What clinics have you set up over the years and what do they involve?
I started off with an asthma/COPD clinic. The surgery would fill my appointments and I would do their reviews then follow up on any changes I had made. A few years later I was asked to cover a hypertension clinic for a year as the IP had left and his successor was still doing his time in practice. It was a steep learning curve in a different GP practice but a very good experience. After that, I added hypertension patients to my clinics. As the funding criteria for clinics have changed I’ve adapted what I do and currently I see a variety of patients but aim for acute conditions that aren’t quite worthy of a GP appointment but beyond the standard EMAS remit. If the clinic is quieter I’ll look through any special requests for prescriptions and deal with some of the simple requests to save GP time.
How do you get time to run the clinics as a community pharmacist?
Health board funding allows me to have locum cover while I go out to the surgery for my clinics. It would be nice to have the clinic in the pharmacy itself but from previous experience, it isn’t practical without access to full patients records. If GP records were accessible e.g. through the PCR it would open up the possibilities for IP in community pharmacy.
What are the risks associated with prescribing in community pharmacy?
We do not have the years of diagnostic training that our GP colleagues have. It is always possible that we could miss a differential diagnosis. Clinical examination skills also take years to hone and no number of 2-day courses are going to be a replacement for years of practice. Self-checking of your own prescribing could occur in exceptional circumstances and lack of access to full patient records may be an issue in some settings.
What support do you think would help mitigate these risks?
Linking community pharmacy to GP records would be the biggest help. GP colleagues and their staff have protected learning time where the surgeries close for a day or half day. In an ideal world pharmacies would have such a luxury and be able to join them but the world might stop spinning if that happened. Opportunities to shadow GP colleagues and be supervised examining patients would be useful.
How have you demonstrated your competence as a prescriber over the years?
By keeping skills and clinical knowledge up to date. I often chat with the practice pharmacist and nurse about what we’re doing and any formulary updates that have come in that may affect my prescribing. It also helps to sound off about any clinical decisions I’ve made and to get feedback from peers. I sometimes have other colleagues sit in on my clinics e.g. student nurses or pharmacists completing their time in practice for the IP course and again that is a good chance to get another perspective and learn different skills.
What do you love about your job?
I like it when I’ve made a difference that has benefited the patient. It can be from simple reassurance about a self-limiting condition to getting someone’s asthma under control with a slight adjustment of their medication. I also enjoy training up new staff and seeing them develop in their roles. Becoming an established part of a team either in branch or with the surgery and learning from the experience of others.
Any aspects you dislike?
Admin and targets. Currently, CMS is a bugbear as the payment structure means it’s often more of a chasing numbers scenario rather than a meaningful intervention for the patient. Hopefully, that will improve.
What is your view on the state of community pharmacy in Scotland?
Apart from the payment structure for core services like CMS, I think community pharmacy is still in quite a good place in Scotland. We have a lot of national services and PGDs in place and there is certainly a drive to get more in place. Some companies offer more services under private PGDs which has its place but I think providing more consistent services under the NHS to allow better access for all patients is the way forward.
How does community pharmacy need to change to survive in Scotland?
We need to be seen as the first port of call for more acute conditions. We’re starting to see this with the pharmacy first PGDs and there is scope for more in a similar vein. An extended MAS formulary for pharmacist prescribers to allow us to treat patients with such conditions without needing to refer to GP practices would help enable this and guidelines/algorithms for the formulary would help.