There are some things an SOP or dispensers cannot do, and an urgent referral is one of them!

Never one to shy away from an argument, independent proprietor Sid Dajani shares examples of where he recently stood up for the cause

 

I guess that, astrologically, this has been a heavy-duty time in my chart and I have little to show for it except exhaustion and weight loss and, as I write, we haven’t even reached June. I usually feel this fatigued after Christmas, not before it! But at least the meetings I have been to have been fun and not the usual ones where you get the rigor mortis creeping up the back of your neck.

I have also done several interviews for newspapers, radio and TV recently. Sixteen radio interviews were about common ailment schemes, one was on prescribing and another questioned why we as a profession think we can do a doctor’s job better than they can.

Some may feel more perturbed about doing live radio or TV broadcasts than newspaper interviews. And rightly so because, until you see something in print, you don’t know how the interview will turn out. I have been misquoted and had things taken out of context almost as if written by an ex-partner where the relationship didn’t end too-well!

Sometimes I have emphasised something as important which was not been included at all and the omission makes me look stupid, and other times I’ve said something that’s clearly not been understood. As some reporters hate letting you see their copy before publication, you’re pretty powerless.

I still cringe when I think of how, on one occasion, I simply explained how statins worked and where cholesterol came from. The reporter cut out the main metabolic source and focused on the less important dietary one, which made me look more of a fool than normal. Having to explain myself after the plethora of complaints, when I was in reality a victim, is comical in hindsight but it was not so at the time.

Learning the lesson

 

The lesson learned is that, if you don’t want to see something in print, don’t even bother mentioning it either for completeness or even in passing. It’s a risk you take, or pharmacy stays the Cinderella profession.

On live TV and radio, on the other hand, what you say and how you say it is what the audience hears. And that for me is the comfort blanket.

For one of these interviews, the radio reporter was obviously very GP focused and seemed to want to ridicule pharmacists as “shopkeepers” and a poor alternative to GPs. I was caught between saying what I really thought and professional restraint. But my top tip is always to introduce new information so that, even if an interview is about a particular subject, highlight another one that you want to talk about. In this way you may be able to steer the interview to a place where you feel more comfortable.

So while the interviewer was looking to get criticism of GPs from me, I was talking about all the good we do when GPs may not be readily accessible – the fact that we are gatekeepers of medicines and their safe use and that we are also the gateway to health services generally. I mentioned prescribing, screening, medicines use reviews, over-the-counter medicines, deliveries and ’flu vaccines, the common ailment scheme, alleviating NHS pressures, GP waiting times (with a polite smile in case any of you might be listening and could see down the phone line).

The interviewer kept saying that she wasn’t aware of this or that. Then she asked why, if we were so skilled, more people did not know about what we did. The discussion then moved on to how we could best publicise our roles. Mission accomplished!

Multitasking for pharmacists

 

We pharmacists have to always think fast on our feet and be good multitaskers. Another quality I think a good pharmacist needs is a sense of humour and a taste for satirical entertainment. I have relied on both this month and more so than usual. I had to visit the local hospital recently for a blood test and blood pressure check. While there I overheard one of the hospital pharmacists answering a query from a pre-registration student about the difference between working in hospital and in community. The answer was short and to the point: “Better shop-keeping skills”.

I could hardly contain my annoyance as I interjected to provide the student with a more accurate and in-depth run-down on my job. I was hoping she would try to defend her opinion and a debate was to be had. Alas, there were no winners. You’d expect such far out and uneducated claptrap from the other side of the galaxy, not from within our own profession.

I asked the pharmacist if she was an RPS member, but she didn’t reply. If she read her PJ, she may have been more informed rather than striving to become a specialised two-legged, encyclopedia of clinical knowledge! She shied away sheepishly with no contest and, when I left, my blood pressure must have higher than normal.

On the soapbox

 

I recently got my first chance since being re-elected – thank you for supporting me to top the poll – to get my soapbox out and talk with great lamprophony about the dangers of remote supervision. At this DH meeting, a hospital pharmacist, and probably a member of the Guild due to his lack of understanding, said it worked in hospital and I was out of touch. I explained the fundamental practice differences are that hospital pharmacists see patients who have a diagnosis and their role is purely medicines optimisation. In addition, hospital pharmacists do not work in isolation; there are other pharmacists and doctors or even nurses to help should problems arise.

In community we do not have a captive audience and anyone can walk in at any time with any complaint and we would need to be there either to make a referral and/or a supply. There are some things an SOP or dispensers cannot do, and an urgent referral is one of them! Worse still, if we are to be absent because we are performing professional services elsewhere, and uncontactable due to a poor signal area, that would undermine our first port of call and readily accessible USP. If patients have to return that would not be in their interests and if something happens, I would be liable as the responsible pharmacist.

Agreed, we need to update supervision. It is not fair that patients can purchase GSL medicines from a garage but can’t get the same medicines from us while the pharmacist is on lunch or undertaking MURs. It is also a quirky state of nature that checked, bagged and sealed medicines cannot be handed out. But remote supervision is not the answer, except in exceptional one-off emergencies.

I also warned about unscrupulous multiples viewing this as an opportunity to save costs and have one pharmacist supervise several pharmacies. This would add workload stress, further remove empowerment away from the pharmacist, and could lead to bullying – you only need to read the PJ or attend branch meetings to hear about how pharmacists are being pressured to deliver MURs.

Clearly the values of remote supervision are different depending on which sector you work in. I didn’t mean to make the hospital pharmacist seem ignorant, but just because he could spell community pharmacy it didn’t make him an expert on it.