Changing roles in Pharmacy

[miss.mystery]

Is there anything else changing in the role of pharmacists other then being able to prescribe?

[Raju]

Re: Changing roles in Pharmacy

Is there anything else changing in the role of pharmacists other then being able to prescribe?

Yes, but not that much. Diagnostic tests, medicines management (MURs, clinical reviews etc) and some pharmacists getting employed by GP surgeries and PCTs.

[Linnear]

Re: Changing roles in Pharmacy

You sound disenchanted Raju.

What do you want to see pharmacists doing?

The EPB wants to be proactive with pharmacy and we stated that we wanted to (Sorry for this) think outside of the box.

Post what you want to see or PM me and we can discuss it.

All the best

[Raju]

Re: Changing roles in Pharmacy

You sound disenchanted Raju.

What do you want to see pharmacists doing?

The EPB wants to be proactive with pharmacy and we stated that we wanted to (Sorry for this) think outside of the box.

Post what you want to see or PM me and we can discuss it.

All the best

Thanks for the interest in finding my views, its appreciated. But on the whole I am not disenchanted with the roles in pharmacy, although it would be nice if the new roles could become universalised and half-decently funded. I've been qualified for just under two years and its bin quite good, better than I had actually thought, and for better pay than most non-pharmacists who left uni at the same time as me.

I've got no problem with current pharmacist roles but there is just too much hostility and stress placed in the way of us fulfilling our duties. I've got a few things to rant about...so may as well get it over with.

I'd like to see pharmacists do quite a lot of things. But mainly just making pharmacists' every day job less hostile and decreasing the unpaid aspect of our work would increase job satisfaction hugely.

For example, if a GP is 15 minutes car journey away, and they've made a prescription error that needs rectifying, a pharmacist should be able to amend the prescription after a phone conversation with the doctor, provided an audit trail is left on by detailing both the name of the doctor and the pharmacist. Instead we have to jump hoops, or get the patient to. We spend huge amounts of time having prescriber's errors amended, there must be a way to reduce the burden on pharmacists. Giving pharmacists the right to add certain legal aspects to CD scripts was a step in the right direction.

We should be able to do emergency suplies on the NHS like in Scotland.

I would like to see independent and supplementary prescribing in the community. I know we could do some parts of the job better than GPs, like monitoring and tweaking hypertenion treatment, which I see GPs messing up every day. I was checking out the application process for various universities' prescribing courses, and was shocked by the huge amount of red-tape and hostility inherent in them, essentially excluding most pharmacists in the community from being able to succesfully enroll, unless they have a VERY progressive PCT.

I would like to see extemp preparations for certain formulae INCENTIVISED so that pharmacy contractors can earn well out of it and save the NHS millions (e.g. we pay hundreds for things like coal tar solution and dermovate ointment in white soft paraffin, as it saves pharmacist time and we earn more through specials ordering...a pharmacis extemping it would be daft without an incentive...but it raids the NHS coffers like anything to keep the current system). It feels like a waste us having done all this extemp stuff in uni.

We also need some incentives for preventing medicines wastage. Right now I can try and prevent waste, but there is little freedom and no incentive. Why should a pharmacist lose tonnes of money and spoil relationships with the prescribers for NO INCENTIVE. Pharmacists who step out of the norm and try and reduce waste pro-actively are seen as irritating meddlers by patients and prescribers alike, not to mention contractors.

Not having access to medical records makes certain parts of our job very tough and makes expanding our professional role almost imposible.

And not having an Athen's password is insulting... as difficult interventions can be made much easier with information access. I've had to decide whether or not to dispense seeminly off-license medicines (e.g. doses much higher than BNF upper limits) based on little abstracts on papers, decisions that could affect someone's health or get me struck off the register, and decisions which have gone both way.

There are quite a few more things that, might PM you them when they come to mind.

[Zoggite]

Re: Changing roles in Pharmacy

Raju,
On the whole I echo what you say.
I too would prefer pharmacy and pharmacists to be rewarded for quality, not quantity- I am being harassed on a daily basis by my employers to churn out as many MURs as possible, I am told in no uncertain terms to "pick patients with only one or two drugs, so it only takes 5 minutes". I am resisting so far, and the Practise pharmacists & surgeries know this and therefore still value my input: when they see my name at the bottom of the form, they know the form is worth looking at.

As for correcting GP's minor errors: I do it regularly, after having spoken to the doctor (or surgery staff) on the 'phone; I just mark the Rx "prescriber contacted by phone", add the time and date, and initial my amendment, along with my RPSGB number. Never come acropper yet. Again, the local GPs know i'm not a time-waster.
The emergency supply-thing like in Scotland is also very high on my wishlist, as I have mentioned in previous posts on this forum over the past 18 months.

I'm not so keen on the extemp preparations: there are simply so many ready-made products available "off the shelf" that I find it hard to justify the need for tailor-made specials, especially at the price that Specials manufacturers are charging! Why is the NHS happy to write out a blank cheque (in effect) to Martindale's for menthol in aqueous cream, but they won't do the same for a Phcy contractor? But even if we were suitably "incentivised" for extemp preparations, I can't see them making a comeback I'm afraid.
Incentives for reducing waste: again, if we weren't paid "by the item", this would addressed...
Athens Account: I've got one, every Phcist in Wales was offered one; what I haven't got is the faintest idea of what I can do with it!!!

Incidentally, why would it be such a bad idea if all Community Phcists were employees of the NHS, like GPs and nurses etc...?

[admin]

Re: Changing roles in Pharmacy

Zo

I agree with virtually everything you say, except the 18 month bit - we only started last March.....

[Raju]

Re: Changing roles in Pharmacy

Athens Account: I've got one, every Phcist in Wales was offered one; what I haven't got is the faintest idea of what I can do with it!!!

If something like Ramipril 20mg daily or pioglitazone 30mg tds is on Rx, you can see if there is some evidence of safety in the unlicensed doses by scanning a few papers. If there wasn't any and the pharmacist was just like yeh what the hell I'll dispense it anyway, he/she would be partly liable if something went wrong. On the other hand, if there was some evidence, then it could be argued pro-pharmacist that the effort was made to check the safety of the dose or just if the prescriber as being a lunatic.

Incidentally, why would it be such a bad idea if all Community Phcists were employees of the NHS, like GPs and nurses etc...?

Are GPs employees of the NHS? Not necessarily I thought. May be wrong.

Anyway, judging by the pay in hospitals, I wouldn't trust the NHS to give the same salary to community pharmacists, especially in the first 10 years after registration. It's all about the bottomline.

[Raju]

Re: Changing roles in Pharmacy

As for correcting GP's minor errors: I do it regularly, after having spoken to the doctor (or surgery staff) on the 'phone; I just mark the Rx "prescriber contacted by phone", add the time and date, and initial my amendment, along with my RPSGB number. Never come acropper yet. Again, the local GPs know i'm not a time-waster.

I'll probly have to do that. What is the limit of what you'd could do? Can you, for example INCREASE the quantity from 1ml of paracetamol susp to 150ml, or fluoxetine capsules from 1 to 30 without a prob? How about if the drug name itself was wrong, e.g. fluoextine 20mg caps 1qds (28), turned out to should have been flucloxacillin. Can it be amended, provided it says PC contacted, and the time, date and pharmacists name and rpsgb number, or would that be pushing it?

[Linnear]

Re: Changing roles in Pharmacy

They say "Be careful what you wish for!"

You've given me plenty to work with here. To be fair some points were already on my possible EPB things to note e.g. Remuneration for services (The whole board has talked about this on many occassions and I don't believe we plan to start any new services without trying to ensure payment first)

The NHS ES in Scotland thing is on my list too.

I have noted all of your comments and will try to add to future debates.

Thanks for your time.

[Steve G]

Re: Changing roles in Pharmacy

Raju,
On the whole I echo what you say.
I too would prefer pharmacy and pharmacists to be rewarded for quality, not quantity- I am being harassed on a daily basis by my employers to churn out as many MURs as possible, I am told in no uncertain terms to "pick patients with only one or two drugs, so it only takes 5 minutes". I am resisting so far, and the Practise pharmacists & surgeries know this and therefore still value my input: when they see my name at the bottom of the form, they know the form is worth looking at.

The MURs that are most beneficial tend to be those with patients who are on lots of meds, IMO. However, MURs for patients on one or two drugs can also be useful, although you would probably be going beyond the 'use' part - examples: asthmatic ordering two ventolins every month and qvar once a year; patient on bisphosphonate but no Ca/vit D; patient with GTN spray, but no aspirin or statin, and so on.

Part of the problem is the same fee is paid, regardless of how many meds the patient is on. How about having a basic fee for the MUR with an additional fee per drug listed. That would increase the incentive to do MURs with those people who are on lots of meds and most in need of an MUR.

As for correcting GP's minor errors: I do it regularly, after having spoken to the doctor (or surgery staff) on the 'phone; I just mark the Rx "prescriber contacted by phone", add the time and date, and initial my amendment, along with my RPSGB number. Never come acropper yet. Again, the local GPs know i'm not a time-waster.
The emergency supply-thing like in Scotland is also very high on my wishlist, as I have mentioned in previous posts on this forum over the past 18 months.

I speak to the surgery on the phone, change the Rx myself and highlight where the GP needs to inital the ammendment, but then 95% of my scripts come from one surgery and I know they'll sign where I ask. Some of the time I change stuff without speaking to the surgery - I've had two scripts for Heliclear this month and I'm not going to waste my time calling the surgery when it's quicker and easier to change it myself.

Scotland are far ahead of the game. Emergency supply on NHS would be very useful and might get rid of some of the large number of faxes I get sent.

I'm not so keen on the extemp preparations: there are simply so many ready-made products available "off the shelf" that I find it hard to justify the need for tailor-made specials, especially at the price that Specials manufacturers are charging! Why is the NHS happy to write out a blank cheque (in effect) to Martindale's for menthol in aqueous cream, but they won't do the same for a Phcy contractor? But even if we were suitably "incentivised" for extemp preparations, I can't see them making a comeback I'm afraid.

Erm, I hope you've looked at the drug tariff this month. Menthol in aqueous cream is now listed in the tariff (cat C, Arjun cream). So you'll get paid £15.30 for 500g menthol in aqueous 0.5%, 1% or 2%. If you've ordered from Martindale this month you've lost a large chunk of money.

The fee for extemp preps would have to be very high to tempt on site manufacture, but even then you've still got issues around product quality etc.

Incentives for reducing waste: again, if we weren't paid "by the item", this would addressed...

Agree

Athens Account: I've got one, every Phcist in Wales was offered one; what I haven't got is the faintest idea of what I can do with it!!!

I've got an Athens account because of the diploma course I'm doing. I get access to large chunks of ScienceDirect - Home which includes Lancet and others. What you can access depends on what the institution providing the account has subscribed to.

Incidentally, why would it be such a bad idea if all Community Phcists were employees of the NHS, like GPs and nurses etc...?

GPs are, on the whole, not employed by the NHS. They are contractors in the same way as pharmacy owners, although I believe there are some GPs who are directly employed by PCTs, and some are employed by GP practices. Nurses I don't know about.

And have you looked at pharmacist pay in hospitals? Thats one reason I wouldn't want to be directly employed by the NHS.

[Zoggite]

Re: Changing roles in Pharmacy

Steve G,
No, I haven't looked at my Drug Tariff that much this month, I only picked menthol in aqueous cream as an example of extemp because it's the first thing I thought of, but I haven't had a script for a specials cream in ages...
And anyway, as you say, even if I could be persuaded to go back to preparing extemps myself, I haven't got the time, the equipment, or the bench space to do as good a job of them as a dedicated company has.
Raju,
I thought of you today: I had a Rx for loratadine 10mg tablets, "take one once daily at night, quantity: 1 tablet"; out came my ballpoint pen, I crossed out the "1", and stuck a post-it on the script saying "please initial our amendment- Thanks", signed it, dispensed it, before sending it back to the surgery tomorrow. I also often round up the quanities of dressings to full boxes when I know it won't be wasted, for instance when I get scripts for 4 allevyn heel drsgs for Nursing Home patients. I'm sick & tired of silly split boxes of allsorts of dressings that just sit on the top shelf collecting dust, and for which we haven't even been able to claim Broken Bulk because they're officially appliances and not drugs.
Today I also changed a Rx for citalopram 20mg, "10 to be taken daily for stress and anxiety", mitte 28 tablets; Surely one can't be that stressed that one requires 200mg citalopram?

[Raju]

Re: Changing roles in Pharmacy

Steve G,
No, I haven't looked at my Drug Tariff that much this month, I only picked menthol in aqueous cream as an example of extemp because it's the first thing I thought of, but I haven't had a script for a specials cream in ages...
And anyway, as you say, even if I could be persuaded to go back to preparing extemps myself, I haven't got the time, the equipment, or the bench space to do as good a job of them as a dedicated company has.
Raju,
I thought of you today: I had a Rx for loratadine 10mg tablets, "take one once daily at night, quantity: 1 tablet"; out came my ballpoint pen, I crossed out the "1", and stuck a post-it on the script saying "please initial our amendment- Thanks", signed it, dispensed it, before sending it back to the surgery tomorrow. I also often round up the quanities of dressings to full boxes when I know it won't be wasted, for instance when I get scripts for 4 allevyn heel drsgs for Nursing Home patients. I'm sick & tired of silly split boxes of allsorts of dressings that just sit on the top shelf collecting dust, and for which we haven't even been able to claim Broken Bulk because they're officially appliances and not drugs.
Today I also changed a Rx for citalopram 20mg, "10 to be taken daily for stress and anxiety", mitte 28 tablets; Surely one can't be that stressed that one requires 200mg citalopram?

Its comforting that my plight is shared.

Today we had a locum doc at the local surgery. He didn't know how to use the computer, so every single liquid came up as 420ml (a 28 day thing, 5ml tds). 420ml of amoxicillin, 420ml of paracetamol susp, 420m of simple linctus, ibuprofen susp and all other things, even trimethoprim susp. After doing one or two at 420 ml, I called him to see what the hell's up. He conceded (though very defensively) that it was "the computer's fault", and advised me just to give whatever I felt appropriate. Since it was a reduction in quantity I knew it was Ok to do without his initials, but when its a matter of upping the quantity, us pharmacists are liable to be looked upon as fraudsters so I have to get the doc to change the script. arrrgghhhh.

[Zoggite]

Re: Changing roles in Pharmacy

I've lost count of how many scripts for "olive oil ear drops, mitte 2000ml" I've seen... also today I had a lady who had 28 days' supply of 6 drugs, but then also 258 tabs diclofenac 50mg, 1 TDS...?!? That got my ballpoint treatment too, and became 28 days' supply...
I'm getting ever broader shoulders as I near the ripe old age of 40!

[hannahd]

Re: Changing roles in Pharmacy

I had a Rx for loratadine 10mg tablets, "take one once daily at night, quantity: 1 tablet"; out came my ballpoint pen, I crossed out the "1", and stuck a post-it on the script saying "please initial our amendment- Thanks", signed it, dispensed it, before sending it back to the surgery tomorrow.

Ooooh, I didn't know this was possible! Can I just check whether I've understood this correctly:
- FP10 has error on
- Pharmacist changes FP10 and initials it
- Sends it back to GP to initial amendment AFTER dispensing
- Pharmacist doesn't get into hot water???!!!

That’s so nice and simple compared to what I’ve seen done in practice:
a) Pharmacist ringing up doctor’s surgery to sort the error and then informing patient to pick up new script from doctor’s surgery and come back with it (cue profanities from patient directed at pharmacist (NEVER the GP)/patient saying they’ll try another pharmacy instead!).
b) Pharmacist has a chat over the phone with GP's secretary and gets dispensing assistant (*cough*) to pick up the script whilst patient waits/plans to return later to collect.

[Steve G]

Re: Changing roles in Pharmacy

Ooooh, I didn't know this was possible! Can I just check whether I've understood this correctly:
- FP10 has error on
- Pharmacist changes FP10 and initials it
- Sends it back to GP to initial amendment AFTER dispensing
- Pharmacist doesn't get into hot water???!!!

Thats what I do. It depends on the relationship you have with your local surgeries. I get about 95% of my scripts from one surgery about a five minute walk away, so we have a really good relationship and I know if I ask them to do something they'll do it. Obviously its going to be a bit different if you are in a town centre and dealing with five or six different surgeries.