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Dipak Nandha
June 1985 to present Director and pharmacy superintendent, Kanset
Pharmacy (Peeredge Ltd), London.
1996 MSc Community Pharmacy, King’s College.
1984–85 Manager, Valu Chemist, Acton, London.
1982–83 Partner/proprietor, Fontain Chemist, Wembley, Middlesex.
1981–82 Self-employed locum pharmacist.
1980–81 Preregistration trainee, Boots, Greenford, Middlesex.
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My career
Thinking of changing your career?
This series profiles different
careers in pharmacy. It is designed to provide a taster of
work in different specialties.
Any pharmacist who would like to
contribute
to the series should contact the editorial office on 020
7572 2429 or e-mail editor@pharmj.org.uk in the first instance. |
I can pin down the birth of my aspiration to be a pharmacist to the
age of 10, when a photograph of me was taken in a Willesden Green pharmacy.
My careers adviser tried to dissuade me from studying pharmacy and had
I followed his advice, I would have been a nurse today.
After graduating from Portsmouth and a year of rigorous preregistration
training with Boots, I decided the corporate shackles were not for me.
I wanted to work for myself, and help patients in a positive way.
My career began with locum work. The difference between pharmacies was
amazing and it highlighted how diverse they were. Towards the end of
my first year as a pharmacist, I took charge of a busy store and that
was the ultimate preparation for the plunge into ownership.
In 1985 I bought a rundown pharmacy in west London, with the support
of my family. I attribute to them much of my subsequent success. Community
pharmacy is still one of the best careers and mine, as an independent
contractor, has been fulfilling.
The evolution of the community pharmacist’s role places greater
emphasis on competencies and skill mix, and we need to be on the ball
to compete with the multiples. Independent contractors bring something
unique to local communities. But their number is dwindling fast.
Increasing
workloads, eroding margins, the threat from 100-hour pharmacies, internet
dispensing and Category M price reductions all require contractors to
fight their corner.
Broadening clinical knowledge and using business acumen offer ways to
survive. That is why I undertook an MSc at King’s College London
in 1996. This has had a huge impact on my career. Patients and customers
recognise the expert advice they get and this has boosted growth in sales
at my pharmacy.
The MSc provided fresh impetus for me to get involved in new initiatives
and to work more closely with my primary care trust. I was appointed
to the area prescribing committee in 2000. I subsequently did some formulary
work for the PCT in wound management, and helped develop its minor ailments
scheme.
I have also contributed as an independent contractor representative on
the pharmacy contract implementation group for the PCT and in the same
capacity on the pharmacy development group. But it was the spell of work
that I did as a coronary heart disease (CHD) facilitator in 2000 for
the Ealing, Hammersmith and Hounslow Health Agency that gave me the greatest
satisfaction.
In that role, which included the roll-out of the joint British Society
guidelines on the prevention of CHD to GPs and implementing the national
service framework guidelines, we facilitated healthy heart clinics for
at-risk patients at GP practices. The sessions were jointly run with
a nurse, and the role of the pharmacist was to review the patient’s
medication and address any pharmaceutical issues.
An interesting facet
of the work was the inclusion of an exercise adviser who provided individual
behaviour change counselling. The multidisciplinary working between GPs,
nurses, pharmacists and exercise adviser in tackling CHD provided benefits.
The project demonstrated the impact of a pharmacist’s intervention
in disease prevention and chronic disease management.
Each day is different. It is not beyond the realms of possibility to
have a patient having an acute asthma attack in your pharmacy, a queue
of patients waiting for prescriptions, a GP seeking prescribing advice,
a request for emergency hormonal contraception, and a client that needs
his methadone dose, all at the same time.
The ability of pharmacists
to multitask amazes me. Most GPs and nurses have no idea how a pharmacy
works and those that have spent a day with me acknowledge the difficult
job we do.
I am now on the brink of a new chapter in my career. What I hope to do
next is to work in a hospital pharmacy, perhaps for one day a week, with
a view to carrying across all the good practice from secondary care to
my community pharmacy.
Hospital pharmacists often see a patient’s journey from admission
to discharge. By viewing patients’ medical and drug charts, they
can ensure that better clinical assessments are made for the appropriateness
of prescribed drugs. There is an opportunity for counselling and to attend
designated ward rounds, and it will also allow me to interact with doctors,
consultants and specialists.
The Government aims to shift more of the secondary care into the community,
so there is likely to be an increased demand on community pharmacists
to monitor and prescribe drugs. Gaining experience in hospital will help
me prepare for such a role.
It is a barrier to best practice that community pharmacists cannot access
patient medical records because that would enable them to make better
clinical decisions. The electronic prescription service could develop
so that basic patient notes are tagged to the electronic prescription.
Even the mere inclusion of the clinical indication for each item sent
to the spine could help. Thus, a prescription that is pulled down from
the server for a drug such as co-amoxiclav could include a note to state “for
dog bite”. This would allow a pharmacist to check whether the drug
is clinically appropriate.
The new pharmacy contract is a quagmire for many pharmacists. The spotlight
has shifted from the patient to regulatory aspects, and that has meant
that pharmacists spend more time grappling with administrative tasks
than at the pharmacist/patient interface.
Despite the turmoil in our profession, I am convinced the new pharmacy
contract can transport pharmacy to uncharted realms of healthcare. I
am benefiting from the wealth of experience that is accumulated only
over time, and this is reflected in the service my patients get. Who
can deny the ring of truth in the words “The years teach much which
the days never know.” |
The
Pharmaceutical Journal