Why has a pharmacist never contributed to the daily briefings?

 

Despite the importance of medicines and vaccines during this pandemic, pharmacist voices have not cut through when it comes to Covid-19 related public discourse.

 

And before folk moan, I’m talking here about what the general public see not what we observe within our pharmacy echo chambers.

 

I understand that as a bunch of procrastinating perfectionists we were out of our comfort zone at the beginning of the pandemic when uncertainty was rife and solid evidence to drive decisions was thin on the ground.

 

Despite this fact, community pharmacy colleagues particularly battled against these cautious instincts to remain at the real front line. For a few months, community pharmacy was literally the front door of the NHS and an accessible location for patients who were scared.

 

We were scared too, but we (as usual quietly) just got on with it.

 

But what an opportunity missed that this was not converted into positive headlines to bolster the standing of our profession. Not enough of the general public know what we did in pharmacies back then.

 

Does this matter I hear you cry?

 

Whether it matters or not, I think that as a profession we are reaping what we sow due to internal division, an existential identity crisis and retreat to our comforting echo chambers. I must also add that the dominance and consolidation of a small number of large pharmacy businesses in the UK over the years has not helped either.

 

And now Amazon is drifting silently into view.

 

The profession of pharmacy is completely divided in my view and therefore I think our lack of collective status at the top table of the medical information machine has been lacking.

 

I’m not dismissing all the good stuff but we have got a problem.

 

The profession in the UK has retreated and this fear has driven unionisation over recent years. Unionisation is a symptom but as someone who has availed of the services of said Union in the past I say this with a grateful tongue in cheek.

 

The nature of professional support has proliferated over recent years. The critical mass in one organisation no longer exists and many pharmacists stumble at a basic understanding of what the role of the various organisations are.

 

If you look hard enough though, there is some hope.

 

It seems that there is a small nucleus of innovative early adopter pharmacists that are trying their best to latch on to and use the myriad of technological assets to help with the delivery of pharmaceutical care. This is across all the sectors of pharmacy.

 

Fundamentally we don’t know what a pharmacist is. So if we don’t know then how on earth do we expect the general public to understand and again does this matter anyway?

 

If we delve deeply into our pharmacist soul I think most of us would really struggle to fully grasp what the purpose of a pharmacist actually is.

 

We are instructed by those promoting the services of pharmacists that we are ‘experts in medicines’ but I cannot see enough evidence to justify this statement. A better description would be that ‘we have a focus on the safe use of medicines’. Some sectors of pharmacy have certain advantages and allow the development of what government officials describe as ‘clinical skills’ but the lack of a clear, consistent postgraduate training pathway led by a professional body means we are incorrectly using the ‘expert’ title in my view.

 

What is the golden thread that holds us all together?

 

This identity crisis is a huge problem for the future of what we understand to be our profession.

 

It could be argued that the lack of understanding by the general public is the least of our worries. The existential threat to what we understand our profession to be is real.

 

Many of us are grandstanding over there while activity in relation to medicines is evolving over there. The innovation happening in the private sector is staggering and pharmacists are silently being painted into insignificance.

 

Divided we will fall but worse than that would anyone notice if we did?

 

Johnathan Laird is a pharmacist who would struggle to host a daily briefing for his cats never mind the nation. 

 

 

Got a view? Get in touch and write us a letter.

 

 

 

GPhC say pharmacists should be able to independently prescribe upon registration

 

The General Pharmaceutical Council (GPhC) Council has agreed on the overall direction of the review of the standards for initial education and training of pharmacists and the next steps to finalise and implement the standards.

 

At the November meeting, the Council reviewed the current draft of the standards.

 

Council members Rose Marie Parr and Arun Midha, who are jointly chairing the Advisory Group on the standards, gave an update on the feedback and key issues discussed at the group’s meeting earlier this month.  The Advisory Group includes representatives from a wide range of stakeholders, including universities, employers, student representatives and statutory education bodies.

 

Rose Marie and Arun also highlighted the areas where further drafting is taking place in response to the Advisory Group’s feedback.

 

The further work underway includes:

 

  • Reviewing some of the levels and headings in the learning outcomes to ensure these are right, with a particular focus on the progression from year four to five and then to post-registration.
  • Making sure the elements of the standards relating to independent prescribing are appropriately woven through the five years of education and training.
  • Setting out the respective roles and accountabilities of the different organisations in relation to the Foundation training year more clearly within the standards.

 

The GPhC is continuing to work closely with key stakeholders, including the Pharmacy Schools Council and the statutory national education bodies, to inform the final drafting. The Council noted the generous offers of assistance from stakeholders to help with this.

 

It was agreed at the meeting that the Council would consider the final draft of the standards at the December Council meeting, once this work has been completed.

 

Council members also agreed that the GPhC needs to work with the Advisory Group to develop a transition plan for how and when the standards would be implemented. There was clear support for the standards being implemented as part of an iterative process and that changes, including to support the aim that pharmacists can independently prescribe from the point of registration, should be implemented at the earliest possible opportunity.

 

Nigel Clarke, Chair of the GPhC, said:

 

“These new standards will transform the education and training of pharmacists, so they will be able to play a much greater role in providing clinical care to patients and the public from their first day on the register.

 

“There is real momentum and support behind the standards from our Council and from the Advisory Group. We are working with pace and ambition to finalise the standards and working closely with everyone involved to develop a practical and realistic transition plan to implement them.

 

“We are very grateful for the hugely collaborative and collegiate approach that stakeholders have taken in working with us to finalise the standards. There is a real willingness to work together to make this happen, whilst recognising that there are still challenges to overcome.

 

“There was a clear steer from our Council that the standards should be implemented in a way that enables improvements to happen as soon as possible to meet the current and future needs of patients and the public.  This includes considering the earliest possible time when newly-registered pharmacists would be able to prescribe, taking account of the knowledge and skills they will be developing and the necessary assurances for patient safety.”

 

 

We are welcoming letters to the editor. Feel free to get in touch using the form below. 

 

 

The great pharmacy identity crisis

 

 

If we, as pharmacists, don’t fully understand our identity – which I think we don’t – then we should not be surprised when the general public doesn’t either.

 

The last few days have seen a flurry social media activity.

 

Outrage. Shock. Disgust.

 

And probably rightly so. We are all quick to jump in and I’m afraid to say on this occasion I took the bait. The response to the #whatwedoinpharmacy hashtag has provided some short term optimism but when I reflect on where the power really sits in the profession of pharmacy I realise that this is nothing but a brief flash in the pan.

 

That said a fire needs a spark.

 

The trouble is as pharmacists I don’t think we have ever been able to operate autonomously within the healthcare system. For years we have been passengers. Our job has been to be the healthcare goalkeeper or more recently free up GP time. We have come a long way across a number of sectors but in my view, in recent years we have never been able to confidently get on the front foot.

 

Any progress made has been down to the selfless effort of the talented minority. Imagine how things could accelerate if we were all on the same page working to a common goal.

 

The systems within which we operate are designed for another time. The impatience played out in wider society is I feel seeping into our profession. Not before time in my view.

 

So what is the result of being pushed around for years?

 

Well, I think pharmacists have largely lost their professional identity to such an extent that we now exist to serve our respective commercial masters. Employer led practise and education. The apprenticeship debacle was a cracking example of how far we have veered off track.

 

What on earth is a pharmacist?

 

I had a very interesting conversation on this very topic with a colleague recently on our podcast. We are both experienced pharmacists and we drew a blank in terms of making a stab at answering this one.

 

This is one of many problems.

 

For years we have had the opportunity to carve out a professional identity for ourselves. But alas if you mention the term ‘pharmacist’ the general public will likely replace that noun with ‘chemist’ and make an immediate association with the retail environment. All sectors are to some extent tarred with this brush, unfortunately. The nuanced skill and expertise of a highly specialist consultant pharmacist is lost on the general public.

 

But a consultant physician is someone who is very important in their eyes.

 

This is another problem.

 

Recent history has actually been very kind to the profession of pharmacy across a number of sectors.

 

In 1948 the then Health secretary launched NHS. This move entitled people to free prescriptions, and therefore drastically increased dispensing volumes within community pharmacies. It heralded a hitherto unprecedented level of investment in the community pharmacy sector and has since driven the growth of a thriving community pharmacy sector. I feel this fact is often forgotten or not mentioned today.

 

The Nuffield report ‘cautiously’ suggested that, for the first time, community pharmacists might give advice to the general public from community pharmacies.

 

In recent years many have hailed Scotland as the visionary centre for innovation in community pharmacy practice. And I would agree with this. The Right Medicine was an excellent document and took many of the themes from the Nuffield report and began to create a plan to apply these principles using the concept of pharmaceutical care.

 

The Right Medicine document was ahead of its time.

 

These moves were the pre-cursors to Prescription for Excellence and most recently Achieving Excellence in Pharmaceutical Care.

 

I have succumbed to my Scottish bias here but I think we have been lucky north of the border that the Prescription for Excellence document was genuinely visionary. For example, it stated that every pharmacist in Scotland should be a prescriber.

 

When was the last time you read ambitious visionary rhetoric like this?

 

Nope, I can’t remember either.

 

But leadership, even here in Scotland, is still coming from outwith our profession. In the last 60 odd years, the Government both north and south of the border has been one of our best advocates. How fickle this support is now proving to be.

 

The Government appear to have called time on the growth of the contractor model in favour of the technology-driven players pouring into the supply market. Click and collect with little or no pharmaceutical care. This approach is happening at pace in England but will likely follow elsewhere.

 

Yet another problem.

 

I have veered towards an extremely brief curated history of community pharmacy but needless to say, there have been great strides in other sectors too not least academia, hospital practice and more recently activity by pharmacists in general practice.

 

Hospital pharmacy has forged ahead in recent times. Those talented individuals in the hospital sector have forged their careers by adding value and giving excellent advice. Pharmacists on ward rounds is now a thing. The early adopters of pharmacist prescribing were largely based in hospitals too.

 

The most recent political rouse has been the attempt to circumvent community pharmacy and place pharmacists directly into general practice. Honestly, if I hear one more time that the primary role of the pharmacist is to relieve the pressure on GPs I think I might spontaneously combust.

 

As the post-1948 supply function for pharmacists diminishes further where does this leave our collective identity?

 

Well, I don’t think the public has a firm understanding of what a pharmacist does and this is ‘our’ fault. We need to look to ourselves and the decisions ‘we’ have made over time.

 

Selling make-up, homoeopathy and more recently CBD products have not served us well as we strive to carve out a more advice-driven role for the profession. I bet if the general public is asked what a pharmacist does they will probably think of the larger community pharmacy company logos.

 

Should we continue to sell sub-therapeutic codeine over the counter and is WWHAM really fit for purpose in the era of the expert patient?

 

I feel the progression of our profession has largely been as a result of individuals existing in a system designed for and protected by medics or others and not geared up to put the pharmacist at the centre of the myriad of activities we now take part in. Given the demographics and epidemic of polypharmacy, this situation really needs to urgently change.

 

Unfortunately, the reason for this confused identity mess is largely down to the commercial pressures that have so far dominated the activity of the pharmacist. It is my view that a registered healthcare professional it is fine to engage with commercial organisations but we must make decisions within that interaction that support the patient who should be at the centre of everything we do. I’m not perfect. I need to put the dinner on the table like everyone else but those who know me well know that I think deeply about these decisions and try to do the right thing.

 

Follow the money and you will begin to understand the mess we find ourselves in. The large community pharmacy companies have had an influence on the top of our profession for decades. A profit-driven approach is fine to a point but the shareholder will always win. This is an important point because community pharmacy teams have become deskilled as a result of a long term lack of investment in the development, particularly of pharmacists.

 

Just compare the GP trainee career pathway with that of newly qualified community pharmacists and it becomes clear.

 

The result is a confusing picture of a profession struggling to find its core underlying visceral identity. Previous to the inception of the NHS pharmacists diagnosed, compounded and treated patients on the high street. They were out front talking to and engaging with their clientele. The cash injection and resultant supply function role after the NHS got up and running meant these industrious souls beat a retreat through the hatch into the mysterious world of the dispensary.

 

Everything has changed yet nothing has changed in pharmacy.

 

So what next?

 

Well, I think we need to come together probably in a way that we have not seen before. I wonder are the days of paid membership to a professional organisation almost numbered. Is there a subscription led charity type union professional body hybrid about to emerge?

 

Probably not but I think something has to change because it is quite clear that the status quo does not suit many, except those of course who have held privileged positions for years within the establishment as we have come to understand it.

 

We have no universal identity and therefore the general public has not got a clue what is going on. Perhaps those people who describe the role a pharmacist in a demeaning way are actually doing us a favour.

 

“Barefoot doctors.”

 

“All they do is put labels on boxes.”

 

“There they are selling make-up in their chemist shops.”

 

Who is responsible for this lamentable state of pharmacy affairs?

 

Follow the money and you will see.

 

Johnathan Laird is a pharmacist who remembers his own identity most of the time. 

 

 

Our editorial board member Gavin Birchall is conducting research into pharmacist identity. He would welcome your views on his survey that is now live. Gavin will be publishing a book on the topic based on this research later in 2020. Click here to access the survey.

New RPS foundation framework prepares pharmacists for prescribing

 

 

 

The new Royal Pharmaceutical Society (RPS) Foundation Pharmacist Framework has been published to support the future of pharmacy education and training across the UK.

The RPS have said that the new framework sets out the capabilities that will be needed by foundation pharmacists to meet the growing demand for pharmacists to provide increasingly complex clinical care across a range of settings. The framework has a greater focus on clinical capabilities including preparation for prescribing.

The RPS Foundation Pharmacist Framework has been developed with senior stakeholders on the Pharmacy Education Governance Oversight Board and informed by more than 800 responses from across the profession to a role analysis questionnaire. It is an important step towards designing the future curriculum, syllabus and assessment for foundation pharmacists across the UK.

Both the foundation curriculum and programmes will focus on the achievement of outcomes rather than the completion of set period of training.

 

Gail Fleming, RPS Director of Education, said:

“With the profession and pharmacy employers seeing an unprecedented demand for clinical knowledge and skills, it’s vital we move towards a sustainable, funded national model for foundation pharmacist training.”

 

Professor Peter Kopelman, Chair of the Pharmacy Education Governance Oversight Board, said:

 

“The RPS Foundation Pharmacist Framework is the first stage towards identifying standards applicable to the desired outcomes from Foundation training for all pharmacists across the UK. The Pharmacy Education Governance Oversight Board will continue to work with key stakeholders across the profession to assure the quality of a future curriculum and assessment strategy.”

 

Duncan Craig, Chair of the Pharmacy Schools Council said:

 

“There is a recognition that the profession can and should do more to support pharmacists at the early stages of their careers post-graduation, so we see the development of the RPS Foundation Pharmacist Framework as a significant step forward on this important pathway. We look forward to working with the RPS and other stakeholders to contribute to this process to the benefit of the profession and the public.”

 

I was bullied, broken and managed out

 

This is not how things should be. The profession of pharmacy has reached such a point that speaking up will destroy your career.

 

Everyone has a voice these days but no-one can speak.

 

Welcome to community pharmacy where rampant asset stripping has been happening for years. Corporate looting you might call it. A few years ago I felt the effects of this culture and environment directly and I can assure you it was not pleasant.

 

Here is my story, for what its worth.

 

I applied myself during my pharmacy degree and I did really well. I flew through pharmacy school. My grades reflected this. I worked hard though.

 

I began my pre-registration year. I was eager to get going.

 

This was my first encounter with community pharmacy. I was at the bottom of the pile and I was ready for that. I was stacking shelves and helping with the running of the community pharmacy that I worked in. This went on for weeks which ran into months. I tried to rationalise the activities I was doing and reconcile them with the role that I was working towards. The reality of pharmacy, and in my case community pharmacy, was completely remote from what I had been sold.

 

I decided to stick with it. I had some previous life experience so I decided to basically put my head down and get on with it.

 

I reached out to colleagues in the company, including a manager above the level of my pharmacist tutor. We had a discussion about my progress. I described how I had come in and basically been allocated to sales assistant jobs. I explained to this colleague how I felt I was not making progress. For example, I had not been given any direction, had been assigned no developmental tasks and had not really progressed towards my goal of becoming a pharmacist at all.

 

We had a great chat and agreed on some steps to accelerate my learning. I was really excited and encouraged at this point. The senior colleague left and I went back to work.

 

What I didn’t realise at that time was that there was now a target on my back. And actually this is how it goes in community pharmacy. The penny would slowly drop over the coming months and things would rapidly go from bad to worse.

 

The concerns I raised about my pre-registration training clearly set alarm bells off somewhere in the bowels of the company. After that day it was absolute hell.

 

The pharmacist in the store was a bully. I have never encountered a non-pharmacist store manager so scared to approach a pharmacist as this one was. It was breathtaking how that pharmacist spoke to the team but also spoke to the store manager.

 

Looking back with hindsight I can now see that the pharmacist was clearly being managed from above because I gradually began to be given tasks and projects but very grudgingly. It was about this time that the sniping passive-aggressive comments started. Before this whole episode in my life happened I prided myself on being really quite confident but, to be honest, these little comments began to really wear me down.

 

And that’s the thing about bullying. The sadness builds over time. Quietly, gradually it builds until one day you really can’t do it anymore.

 

I had wanted to be a pharmacist for years so getting to the end of the pre-registration year was absolutely essential. Besides, I simply couldn’t afford to give up. Again I decided to put a smile on and get on with it.

 

My clinical knowledge was good. I picked up the dispensing role quickly and effectively. I kept going.

 

I was working one Sunday. A lady came in. She said that she was without her blue inhaler. This was the classic emergency supply situation. She asked if she could acquire an inhaler. I said I would go and check but that likely that would be no problem.

 

Just as I turned around to seek help my pharmacist shot out of the dispensary and declared loudly;

 

“I am the pharmacist. He is not. I decide what happens around here not him.”

 

Quite understandably the lady looked shocked. I didn’t know what to say but was completely astounded. I’m ashamed to say I got upset for the first time at this moment.

 

After the lady left the pharmacy the pharmacist took me aside in the dispensary and immediately said;

 

“I could have punched you in the face for what you tried to pull there.”

 

I was upset and completely mortified by this comment. I said to the pharmacist that I was leaving at that moment. I told the pharmacist that I would need at least ten minutes before I could start again.

 

I need to explain at this point that the acute stress I felt as a result of this situation was largely down to the fact that the pharmacist was also my pre-registration tutor and therefore had great power over my future destiny. This pharmacist had the power to deny my route to becoming a pharmacist.

 

This situation was consigned to history and we all moved on. Or so I thought.

 

The next stage of this story is what happened towards the end of my pre-registration year. My pharmacist tutor had indicated to company officials that I would not be signed off as competent at the end of my pre-registration year.

 

I couldn’t believe it. My worst fears were being realised. The reasons given were that there were a few areas of competence that I did not meet.

 

I was told I would have to find another placement.

 

I was pulled out of the store for a few weeks. I was embraced by a new pharmacy team, completed the rest of my pre-registration placement with relative ease and was proud to make it on to the pharmacy register. I had achieved my goal.

 

However, the cost of this achievement has been significant. Over this period I suffered an episode of situational depression and still have anxiety to this day. At the worst point I admit I had dark thoughts.

 

I wanted to write this to hopefully ensure similar stops happening to other pharmacists. I thought I was as strong person but when bombarded repeatedly with horrible comments and behaviours from a terrible individual that strength dissolved and for the first time in my life I reached my mental limit. You should never assume what is happening behind the eyes of your colleagues and if you see them struggling just be kind and try to support them.

 

I can’t see a long term future in community pharmacy for me but I have to endure it for now. I wonder how many others are trying to escape.

 

The author is a pharmacist and wishes to remain anonymous.

 

This was the most professionally frightening situation I’ve ever found myself in

 

I work as a pharmacist in general practice and this incident was a career-defining moment and one I will never forget.

 

I have been a pharmacist for over 20 years and this was the most professionally frightening situation I have ever found myself in. Whilst I cannot reveal my identity for obvious reasons I feel that there is a compelling need to share this experience to make sure others do not find themselves suffering similarly.

 

It was a Wednesday.

 

I came early to work to catch up on emails. The duty doctor was late so I decided to look through the triage calls to see if there were any patients that I could deal with. If I feel that the presenting complaint is something within my sphere of competence I will book patients into my afternoon clinic later in the day.

 

I saw a call logged on the list for a young patient who was reporting suffering with palpitations. As this was not a clinical situation I felt competent to handle I moved on to help other patients.

 

After helping some patients I got on with starting my clinic at 8.30am. In the afternoon every day, I have a number of slots that can be used by the duty doctor to give me patients to see. The presenting complaints must be within my scope of competence.

 

At 12.30 I realised I had some patients booked. It was at that moment that I realised that the patient who phoned in previously with palpitations was booked in with me.

 

My pulse quickened.

 

I swiftly looked to see who was here. I realised there was no doctor, nurse or healthcare assistant in the building. The duty doctor had left just after midday telling reception staff:

 

“I’m just popping out.”

 

I managed to catch the paramedic practitioner in the car park. I went through with him what I would do. What questions to ask etc. He told me that if the patient had any chest pains to immediately send them to A&E.

 

I asked the patient to come to the room. They presumed I was a doctor. I corrected them to inform them of my title. I asked if they had spoken to a doctor this morning and they said:

 

“No. The receptionist just asked me to come at 1 pm.”

 

I began asking questions related to their palpitations and realised they were not feeling well. On examination, the patient had a blood pressure of 171/121 and was currently feeling chest pains. I informed the patient they would need to go to A&E.

 

I asked the reception staff to phone for an eight-minute ambulance. As luck would have it the practice foundation year two doctor happened to come back from lunch and supported me in dealing with the situation. He stayed with me until the paramedic arrived. I arranged for the emergency bag/oxygen/GTN spray to be ready in the room.

 

The paramedics came within six minutes and I handed the patient over to them. The patient had an ECG and was taken straight away to the hospital.

 

One hour and thirty minutes later the duty doctor came back. I informed them about what had happened in their absence. I was clear that I felt that it was not acceptable to leave me on my own or ask me to deal with a situation like this which was out of my area of competence.

 

I asked them why they had not called the patient to triage them?

 

Why did they just lift and shift the patient to my slot?

 

How or when have I demonstrated any competence to deal with palpitations?

 

So what should I make of this situation as a pharmacist now working in general practice?

 

I was left without clinical supervision.

 

I was asked to deal with a situation outside of my clinical competence.

 

I was left with an acutely ill patient to deal with this on my own.

 

The situation felt unsafe and to be honest I was scared.

 

I have completed an incident form and submitted it to the practice. It will hopefully be discussed at the next clinical meeting.

 

The modules completed so far for advanced clinical practitioner (ACP) training have not equipped me for this. My indemnity does not cover me to deal with this. I have felt afraid and to be honest scared.  I am questioning and rethinking my decision to pursue becoming an ACP.

 

I worry if I will be put in a situation out of my clinical competence.

 

I am sharing this to ensure colleagues speak up and make it very clear about the supervision of practice in their training. While general practice needs pharmacists to step up and see patients it has to be done in the correct manner within recognised training frameworks.

 

We have collectively decided to pause me doing slots until a change in the structure of my working day reflects the availability of close clinical supervision.

 

However, this incident highlighted how general practice and general practitioners are pushing me into areas outwith my area of competence.

 

On this occasion, I felt it necessary to stand up for what is right.

 

The author, who wishes to remain anonymous, has experience in medicines management, community pharmacy practice as well as five years in working in general practice. The author has a number of post-graduate diplomas in various clinical areas and has a track record of dealing with professional challenges in a coherent calm manner.