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5 minutes with… Catherine Duggan

WHEN Johnathan Laird asked me to write a blog, I immediately asked him why?

Not because I don’t think I should or could write a blog (believe me, I always have things to chat about!) but more “why would anyone be interested in what I can blog about?”

He said that people would be interested in why I joined the Royal Pharmaceutical Society (RPS), why I work here and what I believe it can deliver for pharmacists. Because I am passionate about what the RPS can and does deliver (obviously), I thought that might read too positively for some, so I asked Johnathan for some questions so that my blog MIGHT be interesting to at least some of you.

1. What is your opinion in pharmacists in the community accessing patient records?

Accessing records is only part of the issue, it’s what we do with the records once we have access that makes all the difference and what we will need to support pharmacists with. As professionals who are integral to the healthcare team, pharmacists are ideally placed to provide some of the missing links for patients around their medicines: what they are prescribed for, how they work, how they interact, what side effects to look out for, how to monitor how you’re feeling. This is how a patient described it to me recently. And the same queries and questions exist if you are a carer, probably more so.

Without access to patient records, we will only ever be able to make a fraction of the interventions and potential impact we could have. I also believe the majority of patients and the public want us to have access, once they understand the benefits such access would bring them. I believe access to patient records would empower us greatly, if we use the influence wisely. We need to be able to provide evidence of said benefit of course and use the access to assist great communications across healthcare interfaces and with other members of the healthcare team, including our colleague in hospitals!

2. Do you think pharmacists are capable of managing a patient completely in the community pharmacy setting?

It depends what management is needed, but in principle yes. I believe patients want an easily accessible port of call where their queries and healthcare issues are taken seriously and managed speedily: from referral to treatment. These may be clarifications around their medicines, prescribed or purchased and how they all relate, as above. These may be advice about lifestyle, health worries and how to manage their common ailments, all the way up to managing more serious and acute conditions. We know that when pharmacists have expertise in clinical management, they make a huge impact on the health of their community. If the community pharmacy setting is equipped to manage more acute or serious conditions, then this is exactly the right place for patients and the public to access healthcare. What’s important is the ability to manage, triage and refer and, with the appropriate support and guidance and communications in place, this is a hugely effective way to manage patients.

3. Do you think every pharmacist will be an independent prescriber as a result of the Scottish prescription for excellence document?

I don’t think the policy alone can make this happen. Instead, all agencies across the profession have a role to play to ensure this vision is realised. What’s important about this document and the preceding independent reviews is the vision and the solution the policies seek to provide. A clear 10-year vision that provides an outline of the challenges (and opportunities) for pharmacy and what we need to do to deliver is a great start. We know that the healthcare system, environment and need will be different in 10-years, but unless we equip our profession with the skills and tools (prescribing included) to deliver for what we can see is needed almost immediately, then we definitely won’t be equipped to deliver the as-yet unknowns. Prescribing is one enabler for us to use to deliver the pharmaceutical care patients and the public deserve. I would say Prescription for Excellence won’t be delivered if we DON’T have enough independent prescribers in Scotland. If that means every pharmacist…then so be it.

4. If you could go back and change one thing about your career what would it be?

I have been so lucky in my career (to date!) I’m not sure I can say what I would change…

I have been lucky to work in many sectors and have many roles along my career to date. I have really reflected on this question and I’m not sure I can answer that. I have definitely been able to influence and carve out elements of my career which, rather than change for myself, I would love everyone to be able to do. I have worked in community, hospital, academia, primary care and various interface roles. I have locummed, managed pharmacies single handed, worked across multidisciplinary teams, managed projects and grants and programmes as well as manage and lead a team myself. All of these roles have helped me to develop a broad set of management and leadership skills that, despite being referred to as soft, are the lifelong skills we need to work on and develop. What’s funny about my career to date is that I haven’t followed a set path or sector, I haven’t had a plan or a map to follow, but I have always found myself surrounded with great colleagues: supportive and helpful, challenging and inspiring! That’s what makes it hard to consider what I should change.

5. What is your advice for newly qualified pharmacists?

My advice to a newly qualified pharmacist is to try to seek advice and support and find a mentor. A mentor doesn’t have to be formal, we can often find the best support from peers. We just need access to them. No matter where you find yourself (whatever sector, whatever stage) feeling alone and isolated is negative and we need to encourage mentors and supportive networks wherever people work. Whats so important when you are in the early days and months of your career is not to feel alone or isolated. We have found so many pharmacists feel so anxious and lonely on day-1 in practice, after being part of a ‘team’ or ‘family’ as a student and then prereg, this can be so destructive in the early stages of your career. It’s such a shame. We (RPS) have worked hard to develop all sorts of support and guidance and networks and tools to help, including our Foundation Champions. It’s very usual for newly qualifieds to buddy up and provide peer support: it’s what they are used to. We just need to enable that to continue. It’s so vital for the future generations of the profession. Plus the friendships and support you find in the early days of your career can often lead to lifelong friends and relationships! Invaluable!

6. How does the RPS help to combat professional isolation?

We have been working on this for 5 years now and haven’t got all the answers but we have got some. All I can say is that the calls and queries we get in the RPS Support Team are markedly different now compared to when I started in 2010. We can now triage members who are very upset and isolated and refer to other supportive organisations if appropriate (Pharmacist Support for example). Alongside this, we now have so many ways to link colleagues up so that they can discuss/share with peers and colleagues through networks, forums or e-mail chats. Returning to practice after a career break can feel so isolating and threatening, so can changing sector. There are so many great colleagues out there, ready to provide a bit of support and advice and a helping hand. We just need to hook people together and the more all the pharmacy organisations play a role in this, the less isolation we will see.

7. What are your thoughts on how community pharmacy is funded i.e. by volume?

Whenever a service is funded by volume, there’s a risk the focus will be on the individual item rather than the outcome. I understand where it all came from but whats evident is that the volume has increased but the value (or funding) simply hasn’t, so it cannot be the only mechanism of payment. Other countries have explored ways to fund by intervention or by outcome and we have some ways to do this too. However, if the impact we are to have on patient care and public health is to be effectively realised, then we need funding to be adapted to match. Where new models of care have been implemented in practice (as pilots or methods to solve local problems), the key issue is demonstrating the impact and the funding has followed. And until the contracts change, we need to influence through evidence of impact.

8. If we met at a conference and we were not allowed to talk about pharmacy or the weather what topic would you bring up?

I would probably ask you what’s your favourite box set of the moment (or all time, if that proved a chatty area)! Either that or your best joke! I have some chemistry jokes if you’re interested….!

9. Why did you become a pharmacist?

I have always been passionate about healthcare but I didn’t start my A levels thinking about pharmacy, that followed my interest in healthcare. I have always believed pharmacists have such a fundamental part to play in the impact of medicines on patients, the public, and society. I had some great placements while at school which made me passionate about healthcare which, combined with a love of science, led me to finally choose pharmacy.

I think it’s what unites us all when we start our pharmacy degrees and what fuels many of us whatever sector we work in. What can be dispiriting is not being able to have the biggest impact, either as individuals or as a profession and feeling that you can’t make a positive impact. The fact that so many passionate pharmacists become disillusioned and disenfranchised by their experiences (often in their earlier career) is very depressing, whether that’s down to the workplace, the pressures of work or not being able to do the job you want to do. Unfortunately this is a story playing out across many professions. Being flexible, open to change and adaptable to cross sectors is hugely helpful and will hold us in good stead and it’s what my reflections on my own career have led me to believe. I do understand this is very difficult in a crowded market and can feel like platitudes to those who are struggling to make the impact they know they should.

10. Why should pharmacists join the RPS?

Well, I am passionate about our profession and the impact we can (and frankly should) make on patient care and public health: whether that’s drug discovery, design, education, clinical). I was passionate about the need for the RPS to change and bring the profession with it as it became more akin to the Royal College/leadership body we all want to be proud of. When this job came up, I had stood for the RPSGB Council to try to affect the ways in which the new RPS could step into the realm of Royal College/leadership body. I decided I would try to make an impact by doing the job itself. The team I lead and manage are passionate about supporting, developing and recognising the profession. The majority are pharmacists but those who aren’t are passionate about pharmacy. They all believe we need a body that can lobby, influence change, provide a vision and standards for the care we should deliver and the services we manage on a day to day basis.

We are nearly 5 years old and I do believe we are getting there. When I started we didn’t have a support service for members (and had calls from many in tears and trouble). Now we do. Now we are developing and setting professional standards, we have hundreds of support tools and guidance and helpful frameworks and tools. We have our Faculty and Foundation schemes to (finally) support and recognise individuals and their achievements. We want our members to have one system that provides the regulator with an assurance they are “continually fit to practice” through their Faculty/Foundation membership. We have campaigns that positively impact patients and their care and the place pharmacy can play. We are increasingly well regarded by other professions and the public.

Of course, there is much more to do and much more we need to be seen to be doing but if pharmacists aren’t members, then they can’t help us actively change and if we don’t change, then we can effectively play into all the wider changes across policy, health, science, education and healthcare. This isn’t meant to be a negative statement, more a way that by being involved, you can affect and assert influence and expertise. All of the work I’ve listed above is co-produced and influenced by our members. Without the profession, we aren’t the professional body (literally). So many members have helped us with standards, guidance, campaigns, policies, practice developments: all of which can support and lead our profession to deliver better patient care.

I really understand why some pharmacists don’t become members and respect the reasons given by many, whether that be the fees, representation, the products or the services. I also know that many pharmacists are just as passionate about our profession as me and now can get involved to help us make a difference to our profession’s future.

11. What is your ten year plan (personal or professional)?

Tricky question. I would say to continue to make the biggest difference I can in the best way I can. That sounds very idealist, but within the role I am in now that would be to listen to pharmacists and engage as many as possible in the work we are doing to shape how we play the biggest part we can in patient care and public health. Wherever I am in the profession in 10 years, I would want to see the profession delivering the visions we set today across the 3 nations of GB (and beyond) in the best way possible, to the highest standards, sharing innovations across sectors. I would love to play a part in that…what a great opportunity for me in my great profession!

Dr Catherine Duggan is the Director of Professional Development and Support at the Royal Pharmaceutical Society. Follow Catherine @DrCDuggan

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