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By launching a community pharmacy warfarin clinic and introducing private prescribing services, Kiran Raja is demonstrating how pharmacist prescribers can expand access to care for patients. By Saša Janković…

Kiran Raja, who won Independent Community Pharmacy’s Prescriber of the Year award at the House of Commons last year, is manager of Dean & Smedley’s Hollybrook site in Littleover, Derbyshire. She has not looked back since earning her independent prescribing qualification in 2021.

Although her original prescribing speciality was hypertension, she quickly upskilled in anticoagulation therapy to fill a critical care gap as a lead prescriber for the pharmacy prescribing pathfinder programme, offering a warfarin clinic for patients after the withdrawal of a local GP practice’s anticoagulation services.

Her weekly one-stop INR clinic, funded by the integrated care board, enables 32 patients to receive on-the-spot testing, immediate dosing instructions and follow-up scheduling.

Despite initial patient reluctance, the service has seen growing trust and better attendance. Survey data shows improved compliance, satisfaction and clinical monitoring outcomes, including closer oversight of TTR (time in therapeutic range) and early interventions when needed.

The success of the clinic generated £25,000 in revenue in the last year and sparked interest from GP surgeries, with plans to expand the service to patients on acenocoumarol. 

Targeted services

Kiran has also used her independent prescribing qualification to introduce targeted private services that respond to unmet patient needs in her community.

One example is a private period delay service assessing patients and prescribing norethisterone where appropriate, which she developed after repeatedly seeing women struggle to access timely GP appointments for what is often considered a lower clinical priority.

“There were always patients coming in saying ‘I need a period off but I can’t get into my GP’”, she explains. “The women were panicking, because when GP practices are triaging calls they’re prioritising chest infections or UTIs, so delaying a period for a holiday or pilgrimage isn’t going to be at the top of the list.

“As an independent prescriber I can assess them, check for contraindications, such as clot risk or smoking status, and make sure there are no interactions with their existing medicines. That way we can prescribe this prescription-only medicine safely while ensuring our patients receive the best possible care.”

Challenges and opportunities

This innovative and clinically robust use of independent prescribing not only fills a local care gap but sets a benchmark for the role of community pharmacy in long-term condition management, but Kiran is candid that expanding into new services can feel daunting at first, particularly when pharmacists are stepping into unfamiliar territory.

“There are always going to be initial nerves when you are thinking about starting a service, because it’s something new,” she says. “Maybe somebody across the country has done it, but you don’t know them, and you’re setting up something by yourself.”

While the process inevitably involves moments of uncertainty and additional learning, Kiran says perseverance is key: “There are going to be occasions where you may not know the answer, and you may have to dig in deeply and do a little bit more CPD, but you do work it out and it’s so rewarding.”

Indeed, for Kiran, getting past that uncomfortable phase is essential if community pharmacy is to demonstrate what pharmacist prescribers can achieve.

“Unless some of us are willing to push for that and try these new services, we’re not going to know whether they’re going to work,” she says.

Missed opportunity

While proactive pharmacist prescribers like Kiran are trying to do more, she believes the lack of a national strategy for pharmacist prescribing represents a missed opportunity for both the profession and patients.

“It’s a real shame because community pharmacists are experts in medicines who are trained and who can improve patient outcomes and accessibility to services”, she says.

“Community pharmacies are uniquely placed to provide rapid access to clinical expertise, particularly at a time when many patients struggle to secure GP appointments, because anybody can come in and see us.

"We’re accessible to patients there and then, unlike urgent care centres or A&E departments where waiting times can stretch for hours.”

For Kiran, projects such as the prescribing pathfinder programme demonstrate what pharmacist prescribers can achieve when they are properly supported and funded. However, she warns that short-term pilots risk leaving effective services in limbo once funding ends.

“We’ve proven what we can do with the expertise when there is funding and when a pharmacist expert is in charge of the service,” she says, “but when the project finishes, people are scrambling to find funding to keep it going.

"I still feel pharmacists’ skills have long been underused but unless we continue to push for that and get involved in these projects, commissioners are not going to see what we can do.”

Future plans

Looking ahead, Kiran is continuing to explore new clinical services that could be delivered through the pharmacy as prescribing opportunities expand. One potential development is a cholesterol injection service that has recently been raised with her by the local integrated care board.

“I had a meeting with the ICB recently and they mentioned starting a service offering the injection that we can give for high cholesterol,” she explains.

“It’s something hospitals recommend, but the GPs don’t have capacity for it,” she says, adding that commissioners have already asked whether she would be interested in delivering the service from the pharmacy.

While details are still emerging, Kiran is optimistic about the potential. “I’ve said yes to that preliminarily now, but there’ll be more information coming out for that, so watch this space.”

The common thread running through all these initiatives for Kiran is a determination to demonstrate what community pharmacy can achieve when pharmacists are empowered to use their clinical skills fully.

Whether developing private services, taking part in national pilots or exploring new commissioned treatments, she believes pharmacists must actively step forward if the profession is to evolve.

“I’ve been in the profession for 20 years and I feel that by embracing new opportunities and showing commissioners what is possible in practice, pharmacies like ours can continue to expand their role in delivering accessible, high-quality care to patients in our local communities, and prove – yet again – what we are capable of.”

Pictured: Kiran Raja (centre) is flanked by Pharmacists’ Defence Association chairman Mark Koziol (left) and Independent Community Pharmacist editor Neil Trainis.