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Pharmacy in the future: students' views

Pharmacy students are the future of the profession. Clare Bellingham talks to students about what they hope they will achieve as pharmacists and what problems they think might hold them back

Pharmacists of tomorrow, today’s pharmacy students, are keen to take on new roles. They will not be satisfied by a career “tied to the dispensary” and hope to use their clinical skills to offer new services to patients.

The problem is that if the profession does not allow them to realise these dreams they might leave pharmacy altogether. And with the current shortage of pharmacists, the last thing the profession needs is to lose its brightest, most ambitious young pharmacists.

Sandeep Ghir, from the School of Pharmacy, London, speaks for many students when she points out these fears. “Initially I would like to go into community pharmacy, but I can see myself getting bored with it and moving into another area of pharmacy, or possibly even away from pharmacy altogether,” she said. “We get a lot of information and knowledge from the pharmacy degree and in community pharmacy we are not using it to the extent we should or could. However, this does seem to be changing and I’m hoping it will change enough so I don’t get bored. I hope this will lead to more of a front-line role for pharmacists in patient care.”

However, there is a general feeling of hope that it is an exciting time to become a pharmacist and that future roles for pharmacists are currently being shaped. Emma Matthews, at the University of Cardiff, thought that “pharmacists are being recognised as having a valid contribution to make” by other health care professionals, particularly by young doctors.

Perhaps Monali Shah, studying at the University of Manchester, recognised the root of the problem when she said: “Pharmacy needs to boost its enthusiasm.” James Davies, also from Manchester, added: “Pharmacy needs to promote itself to the public. Other professions, such as nursing, are really good at it. You get the impression that the world revolves around nurses. Why can’t pharmacy do the same?”

Future roles

Many of the roles that pharmacy students identify as offering job satisfaction should come as no surprise: patient interaction, working with other health care professionals and conducting medication reviews. But these are not enough for tomorrow’s pharmacists: they want new roles such as pharmacist prescribing and extensive diagnostic testing. Altogether, variation is the key. Sandip Ghosh, from the University of Manchester, said: “When I go and work as a pharmacist I don’t just want to be someone who stands behind the counter being a shopkeeper. I want to use my skills.”

Chi Cheung, School of Pharmacy, London, said: “I don’t think my primary role will change from what a pharmacist does today, that is, providing supervision, and overall responsibility for dispensing medicines. Having said that, I would want to expand my role in other areas, such as reviewing patient medication, providing input in determining health policies, or health promotion. I would still want to maintain some level of patient contact — this is very important to me, and is one of the reasons why I entered the profession.”

Lynwen Jones, at the University of Cardiff, hoped that pharmacists would be able to take on more of a medical role, for example, through diagnostic testing clinics.

“I see pharmacists as providing a more informational role,” said Helen Seelly, a student at the School of Pharmacy, London. “As more and more medicines come on to the market the harder it is to make decisions on the best possible treatments for patients. This role should not be left to just doctors but they should look to pharmacists for advice.”

Working with other health care professionals was highlighted by many students. Jayne Williams, studying at Cardiff, suggested providing an advisory role on medicines for doctors. However, concerns were expressed over the lack of accessibility to doctors in the community.

Chi Cheung expects that pharmacists will work more in general practitioners’ surgeries where patients will be able to make appointments to see them.

Sandeep Ghir believes that pharmacists have the knowledge and expertise to deal with roles away from dispensing and those who have been practising for a number of years should not be afraid to take on these other roles. Training and support should be available for pharmacists who do not feel confident to do this. “I know pharmacists who are bored but tied down to pharmacy. I am going to make a promise to myself that if I don’t get job satisfaction then I will change things.”

Prescribing

Pharmacist prescribing was highlighted by many students as something they wanted to happen and something they believed they had the confidence to do. Sandeep Ghir said: “As long as there is enough training and back up I don’t see why it shouldn’t be taken to a high level: we are supposed to be drug experts after all.”

Having a further qualification to enable pharmacists to prescribe might encourage young pharmacists to stay in the profession, providing a focus to work towards, said Navneet Kaur Saggu, from the School of Pharmacy, London.

Many students felt that prescribing is an area where pharmacists should work with other members of the health care team. Pinkie Morjaria, at Manchester, had been impressed by an oncology hospital pharmacist who worked with a consultant. The consultant diagnosed the condition and then the pharmacist took over, prescribing the most appropriate drugs. James Davies agreed that this was the only way. “A lot of things pharmacists do now can be done by other people but this is the one thing we can do better than anyone else and this is the way pharmacy has got to go.”

John Dickenson, studying in London, believed strongly that pharmacists should not be diagnosing conditions but rather playing a role alongside doctors in which the doctor would make the diagnosis and the pharmacist then choose the drugs. According to Ruth James, University of Cardiff, “a joint consultation with a doctor and a pharmacist with pharmacy input from the start would be the best approach”. However, this was unlikely to work in community, the students felt.

James Davies said that pharmacist prescribing should take the form of prescribing for minor ailments and repeat prescribing for long-term conditions. Natasha Povey, from the School of Pharmacy, London, pointed out that there were examples of conditions seen by community pharmacists where the pharmacist knew exactly which prescription only medicine was needed but was unable to prescribe it. She hoped that pharmacists who had had extra training might be able to prescribe these drugs in the future.

Under-rated 

Pharmacy students are frustrated by the fact that pharmacy appears to be under-rated and under-recognised and that pharmacists lack enthusiasm. They are concerned that they will not be fulfiled by a career as a pharmacist.

Sandeep Ghir said: “I think generally pharmacists are under-rated but we need to get ourselves recognised because no one will do it for us. The pharmacist’s role needs to be recognised not only by patients but also by other professions.” Helen Seelly said: “A major problem I see is with our image. The general public still view us as tablet counters. More promotion of the services we have to offer is needed.”

Students also felt frustrated that news often focuses on other members of the health care professions rather than on pharmacy, particularly in recent months over hospital pharmacists’ salaries. Clare Karia, studying at Cardiff, said that pharmacists are good at talking about the problems they are facing among themselves but that no one ever appeared to do anything about it.

Navneet Kaur Saggu said: “We need to be remunerated for the work we are doing: from my work experience it seems that pharmacists are over-stretched and underpaid. This needs to be addressed in order to keep people in the profession. You can only put in so much without being put off.”

Anile Majid, at London, said that she would prefer to have a clinical role in hospital but was concerned that there was not enough money in the area. She anticipated working in hospital for a while and then being forced to leave if the pay was not high enough. Natasha Povey agreed saying that she would work in community first to pay off her debts and then try to move into hospital pharmacy later.

One of the themes of frustration for students was over career progression. “If you go into community pharmacy you are almost saying that you don’t mind not having career progression,” said Natasha Povey. Sandip Ghosh said that little was known about career prospects. Pinkie Morjaria suggested that having careers talks in the early part of the course would have been useful, giving them some time to think about what option they wanted to pursue.

Concerns exist over not being fulfilled as a pharmacist. Andrew Lumby, from the University of Cardiff, said that the Government needs to make the public more aware of what pharmacists can offer, such as being able to give advice.

Monali Shah said that it is difficult to find an enthusiastic registered pharmacist. James Davies explained that some pharmacists had said to him that they regretted doing pharmacy as a degree. Although there were some enthusiastic pharmacists around, the students felt that there was generally a negative air in pharmacies. James Davies said that he thought there was a lot of disillusionment in some areas of pharmacy, particularly community pharmacy where pharmacists appeared to think that they had a “raw deal”.

Misconceptions still surround pharmacy among other professionals. Pinkie Morjaria said: “One of my friends who is studying medicine asked what pharmacists would do if automated dispensing is brought in. He really thought that all pharmacists do is dispense.”

Emma Matthews said that bringing different health care students together in a practical situation would be useful so that each profession could see the input that the others could contribute. Lynwen Jones thought that studying common modules together might be a possibility that would help to break down barriers between professions so that different students could see what issues other professions had to think about. Sharing parts of the course might help doctors to see pharmacists in a better light. Simon Purcell, studying in Cardiff, suggested combining doctors’ and pharmacists’ continuing professional development and arranging local CPD meetings.

Tomorrow’s pharmacists know what they want: if the profession wants to keep them as pharmacists, then now is the time to tackle the hurdles standing in their way.

Preregistration placements and other problems facing students

None of the students interviewed at any of the universities had found finding a preregistration place difficult. A problem identified by some students looking for community pharmacy placements was that companies and hospitals used unhelpful tactics to ensure students were committed to them alone. In particular, students identified two problems: offering places during the summer vacation to try to poach students before they had interviews with other companies and withholding offers of places until after offers from other companies had expired, leaving students in the position of having to reject or accept the first offer without knowing whether or not they had a place with the second company. The problem was not restricted to community pharmacy. Hospital pharmacies also offered places to students and asked them to accept or decline within a short period, knowing that the student had other interviews to come after the deadline they imposed.

At Cardiff, prospective employers were asked to forward offers of placements to the university’s careers office so students received them all together on the same day. Most companies had followed this procedure.

Some students felt that the talks that community companies had given had not been informative. “They were just along the lines of: come and work for use, we are the best, we have never had anyone fail,” said James Davies, from Manchester. Talks from preregistration tutors would be more useful, said Monali Shah, at Manchester as well. Some students had had study days about how to apply for preregistration placements as part of their summer vacation work and this was seen as particularly useful. Talia Flanagan, from Cardiff, said that she did not think there had been enough information about careers in industry.

Support from other pharmacists and preregistration trainees would be useful, particularly more contact with newly qualified pharmacists. This would be useful if it were organised at a local level, not necessarily within the same company, said James Young, studying at Cardiff, perhaps organised by local branches of the Royal Pharmaceutical Society.

A lot has been said about dumbing down of “A-levels”. These have not got easier but resources are more easily available so people have more opportunity to do better, according to Jayne Williams, from Cardiff. In addition, Jenny Richards, a fellow Cardiff student, said that the modular system gave people the opportunity to get better grades: people can resit the module examinations in order to improve grades.

Talia Flanagan pointed out that other health profession students could get NHS sponsorship but that pharmacy students could not. “Since there is a shortage of pharmacists, surely this would be a way of encouraging more people to study pharmacy,” she said. Ruth James, also at Cardiff, thought that this was an example of pharmacy being the forgotten health care profession. “We always hear about the shortage of doctors and nurses but never pharmacists,” she said.

Chi Cheung, School of Pharmacy, London, said that there appeared to be fewer students studying sciences, either at “A-level” or degree level. “In my opinion, pharmacy can do much to reverse this trend by developing relationships with education authorities to convince students that learning about sciences is enjoyable, as well as being a useful skill.”

Pinkie Morjaria, from Manchester, suggested that pharmacists should be giving talks to schools about pharmacy as a career because most pupils knew little about the profession. Other courses are better promoted in schools and at careers’ conventions, the students felt. James Gilbey, from the University of Manchester, said that the perception of the pharmacist among school students was of a tablet counter and that this issue needed to be addressed.

 

Citation: The Pharmaceutical Journal URI: 20005799

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