Johnathan Laird
THE short answer to this, is that as we develop into more clinically focused areas like independent prescribing and managing lists of patients it really has to become a reality.
Being a professional for me, is largely about managing risk and containing that risk, so that we can deliver a service for patients. My career began in the community sector, and to be honest involved the largely technical supply role familiar to community pharmacists in recent years.
Continuing professional development is of course critical to deliver this role safely. In fact my employer to date has, as far as has been practicable, supported this and for that I am very grateful.
However recently, I have been exposed to the much more dynamic and complex risks associated with being a practising independent prescriber. I am willing to take responsibility for those risks, justify my actions, behave professionally and hopefully have a more profoundly positive impact on patient management. I would love to think some day in the future, that I could help and support other pharmacists to take this step.
The management of a patient requires an array of areas of competence, some of which are quite different to those I personally have become used to previously as a non-prescribing community pharmacist. I love the contact and feedback I get from my new medical prescribing colleagues. So far, all the GPs I have encountered are much better at managing dynamic risk than I am. I really enjoyed observing and getting feedback on how it’s ok to make clinical decisions to effectively manage a patient.
A good example of feedback I got recently was about an asthmatic patient who was a smoker. For a number of months I had been fixated with helping him give up smoking, because I knew that in terms of impact this was probably the most profound way of improving his asthma. On conferring with one of the local GPs, she suggested parking the smoking issue and putting all my effort initially into controlling the asthma. The shift of emphasis worked and control was achieved. The patient is now more receptive to the idea of smoking cessation.
Pharmacists, myself included, are in my view, generally quite uncomfortable with this type of change of tack but sometimes it’s ok to take a risk to reduce the overall risk.
The point I’m trying to make here is that this type of feedback based learning is nearly impossible when working in isolation in the community pharmacy setting. I do wonder if, like the hospital setting, this support network is one of the very attractive features for pharmacists working in GP practices.
With this in mind I was delighted to read about the RPS in Scotland advocating the need for protected learning time. Alex MacKinnon of the Royal Pharmaceutical Society in Scotland recently released the RPS manifesto in preparation for the upcoming Scottish Parliament elections. I picked out the following statement.
“It’s really important that we strengthen pharmacy training and development to build capacity across the profession. That’s why we are calling for protected learning time for the profession, the enablement of experienced pharmacists to become designated practitioners to build the capacity across the profession and the introduction of a single integrated vocational training programme for all newly qualified pharmacists”
Protected learning time and peer review sessions like those enjoyed by doctors are therefore essential as our role as prescribing pharmacists evolves away from the traditional supply role.
The thought of having an afternoon when I could regularly meet with other prescribing pharmacists and discuss our clinical decisions is really quite exciting.
As mentioned, I am very grateful for the feedback and support I have received from my medical prescribing colleagues but perhaps selfishly, I hope eventually I will be receiving this feedback from, and be trained by, pharmacists. In this way, I think we will retain the slightly different pharmacological emphasis to our practice that is not evident in other professions.
More than that, this pharmacological emphasis is the unique selling point the pharmacy profession. I think we should follow the RPS Scotland direction and firstly protect our professional learning time before, in turn, protecting the unique pharmacist skill set.
Johnathan Laird is a community pharmacist independent prescriber with a special interest in asthma. He is based in Aberdeen.
Follow Johnathan @JohnathanLaird