Cutting your teeth in the lionâ€™s den
Despite funding cuts, medicines shortages and stress, it is an exciting time to study pharmacy, says Milton Kent Nuako Owusu. The Independent Pharmacy Awards winner talks to Neil Trainis...
Milton Kent Nuako Owusu does not have to think long and hard about her reasons for wanting to become a community pharmacist.
“It’s the fact we get to help people. It just feels really nice. Sometimes patients don’t only come here for medicines,” the winner of last year’s Key Staff Member award says.
“They come because they need to have a conversation with someone. They’re not always at home and being bored.”
We sit in a small consultation room in Fieldway Pharmacy in New Addington, a run-down part of south London, where she works as a dispenser but has just started studying to be a pharmacist. The pharmacy is embedded in a parade of shops between a laundrette and a fish bar.
Like any other area in the UK, this part of Croydon has its fair share of health and social care challenges.
Less than two years ago the local paper, The Croydon Advertiser, revealed that a quarter of children in the town were growing up in poverty. It named New Addington as one of five areas in the borough with the highest rates of child poverty.
Milton, a bright, confident young woman who is prepared to put herself through five years of studying - a “master’s-infused” four-year pharmacy degree followed by the pre-registration exam - estimates that “over 50 per cent” of the local population is below the poverty line, which the government sets at 60 per cent of the median UK household income.
There are big challenges for any pharmacist here but Milton, who created her pharmacy’s healthy living corner to encourage people to make incremental lifestyle changes as well as helping Fieldway raise money for charity, insists it is “an exciting time to be studying pharmacy.”
“It’s about helping people and the fact that we get to be a part of these people’s lives. We get to help them. I can use this opportunity to do more charity runs.
“Last year I did one for Alzheimer’s and this year we’re going to do one for breast cancer some time in June.
“I was in my second year here and I thought ‘you know what, let’s just do something for the community because it is a community pharmacy. Let’s do something to help them.’
“I worked in a care home for six months with people with dementia. I did know how they felt when they go out because we used to go out to beaches and have tea and cake. They were really happy rather than staying in the care home all the time.
“I felt ‘let’s give back to the community.’ Since then, it’s been an annual thing.”
Milton has been at the pharmacy for about three years and, in that time, has gained a strong sense of what makes New Addington tick. Despite the deprivation and poverty, people, she insists, “buy stuff. When it’s needed, they will pay for it.”
“We do 8,000 items (a month). We used to do a lot of minor ailments because if you don’t pay for your stuff, if you’re on benefits, you can always get that.”
The national picture presents huge challenges for community pharmacists; funding cuts, local commissioning, medicines shortages, to name a few.
Yet Milton insists with an air of determination and self-confidence that she knows exactly what she is getting into. And she is not short of ambition.
“I’m currently studying and I will work in a community pharmacy for a while and hopefully, I’ll apply for a job with the NPA or probably go into the RPS.
“I just want to be able to help community pharmacy a lot. There are cuts. I don’t know whether the cuts are to benefit the GPs but obviously, the pharmacies are not being taken into consideration because if you think a pharmacy is doing 8,000 items a month, whatever they’re being paid, they have to pay the suppliers who supply the medications.
“If this place is being rented, they have to pay their landlords, light, gas, water. They have to be a bit lenient because pharmacies do a lot.”
She is unimpressed the government is phasing out medicines use reviews (MURs), the funding for which NHS England said will be “recycled” into the community pharmacy contractual framework to fund other service developments.
“I’m not really for that. It was a chance for the patients to feel more comfortable talking to us and if they’re with the pharmacist, we’re able to send a letter to the GP.
“We should work as a team, the GP and pharmacist. It’s not about pushing everything on the GP. A lot of patients don’t like to go to their GP because they have to book an appointment.
“(Removing MURs) is not going to help patient drug monitoring. GP surgeries can’t say ‘we’re not giving you your tablet because you haven’t come in.’ And if the patient chooses not to come in, what are you going to do?
“They’re going to be taking their medications and you wouldn’t even know how they are doing. They are cutting it now but we have specific people we have to do MURs for.”
Slow rate of CPCS referrals
Talk now is all about the community pharmacist consultation service (CPCS). Milton insists it “is a good move” but four months after the service launched, she says referrals to the pharmacy are slow.
“It’s a good move because it’s at our discretion. If the patient can afford it, they buy it and it saves the NHS money too.
“That is a good move because I feel that some patients just take the service that I provide. If it’s a free service, even if it’s not needed - ‘my child has got a fever, I need it for them’ - whether they need it or not, they are telling you this.
“A lot of people do not like calling 111 but they have to call it, they come in and we advise them.”
She suggests people may simply not know about the CPCS and that public lack of awareness may be behind the slow rate of referrals.
“It is slow. Right now, patients are only calling when they run out of their tablets and the GP is still open and they can’t get access to their medication.
“Or we refer them. If their GP can’t issue a prescription, then they have to go through 111. But I just don’t think people know about it much. I haven’t seen any advertisement online because I do a lot of the pharmacy’s online and social media work.
“I see NHS pop up on my screen and they have an advertisement for flu amongst other stuff and asthma for kids but I haven’t seen that for the CPCS. I don’t know whether they don’t want me to know about it.”
Metformin price leapt overnight
Milton does not dwell on the CPCS for too long and soon turns to the thorny issue of medicines shortages as she ponders what the biggest challenge is for a community pharmacist.
She reveals her pharmacy stocked more than 400 packs of metformin after their suppliers warned them the price was about to rise significantly.
“Medicines running out of stock (is challenging). You should see how we’ve stocked up. I’ve got about, probably over 400 metformin, 400 packs of 84s. Now we just have to keep it.
“It was £1.95 and the next day it was £5.90 to buy one pack from the suppliers. It was just overnight.
“Luckily, we’ve got a good relationship with our suppliers. They are able to tell us ‘the price of metformin is rising so you might as well just stock up.’ And we’ve had to tie down three months’ worth of money where we are not even getting it.
“You’re being told that something is going out of stock, so you should stock up. We stock up, we tie down money. That item, we probably use 10 in a month but if it’s gone out of stock, we don’t know how long it’s going to go for, so we have to stock up.”
Shortages are a battle for Fieldway Pharmacy and the good relationships Milton has developed with six GPs in the area has gone some way to mitigating the problem.
“When items are out of stock, I send them an email, like a bulletin, to let them know this item is out of stock if you can prescribe an alternative. I usually go through it with a pharmacist and we find an alternative and then we send them an email.
“If we’ve got a prescription that has been sent in and the item has been discontinued or we feel we cannot get access to the item and the patient needs it urgently, we still have to send an email. I even sent emails last night. It just feels like a daily routine for me.”
She is asked how many different product lines the pharmacy struggles to get hold of each month.
“I know about four items that I’ve had to consistently write a letter to the GP about, that the item is out of stock. Capsaicin (a cream for joint pain) has been out of stock probably for over six months now.
“The thing is, it’s not a fast line for us so we only order when we need it and when the prescription comes in, we check up on our stock. So god knows how long it’s actually been out of stock.
“The month we knew it had gone out of stock, we had four or five prescriptions for the cream.”
However, Milton tries to ensure patients are not left empty-handed.
“Even yesterday, a patient was like ‘oh my god, I need this tablet.’ But the tablet is out of stock. There’s nothing we can do,” she says.
“I had to write a letter to the GP asking to prescribe an alternative which we found but that was late in the night.
“It was about 7pm when I sent the letter and that was about the time we got the prescription. There’s not much we can do. We feel bad to have to tell the patient who needs something urgently that it’s out of stock.”
Patients sometimes ‘don’t use kind words’
When asked how she goes the extra mile for her patients, she reveals that closing time at Fieldway Pharmacy is never actually closing time.
“I always deliver medicines out of hours. There are times when we have five minutes to close and a new prescription will come in and it’ll be ‘can you issue this new dosette for the patient?’
“So I stay back to do the dosette and then I deliver. I have the pharmacist check it. (I’ll say to the pharmacist) ‘can you just wait an extra 10 minutes and just check this for me so I can deliver it.’
“At least I’m able to supply the patient with one week’s worth (of medicine) to hold them down.
“The pharmacy closes at 7pm but usually we’re here until 7.30pm-8pm.”
Patients sometimes take their frustrations out on Milton and the other staff when they can’t get their medicine because, as she puts it, “they think we have everything.” But handling complaints when it is not your fault is part of being a community pharmacist.
“(Patients) don’t use kind words. I just put myself in their shoes,” Milton says philosophically.
“Would I be like that if I was in pain and they tell me my tablets are out of stock and they can’t get it and this is the fourth pharmacy I’ve tried?
“I would probably go off. We kind of understand how they feel.”