On Saturday 11th March, I was delighted, and surprised, to win the inaugural Independent Prescribing Pharmacist award at the Scottish Pharmacist Awards in Edinburgh. Delighted because it’s fantastic to get the recognition for pharmacist prescribing – a part of our role that I relish, but is not always known and we don’t shout enough about! Surprised because of the strengths of the other nominees. I’m aware of the prescribing clinics they are all involved in and the hard work that goes into them, so to come out as the winner really is an honour.
I currently run a chronic pain clinic at Loch Leven Health Centre in Kinross. I see a wide range of patients, from those with a recent diagnosis, requiring time and information on managing pain, (both with medication and without) to those who have had long, complicated journeys dealing with pain, and require support in managing their medication and finding the right therapy following so many treatment failures. There has been a great response to these clinics. As a pharmacist, I’m passionate about making sure patients understand and get the most from their medication. The clinic allows me to explain the goals of treatment, how the medication works, and spend time understanding the patient’s needs. For the patient, they have time in the clinic (a 30-minute appointment is not unusual) to ask the questions they need, and explain their journey managing their chronic pain. For the GPs, they have seen improvement in patient pain control, as I review and amend what can be very complex medication regimens. For example, I have helped patients taking multiple medications affecting pain to reduce the number of tablets they take, whilst improving pain control at the same time. The GPs can now utilise my clinic as a resource they didn’t have previously.
Working together with GP and other healthcare professionals helps develop the scope of any clinic and I’ve tried to promote the role of the prescribing pharmacist at every opportunity. This has including representing independent pharmacist prescribers at several groups, consisting of professionals from multiple disciplines including Specialist Pain Consultants, Specialist Nurses, GP’s, Physiotherapists, and Locality Pharmacists. As the other healthcare professions learn about the scope of my prescribing, the nature of the clinics develops. I am now seeing patients with more complex polypharmacy issues, completing some consultations as home visits for those who are so badly affected by pain they are unable to attend the clinic. This has included the review of a patient taking over 34 regular medications! We have managed to reduce this patient’s medication while increasing non-medicinal treatment such as TENS therapy and involvement at support groups. This has involved myself, another community pharmacist, the locality pharmacist and the GP working together, with open communication of issues being addressed. This is a great example of the joint role we can play in managing complex patients.
I think it is very important to champion the role of the prescribing pharmacist within the community pharmacy environment. We are now offering treatment of Common Clinical Conditions in several pharmacies in Tayside with independent prescribers. I conduct patient examinations, and can treat for infections and other minor conditions of the eye, ear, nose, throat, and skin, all beyond the means of what is currently available through pharmacy. My assessment of the patient means that those with simple conditions can be prescribed effective treatment within the pharmacy, and the assessments I conduct can help prioritise referrals to the out of hours’ service.
I find the prescribing role an immensely enjoyable part of my job, we need to ensure more pharmacists are looking to get involved. I have supported pharmacists who are reaching the end of the formal training, and needing to have more patient-based experience within a clinic setting. Pharmacists sit in during my own consultations and shadow my clinic. I’ve also spent time with pharmacists in their own practice as they start seeing patients in their first few clinics. This gives the pharmacists support and confidence with their early patient consultations, and allows sharing of experiences dealing with patients
In terms of moving forward, we need to keep looking for ways to enhance the role of the community pharmacist. I would love to find a way to offer patient reviews in the pharmacy setting rather than in a GP clinic. Being based in the GP surgery allows me to access the information I need in the patient’s medication records, and equally, they can see the results of my consultations and any prescription issued is immediately entered onto the system. However, I feel that many of the reviews I have conducted could have been held in my own consultation room within the pharmacy, or have been held in the patient’s own homes. As a model of care, I think this would give greater access to the service, and increase the efficiency of patient reviews.
I am frequently hearing from patients that they are not aware of the services we can provide as pharmacists, in particular the kind of reviews and assessments I am conducting. With independent prescribing, we have a chance to show how we can utilise our skills to significantly improve patient care, and I would love to help more pharmacists to do so.
Glossary of Terms
A pharmacist independent prescriber takes responsibility for the clinical assessment of the patient, including prescribing the necessary medicines. Independent prescribers may prescribe for any condition within their clinical competence. In order to qualify as a pharmacist independent prescriber, in addition to the Master degree programme all pharmacists undertake, you must complete a training programme accredited by the General Pharmaceutical Council. Pharmacists, nurses, optometrists, physiotherapists and podiatrists can all train to become independent prescribers.
The term polypharmacy itself just means “many medications” and has often been defined to be present when a patient takes five or more medications. While some polypharmacy can be both rational and required, polypharmacy can be inappropriate when medications are prescribed when no longer needed, or medication is causing adverse drug reactions.
Community pharmacists work at the frontline of healthcare in cities, towns and villages. A community pharmacist focuses on helping the public, assessing their conditions and making decisions about which medicines they should take. They are involved in dispensing medicines and ensuring medication being prescribed is safe and suitable for the patient. Community pharmacists are also taking on roles supporting patients with long term conditions, such as the management of asthma, and diabetes as well as blood pressure testing. They also help people give up smoking, alter their diets to make them healthier and advise on sexual health matters.
Locality pharmacists are largely based in GP surgeries and play a significant part in managing medicines. They have a strategic role, to focus on maximising benefit and minimising risk of medicines, as well as making the best use of resources allocated for medicines. In some places locality pharmacists also run medication review clinics and have lots of patient contact, as well as close working relationships with GPs, practice nurses and other healthcare professionals.
Transcutaneous electrical nerve stimulation (TENS) is a method of pain relief involving the use of a mild electrical current. A TENS machine is a small, battery-operated device that delivers small electrical impulses to the affected area of your body. The electrical impulses can reduce the pain signals going to the spinal cord and brain, which may help relieve pain and relax muscles. They may also stimulate the production of endorphins, which are the body’s natural painkillers.