His first job in the Western Isles hospital was under the supervision of Tim Dodd, who gave him great encouragement and helped him establish a career path. At that time, Chris says, there were no pharmacists working in the hospitals in Orkney and Shetland and he determined that remedying this situation would be a career ambition.
Chris moved to Aberdeen to gain experience in a bigger hospital. A year working as a resident pharmacist, he reflects, was the scariest year in his career and the learning curve was steep. Working at night in a large teaching hospital, however, helped him develop self-sufficiency and instilled confidence for the years ahead.
Relocation to Orkney followed with the opportunity to work in community pharmacy. This business specialised in providing wholesale arrangements and logistical support to GP dispensing practices. Chris says it became clear at this time, that small GP practices in remote locations would benefit greatly from pharmacy support and that their patients really needed pharmacist input. He also developed an understanding that cooperation between dispensing doctors and community pharmacists had to be the way forward. In the village of Stromness, he began to spend a half day a week working with the local GP practice, supporting them in medicine reviews and undertaking what we would now call medicine reconciliation.
At this time, formal prescribing advice was just starting and in 1997 NHS Orkney, and subsequently NHS Shetland, agreed to employ him with a remit to make savings through prescribing advice. The use of these savings helped fund the development of a hospital pharmacy service. Chris felt a need to brush up on his clinical pharmacy skills and gained a diploma in prescribing science. Pharmacists and technicians require a particular skill set to work in the islands. For example, pharmacists are often a link between consultants and junior doctors, with few middle grade doctors.
Chris has overseen new models for dispensing medicines in the islands which place community pharmacists at the hub. He believes that technology is the future and is keen to link practices with pharmacies. Robotics, even simple vending machines augmented by video linking, will be of increasing relevance. The need for clinical pharmacy, delivered as close to the patient as possible, is now written into Scottish Government legislation. An integrated arrangement exists in the Northern Isles where there are pharmacists with a range of clinical skills providing an outreach from the hospitals to even the most remote GP practices.
Prescriber roles, medicines safety and improving patient experience are crucial elements of modern pharmacy. Additionally, a particular skill set is required in remote pharmacy; skills include a willingness to work confidently across boundaries and an ability to apply specialist knowledge to general practice. Getting pharmacists with the right clinical skills is difficult in the islands and these pharmacists need the confidence to work ‘on the edge’ of established practice. Chris continues to work towards establishing more formal training and career pathways for remote pharmacy practice.
Throughout his career Chris has tried to network widely, something which is not easy when living on an island. The pharmacy community in Scotland is relatively small and Chris does as much as he can to support other pharmacy leaders across Scotland, taking a stint recently as vice chair of the Scottish Directors of Pharmacy. He has also been a member of the Scottish Medicines Consortium and provides input into the Yellow Card Scheme. Chris too, has a keen interest in developing the role of pharmacists and technicians within care settings and has contributed to this work nationally.
Chris believes that the success that he has seen in his team has been achieved through allowing pharmacists to develop their own interests within practice, responding to patient need and prioritising their own work accordingly. He suggests the success equates to the extent to which staff stretch themselves, particularly in their clinical work. They need to be inspired to value their own judgments, and to be supported in becoming less risk averse. Where pharmacists concentrate on effective prescribing, safety and ultimately efficiency follow.
What does being a Fellow mean to me?
Sometimes "working on the edge", geographically and professionally is a lonely place. So it means a great deal to me that I have been recognised by my peers as having added to the practice of pharmacy. It is an honour to be awarded this RPS Fellowship by my profession. I believe being awarded the fellowship says much about my pharmacy colleagues in Orkney and Shetland too – their skill, enthusiasm and dedication make me very proud.