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A total of 240 pharmacists have now registered as supplementary prescribers,
Gul Root, principal pharmaceutical officer at the Department of Health,
told a conference session that heard about the experiences of three
of these prescribing pharmacists.
Rimal Patel, a community pharmacist in Brixton, London, described his
experience as an independent pharmacist. His key message was to find
out about the process of supplementary prescribing and whether it would
fit into a proposed service before undertaking the course. In addition,
he stressed that it is important to find out if there is funding for
the future service and exactly what that funding is for.
“My expectation was that I would get funding because the primary
care trust supported my application to become a supplementary prescriber.
However, that has not been the case,” he said. The PCT had even
contributed to his locum costs so that he could undertake the training,
something that he believed to be relatively unusual.
“Initially I proposed a diabetes and coronary heart disease service
but that was not funded by the PCT,” Mr Patel said. Instead, he
has set up a smoking cessation service and has plans to extend this to
asthma
and chronic obstructive pulmonary disease.
Before he became a prescriber Mr Patel already ran a smoking cessation
service in which nicotine replacement therapy could be supplied by protocol. “As
a prescriber, I can work outside product licences as well so, for example,
I can prescribe NRT to patients with coronary heart disease,” he
explained.
This experience has led him to conclude that there are three questions
that should be asked about any proposed service: Does it meet the needs
of the patient? Does it meet the needs of the organisation? Is the service
safe?
“Training to become a supplementary prescriber is worth it if you
are prepared to put in a lot of work,” he concluded.
Clare Watson: service to start soon |
Clare Watson, a pharmacist at Boots The Chemists in Aldershot, gave
a perspective as a supplementary prescriber working for a multiple organisation. “The
opportunity to become a prescriber arose through a local asthma project,” she
explained. “At the time, I was coming to the end of a clinical
diploma and looking for an opportunity to use those skills.”
Ms Watson received financial support for her training from Boots. This
included her course fees, salary on days she attended the university
and pharmacy cover to allow her to take time off. “The challenge
for me was finding an independent prescriber,” she said. “I
already had a place on the course and had to find an independent prescriber
afterwards.” This was made difficult because her training was not
funded by the local workforce development confederation. “This
is a problem for employee pharmacists,” she commented. Eventually,
Ms Watson found a GP and completed the training.
The service she has developed is to manage patients with asthma and COPD.
It will be based in the Boots store and will be provided free of charge
to her linked GP’s practice for six months, after which she hopes
the practice will decide to fund it. “A consultation area is about
to be built beside the dispensary so the service is not up and running
yet but I am optimistic that it will be in the next few months,” she
said. “Then, I will spend one day a week working as a supplementary
prescriber. The independent prescriber has already identified 16 patients
to take part in the service pilot.” Scottish experience
George Romanes: successful service |
George Romanes, a community pharmacist in Duns, Borders, gave a Scottish
perspective on supplementary prescribing. He has already started to
prescribe and 50 clinical management plans have been written, of which
17 are now operational.
“After a discussion with the local GP practice, we decided that the best
way to offer a service was to start with the people that annoy them:
the ‘do not attends’,” he said. Specifically, they
selected patients with asthma, particularly because monitoring required
non-invasive checks that could be
easily carried out in the pharmacy. His pharmacy is in the centre of
town so allowed easy access.
“Being able to prescribe has helped me to encourage patients to use
preventer inhalers because I can talk to them about the inhaler and then
give it
to them to take away there and then,” he commented.
The success of the service has led Mr Romanes to expand his prescribing
role into a different clinical area. From October, he will be one of
three supplementary prescribers in the NHS Borders area who will be screening
patients aged over 60 years for
hypertension and taking over their care using clinical management plans.
His advice to other community pharmacists was to make effective use of
trained technicians and to have a good-sized consultation room. In terms
of funding, he said that he was paid £93 for a three-hour prescribing
service based at his pharmacy. “Through supplementary prescribing,
you are seen as a primary care team member,” he said. “I
would encourage other pharmacists to go for it.”
During the question session that followed the presentations, the pharmacists
were asked about problems with access to patients’ medical records.
Both Mr Patel and Mr Romanes said that access to notes was achieved by
physically going to the GP surgery. Neither was restricted in the level
of access they had. Mr Romanes also pointed out that access to notes
is needed not only before prescribing but also afterwards to add information. “We
are lucky to have NHSnet connection so we can send information to the
surgery which can then be added to the notes,” he commented. Ms
Watson is planning a system of remote access to the surgery’s patient
records, but only to those patients for which she has clinical management
plans.
Another questioner raised the issue that if a nurse and a pharmacist
were both qualified as supplementary prescribers, was it cheaper for
the PCT to fund a nurse-run service? Ms Root said that she hoped pharmacists
would be able to demonstrate added value. Ms Watson pointed out that
pharmacies are open long hours and on Saturdays but a nurse clinic would
be run during surgery hours, which might not be convenient for patients.
Mr Romanes added that the introduction of the new GP contract means that
many surgeries are closing on Saturdays, something he described as a “black
hole”. He commented that patients will start demanding access to
health services on Saturdays
and asking PCTs what pharmacists could
provide. |
The
Pharmaceutical Journal