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We need to have a grown-up conversation about independent prescribing in community pharmacy so we can use the skills we have, says Nick Kaye...
“Please can I speak to the pharmacist” is a phrase heard many times in community pharmacies up and down the country every single day. It is used with good reason by people who recognise our skill set and ability to help them with an issue more quickly and efficiently than most other parts of the healthcare system.
As a profession we are accessible and ready to help with a great generalist knowledge. This is recognised by decision makers, given that the Community Pharmacist Consultation Service is a pillar of service delivery for NHSE. However, is the experience for the recipient as good as it could be?
I have been thinking about this a lot recently given that our pharmacy has started to receive GP CPCS referrals. Does this change the person’s expectations of what will happen? The doctor has sent me so can I get a prescription? What happens if the pharmacist can’t help?
As the pharmacist am I going to get something that I can’t deal with? Does that mean my GP colleagues will lose faith in me? Of course, in reality GP CPSC is building on the conversations we have every day of our professional lives, but back to the first question: is the offer equivalent to the service a person would get in a GP’s surgery?
I think I am asking the question because I work both in a community pharmacy and general practice, and I think of myself exceptionally lucky to practice in Cornwall. Here we have massively challenging workforce issues, and this results in many of us, including myself, working across sectors. This is changing my perspective of what is possible for myself and in what I can offer my patients.
When I am in GP land, I can sign a prescription for end-of-life drugs to help ease the GP’s workload and make sure people can be more comfortable in their last days. I can titrate beta-blockers and I can write prescriptions, if appropriate, for antibiotics.
However, back in my community pharmacy I can’t prescribe anything on the NHS. I am the same person and I have the same qualifications, yet in community pharmacy my skill set is not recognised in a way that would allow me to serve patients in a way that would truly shift demand away from GPs, who by their own admission are drowning in workload post-Covid (if such a place exists).
Working in an area with a high level of depravation, although we are getting GP CPCS through, I do get push-back from people who genuinely can’t afford the medication we are suggesting. In a recent case I had a family of six sent to the pharmacy for worm threadworm treatment.
This causes lots of difficult conversations and in this case, ultimately a referral back to the pharmacist in the GP practice. Yes, the pharmacist who, one day a week, works in a community pharmacy.
This situation can’t carry on. We need to have a grown-up conversation about independent prescribing in community pharmacy so we can use the skills that even a legacy pharmacist like me has. Does that mean prescribing from a limited formulary? I am not sure, but we can’t carry on frustrating the people who come to us.
GPs will see us passing work back to them that pharmacists in general practice can sort out, and this creates an unfair impression of the clinical skills that community pharmacists use every day.
How we enable that capability will be key. Whatever system is put in place, let’s not over-complicate it, let’s not make barriers for delivery.
In a world of pharmacist shortages and unprecedented workload in the healthcare system, we must be released to fulfil our potential, not only for our own good but also the communities we serve.
Nick Kaye is a pharmacist based in Newquay and vice-chair of the National Pharmacy Association. These are his personal views.
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