The Pharmaceutical Journal
Vol 280 No 7488 p164
9 February 2008

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Independent community contractor

A community pharmacy career can place you at the cutting edge of health policy development, says one independent contractor. Sue Laird reports

Careers series

Community pharmacist Andrew Burr is a man on a mission: to “make medicines work for patients” by expanding the role of clinical pharmacy outside hospital.

The logic is unassailable: as he points out, pharmacists see patients a lot more often than GPs do. “A patient on repeat prescriptions will probably only have a six- or 12-month review with a GP,” he said.

“But patients and carers come into the pharmacy every month for prescriptions, and that provides a real opportunity to intervene that the GP simply does not have.”

Pharmacists are experts on drugs, but have not played to that strength, he believes.

In becoming a pharmacist Mr Burr followed in his father’s footsteps, but the decision was not a foregone conclusion.

“When I was 18 I thought about my future and saw a real opportunity in pharmacy. I wanted to make sure that medicines work for the patient. I was interested in the clinical possibilities. I did a hospital preregistration to get clinical experience, followed by an MSc and clinical diploma — novel because at the time clinical and community pharmacy didn’t mix — in Newcastle.

“After the MSc I embarked on a research programme, which involved developing drug formularies for cardiovascular disease with about 60 GP practices across Mid Glamorgan. From there I was involved with the Audit Commission, which was preparing a report on prescribing, looking at how to bridge the gap between hospital and community.

“The work in Wales led me to the idea of pharmacists working in GP surgeries. I was doing sessions, running clinics 15 years ago.’

The other element of Mr Burr’s work in Mid Glamorgan (Rhondda Fawr) involved introducing new services, delivered in community pharmacies.

Mr Burr said: “GPs are less accessible than pharmacists and have less time to spend with patients.” Under the new service developed and piloted in Mid Glamorgan, the community pharmacists would identify prescription interventions and provide written notification to the respective GP.

The GP would then decide whether or not to implement the intervention and had the help of the primary care pharmacist to ensure decisions were followed through. There was one primary care pharmacist in each cohort of about 10 pharmacies and six GP practices.

The pharmacists also developed a medicines management role in patients taking ulcer-healing drugs. “We wrote to about 400 people on the drugs to invite them to go to their pharmacy for a Helicobacter pylori test. Only those pharmacies that met the standards and had a separate room in which to see patients were allowed to participate.”

The initiative resulted in a significant decrease in ulcer medication. “It had a very big and positive impact on patients,” said Mr Burr. It was the collaboration between GPs and community pharmacists that led to the improvements in service, he added.

Mr Burr then made a career jump to a company developing electronic prescribing. “This was highly controversial at the time as many pharmacists saw the company as a threat to the future of the profession,” said Mr Burr, who is convinced that electronic prescribing is the way forward.

Mr Burr subsequently returned to community pharmacy to run his father’s business. “We rebranded the Tamworth Pharmacy in 2002 and won six different awards.” Services included telephone blood pressure services and others for heart disease and diabetes.

The telephone approach made services more accessible. Patients could go to their local pharmacy instead of the GP surgery. Mr Burr said the system would work best if the pharmacist had access to the patient’s clinical record.

Mr Burr has now qualified as an independent prescriber. “My ambition when my career started was to see the pharmacist prescribe, to use my knowledge of medicines. I want to develop that in community pharmacy through services such as travel advice clinics. Independent prescribing will open many opportunities for pharmacists.”

The next step for Mr Burr’s business is use of robotics. He said: “We are about to open a new pharmacy with robotic dispensing. This will minimise selection errors, the biggest source of error in pharmacy.

“When electronic transfer of prescriptions (ETP) comes in what the GP puts into the computer system will hit the robot system and the robot will get it off the shelf.”

Mr Burr believes ETP could open the way for greater pharmacist involvement in patient follow-up. “You need to put pharmacists further up the chain, so they can talk to patients about the effect of the medicines they are taking. We (healthcare professionals) are appallingly bad at follow-up. We need to build systems to ensure that when we prescribe we follow up and review the patient.

“Prescribing is what pharmacists can bring to the party.” The ETP programme could open the way for pharmacists to have much more contact with the patient, Mr Burr believes. It heralds the end of the days when proximity to a GP practice would guarantee a profitable community practice.

Pharmacies could be sited in areas where there are no GP services and, with electronic transfer, that would not matter so long as it was convenient for patients, who could pick up their prescriptions and get medicines reviews close to home.

Mr Burr believes that pharmacy is a good career, with plenty of opportunity, “One of the biggest things that holds pharmacy back is pharmacists themselves.” Pharmacy as a career offers many opportunities and if you don’t take them, someone else will.

“It is said that the real art of discovery is not in finding new lands but seeing with new eyes,” he added.