| Although a great number of pharmacists want to become supplementary prescribers,
the number of places on the training courses is limited. Only a select
group of pharmacists have made it into the first cohort. Lyn McDonald
and Dr Mohamed Elfellah are two such pharmacists. Both are attending
the supplementary prescribing training course at the Robert Gordon University
in Aberdeen.
Lyn McDonald |
Mrs McDonald is a primary care pharmacist in central Aberdeen. Her time
is split between four GP surgeries. One of her roles is to support nurses
by reviewing patients’ medicines before chronic disease management
clinics and as part of annual care of the elderly assessments. “Recently
I have found this can be quite long-winded and involves me speaking to
the nurse, patient and doctor,” she comments. Becoming a supplementary
prescriber will allow Mrs McDonald to review and make necessary alterations
to medicines by having a consultation with the patient herself. “Initially
I would like to prescribe in hypertension, but there is scope to include
more chronic diseases, such as asthma, chronic obstructive pulmonary
disorder and diabetes,” she says.
Dr Elfellah has worked in the cardiac unit at Aberdeen Royal Infirmary
for the past eight years. “So I hope to be a supplementary prescriber
in cardiology,” he says. He expects that this will also extend
beyond drugs specifically for cardiac conditions to other drugs that
cardiac patients might need such as laxatives or pain killers.
Mohamed Elfellah |
Dr Elfellah is frustrated with the current system: “I have been
writing discharge prescriptions on the cardiac ward for two years but
each has to be confirmed by a doctor.” In addition, he has written,
with the consultants’ approval, the hospital’s prescribing
policies for various cardiac diseases such as heart failure, myocardial
infarction and atrial fibrillation. His frustration is that, despite
this knowledge, he has not been able to prescribe himself. Progress so far
So after six weeks on the course, how are they getting on?
“I’ve completed the therapeutics module in hypertension,” says
Mrs McDonald. “And I’ve just started the next module which
is about models of consultation. This is the new thing for me as a pharmacist.” She
explains: “I have done lots of patient counselling but it is always
at the end of the patient’s journey. When pharmacists have prescribing
rights it will mean that we are discussing the patient’s management
at the beginning. This is what is so new for me so there is plenty of
learning to be done.”
Mrs McDonald adds that she has found it interesting to see the different
range of consulting styles that doctors have.
Ruth Edwards, lecturer in pharmacy practice, comments that a lot can
be learnt from doctors: “Because it is a new role for pharmacists
we have got to learn from medical models,” she comments.
Dr Derek Stewart, senior lecturer and prescribing course lead, says that
the course examines communication and asks pharmacists to reflect on
their own styles of consultation. Learning styles have changed, and many
of the pharmacists on the course have been qualified for a number of
years. This is inevitable since having experience in practice is a prerequisite
to become a supplementary prescriber.
Students are encouraged to identify their own needs. Dr Stewart explains
that the philosophy behind this is the Royal Pharmaceutical Society’s
approach to continuing professional development — reflect, plan,
record and evaluate. “Obviously this is more difficult for a learner
than being told what to do,” he comments.
Part of the supplementary prescribing course is a period of learning
in practice, where the pharmacist works with a medical practitioner who
acts as a supervisor. Mrs McDonald has already started this part of her
training. “I have been sitting in on consultations with the GP
and have been learning to take blood pressure measurements,” she
explains. Dr Elfellah plans to start his period of learning in practice
after the residential course. “I thought it would be clearer after
the course what had to be done in the 12 days,” he says.
Dr Stewart explains: “We do not specify what the student has to
do during the period of learning in practice: it is up to the student
and medical practitioner to come up with a plan to meet the required
competencies.” Pharmacists have to complete the equivalent of 12
whole days of practice but they do not have to be done at once. Mrs McDonald,
for example, has completed several four-hour sessions.
Patients have been positive about Mrs McDonald’s new role. “The
patients have been fine about me being present during the consultations
despite the fact that they have had a wide variety of presenting complaints.
None was surprised that a pharmacist was there: this shows the change
in perception that pharmacists are now considered part of the primary
care team,” she comments. “The doctor said to some of the
patients that I would be giving consultations in the future and their
reaction was ‘that’s fine’.”
Is it easy to balance the course with work and other commitments? Both
Dr Elfellah and Mrs McDonald admit that it is hard but that it will only
be for a short time.
Some pharmacists might choose to develop their skills further. Dr Scott
Cunningham, postgraduate programmes leader, points out that credits earned
in the supplementary prescribing course can count towards the postgraduate
certificate in prescribing sciences.
All the pharmacists on the course at Robert Gordon University had to
prove that there was a clinical need for them to become supplementary
prescribers. But what do they think the future will hold for pharmacists?
Mrs McDonald sees a role for pharmacists managing chronic diseases “that
doctors just don’t have time to do”. She hopes to have a
clinic within each of the surgeries she currently works in. This could
be open to 35,000 patients across the four practices. “If pharmacists
want to feel integrated in primary care then supplementary prescribing
is something that is inevitable. It will improve patient outcomes,” she
says.
Dr Stewart comments: “One of the consultants at the local hospital
told me that he has problems getting medical staff to run a heart failure
outpatient clinic. This is an obvious area for supplementary prescribing:
if the patient is given a clinical management plan on discharge then
a supplementary prescriber can ensure its implementation at the follow-up
outpatient clinics.”
Dr Elfellah hopes that supplementary prescribing will be a step towards
independent prescribing for pharmacists. “Once the patient is diagnosed
as having a condition then we don’t need the doctor to prescribe.
It should be the pharmacist’s job,” he says. “Every
pharmacist should be a supplementary prescriber.” |
