Patrick’s University Hospital. Both are private not for profit mental health hospitals which is quite a change from the NHS. It was a big adjustment to leave the NHS and come to a fragmented health service with multiple providers and tiers of service, no defined role for pharmacists within MDTs, and no pharmacist non-medical prescribing. However, a big advantage has been knowing what works in practice and being able to apply that to develop future services.

 

I obtained full credentialled membership of the CMHP in 2013 which is still my proudest achievement, though presenting my MSc research at the CMHP Conference in 2015 is a close second.

 

Could you describe a typical working day for you?

 

In my day job, I am Chief Pharmacist in St Patrick’s University Hospital in Dublin. This is Ireland’s largest, independent, not-for-profit mental health service with just over 300 inpatient beds and several outpatient centres. I manage a total of 18 staff members, including part-time staff and vacant posts, and we have a dispensary on-site.

 

I typically start the day following up on emails and voicemails and checking what has been prescribed for my patients on our ePrescribing system (RiO) overnight. I have learned that it’s best I have minimal verbal interaction with people first thing in the mornings as I’m definitely an owl not a lark. I may have to rearrange the rota if there is sick-leave and advise clinical pharmacists if there is a change to the wards they are covering. We work in a shared office so communication is straightforward.

 

Once any urgent medication is ordered, I will then go to the ward(s) I’m covering to see if any additional items are required and I will see new admissions for medicines reconciliation.

 

I often have a meeting around 11am (e.g. the clinical governance committee, drug and therapeutics committee, or falls committee) and if there is time after that I will try to speak to any patients I didn’t see earlier to complete medicine reconciliation. Occasionally I will take my morning tea-break and catch up with what is happening in my work-colleagues lives.

 

We close for an hour for lunch and I try to get out for some fresh air if it isn’t raining. That doesn’t happen too often in Ireland though.

 

After lunch I see what changes have been made to medications, follow up on queries and/or prescribing errors with the doctors, and spend an hour or two working on management tasks, staffing, policies/SOPs etc. Most often, those couple of hours fall from 4.30pm onwards. CMHP work gets done after 5pm too but I don’t mind that as I’m at my most alert in the evenings and it means I miss the traffic going home at rush-hour.

 

Pilates, meals with friends, and time spent with family help me to relax in the evenings so that I’m ready for the next day at work.

 

Are you a member of any professional bodies? Which ones and why are you a member?

 

I joined the College of Mental Health Pharmacy (CMHP) in 2005 and was Co-opted onto the CMHP Council in October 2014. I have since been elected and held the posts of Assistant Registrar, Registrar and Vice- President. I am currently the President. I’m still getting used to that. It’s hard to comprehend as I recall the high esteem with which I held Council members and longstanding CMHP (and formerly UKPPG) members’ knowledge and expertise. Imposter syndrome affects most of us to some degree, but I’m driven to carry on the legacy of those who have done outstanding work before me.

 

I joined the Executive Committee of the Hospital Pharmacy Association of Ireland (HPAI) in Feb.’16. I wanted to ensure the voices of pharmacists working in mental health were heard, and I wanted to get to know more of my peers in the Republic of Ireland. Working with Chief Pharmacists and colleagues through this Committee has given me the confidence to advance my career and access to experienced colleagues to seek advice from where necessary.

 

What is credentialing and why does it matter?

 

Credentialing with the CMHP is a huge achievement as it is recognition of your expertise from a panel of your peers. Having held the posts of Assistant Registrar and Registrar for the College, I know what an undertaking the assessments are and how seriously the assessors view them. Putting together a portfolio of evidence of expertise and sitting a viva ensures we have a comprehensive picture of the applicant’s knowledge and skills, so having the honour of using the post-nominals MCMHP is an important validation.

 

What are the big issues that concern you at the moment in mental health pharmacy?

 

We talk a lot about stigma in society but an issue I have only become aware of in the last few years is the stigma of mental health amongst healthcare professionals. I have experience of a colleague whose wards were not covered whilst she was on maternity leave as no-one wanted to cover the mental health wards, and I have had a conversation with a highly experienced pharmacist who had no problem seeing a patient for warfarin counselling but was very apprehensive about lithium counselling. Add to this that the most frequent question asked when we do talks to community pharmacists is “how do I talk to someone with mental health problems?” and I do think we have a real problem with awareness and understanding of mental health. (The answer is “just the same as any other one of your patients”, in case you were wondering!)

 

With more pharmacists moving into primary care, many have identified a need to improve their knowledge in the area of mental health and the CMHP is working with CPPE, MORPh and others to provide opportunities for education, but it would be great if undergraduate training was going further to meet that need sooner.

 

What are the risks of pharmacists taking on more responsibility in the area of mental health pharmacy?

 

Pharmacists have significant expertise in assessing risks and benefits of various scenarios. I think the majority will recognise their limitations and the areas in which they can add value. However, there are some people who lack a degree of self-awareness and/or may present themselves as having expertise which may not be valid. Use of non-protected titles such as Consultant Pharmacist should not be encouraged except for those who have followed the recognised pathways to obtain such titles to ensure that only experienced Pharmacists have responsibilities appropriate to their level of expertise.

 

Are there any particular traits or skills that pharmacists who specialise in mental health need?

 

Empathy and compassion are essential, although people must also learn self-care and how to protect their own mental health. Flexibility backed up by a knowledge of what the boundaries of guidelines are (and why) usually results in good patient outcomes.

 

What contribution in caring for people with mental health issues would you expect from a community pharmacist?

 

Community Pharmacists are tremendously important to patients with mental health issues. I am always delighted when completing medicines reconciliation if my inpatients tell me to ring the pharmacy and ask for their pharmacist by name. There is a lot of trust there in the health professional they often have the most contact with.

 

Do you think suicide prevention techniques should be taught to community pharmacists?

 

Yes, definitely.

 

Mental health first aid should be seen on a par with basic life support courses, and more widespread uptake may also reduce stigma. There is a wonderful suicide prevention taxi service in Ireland (taxiwatch.ie) where drivers learn how to bring up and discuss suicide with passengers whom they may identify as vulnerable – it’s nothing magical, just talking and signposting, but it can be just the right thing at the right time to change someone’s path. Similarly, the Foyle Search and Rescue Services in Derry have set up patrols to make contact with and provide another way for those in distress who may be contemplating suicide. These are not healthcare professionals, but their work is making a big difference. Imagine what a community pharmacist could do with their knowledge and skills!

 

What has been your proudest moment so far as a pharmacist?

 

Becoming a Credentialed member of the CMHP!

 

As a profession how should we reward pharmacists for outstanding practice?

 

I would like to see more consultant pharmacist posts being funded with clear requirements and a recognised pathway that identifies outstanding practice.

 

One of the best things about the CMHP is that it is a forum for sharing best practice and therefore improving standards of practice internationally. We celebrate such good practice with our poster and oral presentation awards at our Annual Conference and we are now publishing the award-winning abstracts in the Online Journal of Psychopharmacology for wider dissemination. Recognition of work being done is good for individuals and for the profession as a whole.

 

Are you optimistic about the future of pharmacy in the UK?

 

This is difficult to answer as a Europhile. On a day to day level pharmacists will continue to provide skilled care and expert medicines management but there are certainly challenges ahead with medicines shortages due to global drug supply issues and Brexit; the increased power of politicians to change the structure and function of the NHS; and the ever-increasing demands of the health service. I have no doubt, however, that pharmacists will always do the best they can for their patients no matter the circumstances.

 

What’s next for you?

 

I’m going to have my hands full for the next few years developing my department as Chief Pharmacist and being President of the CMHP. I have plans to introduce an admissions pharmacist role – something which is new in mental health in Ireland and I will be looking at opportunities to maximise the impact of clinical pharmacists through limited prescribing roles. We will be surveying CMHP members early in the new year and taking direction from them as to the future development of the College so, no doubt, that will generate some interesting and engaging workstreams over the next few years.

 

What advice would you give to pharmacists who wish to pursue a career in mental health pharmacy?

 

Go for it!

 

If you’re interested, you’re more than halfway there. Mental health pharmacy isn’t for everyone. There is ambiguity, legitimate treatments that may be outside the guidelines, and patients’ behaviour may sometimes vary more than with other health conditions. But, if your pedantic pharmacist nature can accommodate that and maintain empathy for your patient whilst keeping their best interest at heart, you will thrive.

 

Ciara Ni Dhubhlaing MPharm, MSc, MPSI, MCMHP. is Chief I Pharmacist at St. Patrick’s University Hospital, James’ St., Dublin 8. She is also the President of the College of Mental Health Pharmacy (CMHP)

 

If you would like to find out more about the College of Mental Health Pharmacy or would like to join click here.