Primary Care Pharmacy November 1999 Vol 1 No 1 p8-9
Working for Boots
Primary care pharmacy a company perspective
By Andrew Bellingham BPharm, MRPharmS
Boots the Chemists now employs many primary care pharmacists, but the role is adaptable to suit local needs
The recent changes to the National Health Sevice, and the formation of primary care groups, have resulted in pharmacists and pharmacy needing to adapt quickly to new roles. The primary care pharmacist (PCP) is a relatively new role for Boots the Chemist Ltd, which has created PCP jobs in each region of the country. My area, East Kent, covers four PCGs.
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Andrew Bellingham: "communication is vital" |
Health promotion
Health promotion is a topic which takes up a lot of my time. I feel that it is an immensely important area. Health promotion is a vital tool in improving health, and the days of only having a few leaflets in a rack are long gone. Instead, leaflets form just a small part of a display which tends to be "hands on". For example, as part of No Smoking Day, we organised a machine that measured the level of carbon monoxide in the breath to be available in a store. This was a useful tool to explain to people the damage smoking was causing and stimulated a lot of interest in the health promotion stand.
Each health authority and PCG has topics which they are focusing on. In my area, one of the PCGs has selected diabetes and coronary heart disease and, in particular, how to reduce their incidence. I work with pharmacists at Boots stores and the PCG on a particular promotion to achieve a joint approach which makes a bigger impact on the general public. If a patient sees information about, for instance, coronary heart disease at the doctor's surgery and then receives advice about lifestyle changes to reduce heart disease at the pharmacy, then a stronger message comes across. One of our recent successes in health promotion involved a nurse measuring patients' blood glucose levels in a Boots store during Diabetes week. In addition, staff tested patients' glucose monitors, gave advice about diet and foot care and discussed the risk of heart disease and appropriate lifestyle modifications.
Relationships
I find that an involvement with health promotion has great benefits for our patients, builds strong relationships with other health care professionals and institutions (like schools and universities) and is also beneficial to myself as I can increase my knowledge in a particular area. A topic which I am looking to promote in the future is men's health, specifically prostate and testicular cancer.
I spend a great deal of time looking at ways of working with GP surgeries. This is another key area that pharmacists can, and should, become involved in.
Joint health promotion is an obvious link but there are an increasing number of opportunities for pharmacists. A repeat prescription collection service reduces patient pressure on surgeries while saving patient time. It also provides a starting point for pharmacists to build relationships with the surgery staff. Likewise, pharmacists can suggest drawing up joint protocols for dealing with missing details, such as quantities and strengths, from prescriptions.
Another idea for working with GPs, which is still in the early stages of development, is the referral form. For example, in the case of influenza symptoms, instead of writing a prescription, the doctor will pick an appropriate type of medicine, eg, cough suppressant, from a list of over-the-counter products. The patient then takes the form to a pharmacy where the pharmacist can decide which product is most appropriate for the patient. At present, the form is on trial in certain areas of the country and although it is not yet operating in Kent, I would like to see it being introduced in the future.
The surgeries that I have visited have been receptive to these kinds of ideas and it is my job to encourage other pharmacists to continue to develop good relationships with their local GPs.
In addition, I build links with other health care professionals such as district nurses and dentists. We all share a common interest - the patients' welfare. A current important issue is the change over to CFC–free inhalers. Earlier this year, I visited a nurse who was running an asthma clinic at a GP surgery and gave her advice about CFC–free inhalers. As a consequence, I have built a good relationship with both the nurse and the surgery, and they have benefited from being well informed, so the transition of their patients to CFC–free inhalers was smoother.
Some Boots pharmacies in my area supply residential homes with medication using our monitored dosage system. Advisory visits to the homes form an integral part of the process. I make some of these visits which I find very rewarding because making small changes can be very beneficial to patients. I also give advice to pharmacists who have not previously been to residential homes about how to make a successful visit.
There are four PCGs in my area and I liaise with them all. Many PCPs are involved in prescribing work with GPs. Within Boots, they use the company's clinical pharmacy services package which looks at topics such as generic prescribing and repeat medication review. In East Kent, each PCG has appointed a prescribing advisor so this is not an area I have been able to become involved in at present. I also have a good relationship with the health authority's pharmaceutical advisor who keeps me informed of items of interest for local pharmacists. For example, at the end of 1998, East Kent health authority launched a methadone supervision programme which has been very successful and most of our pharmacies are involved in the scheme.
I also attend local branch meetings and am a local pharmaceutical committee (LPC) observer. The LPC provides a vital information source for me. It is useful to find out the ideas that the LPC has, which I then try to incorporate into my objectives.
Training
I am involved in the training and development of all our staff pharmacists, preregistration trainees, dispensers and health care staff. I assist the Boots teacher practitioner (based at Brighton University) in the training of preregistration trainees as part of special training days covering clinical topics. I also visit the graduates in store to check on their progress and offer them support if needed.
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Training health care staff is a key role |
Conclusion
There are two keys to my role: locality and communication. Everything that I am involved in is at a local level. Every area of the country will have different health needs or goals to suit the local population, so the PCP role has to be adapted according to these constraints.
Communication is vital to PCPs. I ensure that all our pharmacists in East Kent are aware of local initiatives and share ideas between them to constantly improve our service as a whole. I communicate ideas between the health authority, PCGs and Boots. Effective communication is vital for liaising with other health care professionals and is also essential when seeing patients in the pharmacy.
The future for my PCP role is an open road. It will change to encompass developments occurring in the NHS and in the profession of pharmacy, but its aim, as ever, will be to deliver the best service to the patient.
Andrew Bellingham is a primary care pharmacist working for Boots the Chemists in East Kent.