Independent proprietor Sid Dajani tackles a tricky subject for the first time and gets to grips with a brand new CPD topic

I’ve tackled just about everything in this columns over the past 11 years: life, death, bunkum, waste, cant, dishonesty, management, secrets, cover-ups, bureaucracy, stupid politicians of all flavours, and NHS-employed primary care pharmacists. I've looked at money, procurement, technical stuff, and the horrors of patients being forced to drink water from flower vases. I’ve done success, triumphs and failure. But, I’ve kept away from one topic – hospital pharmacists!

I was invited to the HPE Live conference, which is organised for hospital pharmacists across Europe, where I was asked to discuss how we and they could improve working for the sake of our patients. Now, traditionally this sector thinks we are nothing more than money-grabbing shopkeepers while we think they hide in hospitals because they don’t live in the real world and can’t handle it. So, off I went armed with killer answers to the usual killer questions, a concerned smile and, as I was on their turf, I apologised for being a community pharmacist.

They were a surprisingly lovely bunch. Over 100 attended the Q&A session I was in, where I talked about seven-day services, how best to unburden A&E, minimise the revolving door syndrome, reduce unnecessary hospitalisation, and so on, through community pharmacy services.

I explained the pain of poorly-written hospital prescriptions and the time wasted in contacting the prescriber, which was usually in vain. I described the future in shared care records, electronic discharge notes, registering some patients with their local pharmacy, and in hospital colleagues liaising with their community brethren as part of a discharge plan for the complicated long- term-care cases.

The killer question

I had general agreement and was almost beginning to relax, when whoosh! The expected upper-cut to the gut question: “Won’t services in community improve once the dispensing fee per item reimbursement is removed?” In other words, it was in the interests of community pharmacists to dispense medicines that were not needed.

I was asked what my views were. I explained that we were bound by the same regulations and ethics as they were, and if they worked in community and they wouldn’t knowingly do it, then the same applied to us.

I described the future in shared care records, electronic discharge notes, registering some patients
with their local pharmacy, and in hospital colleagues liaising with their community brethren as part of a discharge plan

We had no access to care records to appreciate diagnosis, our PMRs were only good when the patient used the same pharmacy and we didn’t supply either POMs or P medicines to those that didn’t need them. I then argued that the issue of over- dispensing and a volume-based fee was not the problem. We needed to stop inappropriate dispensing before it started and that was down to inappropriate prescribing, and the responsibility for that lay with the prescribers.

The responsibility for prescribing was not just about writing a prescription; it was also about monitoring the clinical use of that drug to ensure safety and efficacy in that patient from that day forward. You shouldn’t wash your hands of responsibility for a patient after you had written the script and ignore the monitoring of that patient, and yet that was currently what happened.

Upstream solutions

So the solution of wasted medicines lay more upstream than downstream. We needed to ensure that prescribing was appropriate, but it was the effective monitoring and review from my colleagues and me in the community that actually prevented even more waste. And not only that, MURs and the NMS had consistently shown fantastic benefits in taking people off many medicines that potentially did more harm than good.

At that point I was getting ready to dive under the table and dig for freedom as many other hands went up. Luckily, time was on my side and the chairman called the meeting to a close. I have spoken all over the world on so many issues, but I have to say this was a hugging-the-cactus moment.

Fatherhood and CPD

Some of you may know I became a dad for the first time recently. We decided not to know the sex of our baby until he or she came out of Mum, but after 62 hours between the waters breaking and baby making an appearance, I should’ve guessed it would be a girl.

We spent six days in hospital, with me sleeping on the floor or in the seat by the bed. I live in Hampshire, but because Mum lives near Wimbledon, the baby was born in Kingston Hospital.

I survived blood, gore, guts and much more besides. She had hot meals and I survived on Costa sandwiches in between giving Daily Mail interviews, writing articles, reading, reviewing SOPs, doing various paperwork, as well as all the nappy changes, baby changes and ensuring Mum and baby were recovering from their marathon ordeal and their infections. Home time meant getting baby supplies from the local pharmacy, Barkers Chemist in Raynes Park.

Dinesh the pharmacist couldn’t have been more helpful or knowledgeable, and his baby range was magnificent. I even bought things I didn’t know we needed, and I’m told on good authority that the maternity pads I bought were the best ever! I also met his daughter who looked as we all did once – young, fresh, enthusiastic and excited about embarking on a long career as a great pharmacist. She has a good teacher.

When I made it back to Hampshire to sign off a refurb, I made a mental note to refresh my baby section, which I duly did. A week later, it became a CPD entry, and all because of a little 6lb 4oz little baby girl.

No part of this article may be reproduced without the written permission of the publishers. Published by CIG Ltd © CIG Ltd. Unbranded pictures copyright Photodisc/Digital Stock. Some of the editorial photographs in this issue are courtesy of the companies whose products they feature. The publishers accept no responsibility for any statements made in signed contributions or in those reproduced from any other source, nor for claims made in any advertisements.