Prescribing: A Game Changer for Community Pharmacy
'By 2030 there will be an independent prescriber (IP) in every community pharmacy’. This is a central aim of Pharmacy: Delivering a Healthier Wales. Here, community pharmacist Jon David describes how he uses his prescribing skills and explores both challenges he has faced and the myriad of opportunities it offers the profession and our patients.
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 regard to independent prescribing, see another 10-15 patients a day and
that is 6 days a week.
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.
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.
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.
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.
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:
Thefuture 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.
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 inevitably become more and more important in this field.
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