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Prescribing the way forward

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My journey as a pharmacy manager has had its ups and downs. Yet, something that never ceases to make me smile is remembering the sensation of panic that would to overcome me every time a doctor would ask a clinical question. Every time, I would make a dash to the BNF, frantically flick through the index pages for my dear life and try to construct an answer that would appear reasonably intelligent. After the commotion, I would reflect and ask myself ‘Why would I know? I’m only a community pharmacist’.

And this is where I went wrong...

One of the perks of working in a medical centre is the direct phone line from the surgery next door to the dispensary. Thus, any questions related to patient medications are ringed through. If I wasn't such a goody two shoes I would have clipped that phone line on day 1!

Initially, queries were small and I would answer them to the best of my ability, put the phone down and then feel a sense of achievement. As my relationship with the surgery grew, I began receiving more complex queries; about licensing issues, whether certain patches can be cut in half; about formulation alternatives for patients with dysphagia etc. 

To help, I began taking my UKMI training manual from my Medicines Information rotation at Guys Hospital to work and using it to answer queries-something I thought I would never need while working in community pharmacy! I began thriving on the pressures of finding solutions to problems. Finally, I was making full use of my pharmacy degree! This in turn has helped in not only becoming part of a close-knit team within the medical centre, but also in aiding prescribers regularly on treatment regimes.

…So, all of this has got me thinking: What if a doctor’s role was to diagnose and a pharmacist’s role was to prescribe?

Imagine a patient walking into a pharmacy clutching a script detailing their diagnosis. The pharmacist would study the diagnosis, be able to view the patient’s medical history and formulate a holistic treatment plan. For example, if this patient had asthma, the history of symptoms, peak flow readings, past medical history, would all be accessible. This would allow the pharmacist to calculate what step of treatment according to the BTS/SIGN guidelines should be initiated. With placebo inhalers at the ready, a decision on whether a easi-breath, accuhaler or an evohaler would be best suited to the patient, could easily and efficiently be made.

With pharmacies being easily accessible, any adverse drug reactions could be readily reported and alternatives prescribed swiftly. The need to see the GP due to drug incompatibility could be prevented with a pharmacist being able to prescribe an alternative medication, especially in long-term conditions. This would not only save GP time but also allow pharmacists to reach out to patients that cannot get time off work to report treatment failure. Long-term conditions such as diabetes could be monitored and controlled within a community pharmacy and if complications arose, the pharmacist could liaise with the doctor to decide the next step.

Of course, this hypothetical utopia has some issues that would need ironing out, but with recent news that some 100 hour pharmacies might be going bust (here)perhaps providing funding for the pharmacists to become independent prescribers in such pharmacies can benefit walk in centres and A&Es.  The NHS should formulate a crash course that would allow pharmacists to prescribe a series of medication that are currently regularly prescribed by doctors working in A&E- a sort of 'step up' from the minor aliment service. If this reduces the number of A&E admissions for ailments that can easily be treated in the community, then potentially millions of pounds can be saved for the cash-strapped health service. 

Adding to this, a system can be formulated where access to A&E can only be achieved on referrals, where a message is sent to the patient's choice of A&E allowing the use of the service. Without this the individual will not be able to use the accident and emergency services. Such referrals can only be made by 999 and 111 numbers, doctor surgeries, walk in centres and of course pharmacies.

We, as pharmacists, know that we have the potential to make real difference in the community. But this potential can only be tapped if our skills and expertise are fully utilised. 

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From: Tomorrow's pharmacist blog

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