6th September 2018
Before moving into GP pharmacy, I was a community pharmacist for about 13 years (I can’t believe it’s been so long already). I’ve done a lot of travelling and worked as a pharmacist in Sydney, Dublin and Liverpool before moving back closer to home to settle down.
I’ve also had experience working in the regulatory sector – sitting on the Research Ethics Committee for Northern Ireland (comes in useful when discussing drug trials with reps), an advisor on the Pharmacy Policy Development Committee for the Pharmaceutical Society of Ireland (PSI), and regional representative for the Pharmacist Defence Association (PDA) Union – helping colleagues through any employment issues where possible.
I chose to make the transition to GP practice as I wanted a role which would have a greater impact on patient outcomes and facilitated my enjoyment of learning and development. Getting a proper lunch and toilet breaks also made it much more attractive than community pharmacy!
Though I have had limited experience in GP practice (having only worked there for the past year), I am becoming more confident and skilled in the role each week. This is typified by the fact that the GP partners are regularly approaching me for more complicated presentations and advice. I feel that my work in community pharmacy has given me an insight into the challenges and problems faced by pharmacists very much on the front line. Because of this I was proactive and keen to form partnerships with the local community teams to work together to identify any issues and opportunities that the surgery could help with. By collaborating and communicating and focusing on the patient we’ve been able to work together to reduce workload for the surgery by utilising community schemes such as repeat dispensing prescribing, minor ailments and signposting patients to the pharmacy to support self-care.
Moving into General practice from community requires a different way of thinking. In community pharmacy, we’re trained to see things very much clinically and legally in black and white. The prescription is either legal or not, the dose is correct or not, there’s an interaction or not.
In general practice with differentiated diagnoses – things are a bit greyer, there’s a patient who often doesn’t conform with textbook symptoms and you end up becoming detective like – trying different investigations to come to a ‘best guess’ of what’s going on.
Increasing proficiency in soft skills training and learning how to conduct effective consultations with patients to draw out the pertinent issues and problems. Becoming an effective communicator and especially listener helps to build a complete picture of what’s causing the patient issues, what is important to them, their expectations and involving them in the decision about their treatment leads to better outcomes.
I think the successful uptake in practice pharmacists, has in the most part been due to a shortage of GPs rather than a realisation of the unique expertise pharmacists can bring to the patient journey. Because of this, there is an expectation in some areas that the pharmacists can act as ‘Mini-GPs’ and do everything to free up the GPs time from acute prescribing to open heart surgery! This expectation has led to challenges when resisting the invitation to perform tasks outside my area of competence.
Explaining the role and providing evidence of the value of practice pharmacists, which I believe is ongoing disease management and medicines optimisation, has meant I can focus on areas I’m comfortable with and provided the surgery with better clinical outcomes in the long-term. I’m fortunate that my GPs want to get the best use out of my time – while they would love for me to clear their acute list of minor ailments, when it come’s to our prescribing advisor visits and compass reports they appreciate the projects and clinical governance I’ve contributed to.
Upskill and carve out a role in your specialised area – try to be assigned to tasks that only pharmacist can do – otherwise you could end up becoming a pretty expensive admin assistant buried in paperwork!
As well as reviewing Asthmatic patients and working through a list of patient’s overdue spirometry who are coded as having COPD (some of which are showing more complex presentations), I’m focused on the prescribing of high risk medications such as Methotrexate – ensuring the patient’s dose is correct and they are attending for monitoring to ensure good clinical governance and safety.
I’ve also been working to improve our opioid prescribing, reducing the use of tramadol immediate release where possible and in general conducting medication reviews to ensure that the therapy patients are on is appropriate, effective and in some cases, following the most up to date guidelines.
I’ve become the point of contact for community pharmacists – utilising their high patient engagement in a local Asthma project and also freeing up the GPs call time (which they love) when I can pick up the phone and field calls about medication changes or dosage queries.
Outside of my 9 to 5 in the surgery I am working with a core team of blockchain developers and entrepreneurs advising on an adverse drug reaction framework using big data to help pick up adverse or even beneficial side-effects from the millions of medications dispensed each year.
The easiest way for any practice pharmacist to demonstrate their impact is by getting to grips with cost effective switches and specials prescribing. It provides an identifiable value to the surgery which is more tangible to the practice manager (though as important), than the emergency hospital admission that never occurred because you switched a patient’s inhaler to a more suitable one.
Another way to demonstrate value is helping the GPs with the mountain of paperwork and letters they receive each day. Although as pharmacists we probably take a little more time and delve into discharges a little deeper – questioning doses, diagnosis and indications – this is an important part of our role. If we’re just transcribing changes without question then it becomes more of a technical role rather than a reconciliation.
I’m continuing to learn and develop my skills in respiratory disease – once you start getting into such an area you realise what a complex but interesting field it can be.
I’ve undertaken training in FENO and currently studying for my Level 5 Asthma Diploma and Level 5 Spirometry. It is an area that I am passionate about and find extremely rewarding.
Pharmacists are unique in that they straddle all aspects of clinical care – from Hospital pharmacy, to Primary care, community pharmacy, and in some cases Care Homes. No other healthcare professional has that patient contact at every point in their journey to advise and guide. Because of this I think we should work closer with all our pharmacist colleagues – a patient doesn’t become someone else’s problem when I hand them a prescription or they’re admitted to hospital. We can have continuous engagement, and studies show that wherever pharmacists are involved, patient outcomes are improved. We should Communicate, Collaborate, and Care!
I really appreciate the tools developed by the i2i Network – they have enabled me through the utilisation of their ABCDE framework to facilitate the implementation of a concept I had to increase the assessment and adherence of inhalers in asthmatic patients in partnership with local community pharmacies. Without their easy to follow processes and support it would probably still be an idea bouncing around in my head!
That you need to go ahead and be the change you want to see. If there’s something wrong within the system – don’t wait on someone else to fix it with more time, resources, protocols etc. Work above what is expected and adapt a constant process of quality improvement in small incremental steps that delivers real value to patients.
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