by Jon David, Community Pharmacist in Pembrokeshire
It’s a fight; it’s relentless, and day in day out just like others working in the NHS, it doesn’t stop. COVID was the last thing we needed but the second wave is here now and ‘cometh the hour’ we haven’t let anyone down. Like most Community Pharmacies, on a daily basis, we do between 400-600 items, probably see 200 people and with regards independent prescribing, see another 10-15 patients a day and that is 6 days a week.
Having worked as a community pharmacist for 25 years (and before that at Charing Cross Hospital and Northwick Park Hospital, London), I feel that Independent Prescribing (IP) has allowed me to use my skills more fully than at any other point in my career. Providing this service, from a community pharmacy has been nothing short of a game changer in terms of patient care.
The IP service was introduced in May 2020, as part of a trial of the service on Choose Pharmacy, an IT platform for community pharmacies in Wales. It has been very popular in the pharmacy and last month (September) I saw 136 patients. I have now seen 300 patients since the trial began a few months ago. I specialise in ‘acute minor ailments’ – shingles, UTIs, ENT, rashes etc. Most of the patients were seen immediately at the pharmacy, without having to book an appointment, improving the patient journey and care whilst also making huge savings for the NHS.
Often patients presenting with seemly innocuous symptoms, are often quite serious and so consultations can be intense and complex, and nothing is ever ‘black or white. Is it a simple condition or a red flag? A pulled calf muscle or DVT? Is it within my scope of practice or something more chronic? A simple UTI or pyelonephritis? IP is certainly a challenge but incredibly rewarding.
There have been some challenges to delivering IP services from the community pharmacy. The workflow has had to change, including the PMR system and retraining of staff to become ACTs. Delivering an independent prescribing service effectively in the community requires the support of the entire team and that is one aspect that becomes very clear when you undertake this service.
I am a keen advocate of community pharmacy services and feel that generally they have been underutilised. Reflecting on what we contribute to the local community with regards the Common Ailments Service, a ‘Triage and Treat’ service and now the IP service, community pharmacy has a huge potential to improve access to NHS care. That’s why I was pleased to see the RPS pushing for all patient-facing pharmacists to be trained as independent prescribers in their recent Policy: The future of pharmacy in a sustainable NHS . It is so important that we develop the infrastructure, like the Choose Pharmacy system in Wales, to support and facilitate its use.
The need for ongoing professional support is also vital. As a prescriber, I value the peer support that I get through some social media groups and would encourage any pharmacists to discuss their practice regularly. Having the infrastructure in place to support this is going to be essential as IP continues to expand in the community. Peer support and mentoring spaces, such as the RPS mentoring platform will inevitable become more and more important in this field.
I would fully recommend implementing an IP service to any community pharmacist thinking about this. It is hard work and challenging in terms of time and capacity, plus each consultation can be a step into the unknown. It is however deeply satisfying and renews a sense of pride in being a pharmacist. Don’t just take my word for it, go for it!