From a mother worried about her son’s management of his diabetes to seeing how the consumer champion Healthwatch goes about its business, our local pharmaceutical committee chairman, Dilip Joshi has another eventful month

Tuesday January 6

Today, I am seeing a woman whose family I have known for many years. She is concerned about her teenage son’s management of his type I diabetes. She complains about his erratic behaviour, including drinking sessions with friends, poor eating habits and, generally, not taking his condition seriously. She adds that he was much easier to manage when he was younger. She tells me she is worried, as she has seen her son confused and trembling, yet he has recently started taking driving lessons. It occurs to me that, in spite of efforts made to ‘educate’ the patient, self-management of chronic diseases remains a huge challenge. There are, of course, additional complicating factors in this case related to the patient’s age – most teenagers feel invincible and are not the most risk-averse of individuals. However, I reflect on how other patients with chronic conditions are not as risk- aware as I would like. Together with complex psychological factors, this contributes to poor adherence with medicines regimens and compromised outcomes. I return to considering the particular rather than the general and realise there are a number of issues, including hypoglycaemia risk, proper eating, alcohol consumption and medicines-taking that need to be addressed, and ask if the son could come to see me – with her or on his own if he prefers – on Saturday. I believe that, whatever the quality of information leaflets or information obtained through other means, including online, there is no substitute for personal face-to-face contact, especially for building relationships.

Monday January 12

A local surgery is closed this morning for staff training. Very often, the first we know of it is when patients come to us to ask why the surgery is not open and if we can ‘lend’ them some medication. Many colleagues are unaware that GPs are entitled to four hours per week of paid ‘protected learning time’ and can close from time to time for staff training, whereas, in pharmacy, we are expected to maintain our CPD requirements and provide staff training without additional resource. I think about the quality of CPD for both professions. I have seen practice managers and GPs attend lunch-time meetings, indicate their presence on signing-in sheets and leave shortly after lunch – they are paid to attend such meetings. As far as our CPD goes, I have long held the view that it is not fit-for- purpose and records are made in order to ‘tick a box’ rather than making an actual contribution to self-development. I am hopeful the new RPS Faculty Framework, now accessible to those in practice for more than two years, will be a far more useful tool for CPD.

My health champion gives advice on diabetes and hypoglycaemia

Monday January 19

This evening I attend an Ace of Clubs trustees meeting where discussions centre on fund-raising. The manager reports a good level of engagement and support from the community. The charity’s centre, which provides
food and showering facilities and learning opportunities to the disadvantaged, has many visitors with healthcare needs. I suggest that we arrange health advice sessions at the centre, check whether visitors are registered with a GP practice, and investigate how they access healthcare. The manager believes that some may have no fixed abode. This is exactly the ‘hard-to-reach’ population- group we are well placed to help because of our accesibility. The trustees agree to support the manager to investigate further.

Tuesday January 20

This morning, I host the first formal Healthwatch visit made to community pharmacies in Lambeth. Healthwatch, described as consumer champion for health and social care, has powers to request information from commissioners and providers and to enter premises, including pharmacies, and has a seat on the local statutory health and wellbeing board. This visit is carried out by trained, learning-disabled adults and their support worker to assess healthy living information and advice. They ask several questions about pharmacy services, and the health champion carries out blood pressure tests at their request. Their aim, I am told, is to support and extend good practice across all Healthy Living Pharmacies in Lambeth and to develop greater confidence in the learning disabled community to use pharmacy services more effectively, in place of unnecessary visits to GPs and hospitals services. I couldn’t agree more with this approach.

Thursday January 29

I am at a Pharmacy London meeting today. Gul Root, principal pharmaceutical officer, Department of Health, introduces the
NHSE blood pressure lead, Ben Lumley. We are told that Public Health England is very pharmacy-friendly, but we must demonstrate how pharmacy adds value. There are huge opportunities for us to make savings in the £2bn per year cost to the NHS of high blood pressure-related diseases. I think it would be good for our negotiators to enter into benefit-sharing discussions on the savings made. On a negative note, we hear of contractors who have claimed out-of-pocket expenses well above the norm; £200 for obtaining calamine lotion and £50 for Ventolin inhalers are cited as examples. It is difficult to see how these costs might have been incurred and we need to be aware of the impact such claims might have on the vast majority of contractors.