When I entered my Wheathampstead branch on a Wednesday in March the atmosphere was supercharged and the emotion palpable. I noticed a distraught young mother being comforted by one of my counter staff while holding an obviously unwell child.
Pantea, my Pre-Registration (trainee) pharmacist takes up the story:
I was working at the Wheathampstead pharmacy. Our pharmacist, Simon, and I were taking turns to answer patients’ queries. It was around 1pm when a very distressed young mother came through the door with her child. One of our counter staff asked me to help. Even before speaking to the mother I noticed a very poorly child in the pram. He was of pale-yellowish colour and he was having such a hard time breathing. As I asked the mother how I could help, I sat down to take a closer look at the child and when holding his hand I was shocked how cold he was. I was told that he had no previous medical conditions and that he was 20 months old. I observed that he was trying to hide from the light. He started to moan. He was very agitated and stiff. I was concerned that he might be suffering from sepsis or meningitis so I asked Simon for assistance and a second opinion.
Pantea sought my opinion and I asked the mum a number of questions before pulling the little boy’s jumper up to have a look at his arm. I observed a non-blanching rash, stiff limbs, cold extremities and shallow breathing. I was concerned that the cause could be septicaemia and/or meningitis. As the mum did not have access to transport I decided the quickest and safest thing would be to call an ambulance, which Pantea did immediately. She was told the ambulance would arrive quickly but there were numerous delays. After 45 minutes I became very concerned that the ambulance would not arrive in time, and decided it would be best for the family to take the baby themselves to the hospital (the dad had arrived in the pharmacy by that point). From a safety-netting perspective, I asked them to call NHS111 while in the car to seek supportive advice.
I later contacted the patient to confirm they had arrived at the Luton & Dunstable hospital. The child was stable on an antibiotic IV and later was diagnosed with leukaemia. The grandparents popped in a few of days later to thank us and we are all delighted to have played our part in saving a child’s life. The child remains hospitalised but the prognosis is positive.
Community Pharmacists have the skills to manage the bulk of minor ailments, and as this case demonstrates we are also well able to spot ‘red flag symptoms’ of serious illness and act accordingly.
GPs are under impossible pressure, so we welcome the NHS “Stay Well Pharmacy” campaign which encourages parents to “think pharmacy” for common childhood ailments. Clearly, the campaign is working. The government suggests that the campaign will save the NHS £850million but none of the savings are to be shared with community pharmacy.
The government needs to reconsider how minor ailment interventions are being thrust on community pharmacy without appropriate resources or any funding.
Simon recently qualified as an Independent Prescriber. This additional qualification takes at least six months and comes at a cost of around £10,000 when course costs and backfill costs (locum cover) are taken into consideration. The NHS refuses to help with these costs – so pharmacists are forced to self-fund or not upgrade their skills. Simon is now far more confident in assessing symptoms. He often takes 10 minutes or more when thoroughly assessing a patient (including the use of the stethoscope otoscope etc, all purchased at our own cost) Most patients do not require much more than reassurance and some paracetamol. The few pence profit does not come close to covering the costs of our time, still less the £10,000 cost of the course.
Government policy is to close 3000 local pharmacies and not in any planned way. They have imposed £321m of indiscriminate funding cuts. Most local pharmacies rely on the NHS for 90%+ of their income and many pharmacies have seen a drop of up to 20% in revenue as a direct result of the cuts. What kind of natural justice is it that rewards an £850m saving for the NHS with a huge pay cut?
On this occasion, we were there to support a severely ill child and his family, but our pharmacy group is currently loss-making. Next year we may well not be here. Had we not been there what would the mother have done? What additional delay would there have been before the child received medical attention and what might the consequences have been?
This article is called, The Day We Saved a Baby’s Life. Perhaps I should make it clear that pharmacists are in the business every day of keeping people alive and well. The incident with this baby is significant in policy terms not because it is unusual but precisely because it tells a universal truth about community pharmacy – we are life savers.
Graham Phillips is the superintendent pharmacist, Simon Phillips is a pharmacist and Pantea Shahiri is a pre-registration trainee. They all work at Manor Pharmacy, Wheathampstead, Herts.