Bernadette Brown
Congratulations on winning Pharmacy Practice of the Year at the Scottish Pharmacist Awards 2016. How does it feel to be recognised in this way?
I feel very proud of my team and thankful to the loyal customers who trust us with their care every day. It is an honour and a privilege to be recognised in this way. I am thankful for all the hard work and dedication of all my staff and proud to work in NHS Fife who have also supported my pharmacy practice.
Jenny Gilruth MSP has also recognised the hard work, and dedication of my team with a parliamentary motion which is also an honour.
What elements of your practice contributed to this win?
The people we serve are the most important part of this, and I’m proud that independent prescribing has enabled me to work with them, not just to improve their health and quality of life, but to give them back real enjoyment of their life again, enabling them to restart hobbies and spend active time with family and friends, and in some cases, improve their independence. It is a gift and one to cherish — one I never dreamed of being possible in my lifetime.
- Investing in my team to reach the highest standards that they can practising at the top of their professional role to release time up for me to be able to do more face-to-face consultations. My pharmacists are all enrolled on clinical diplomas or independent prescribing courses, and by 2018 we will have four independent prescribers at Cadham and an additional two accuracy dispensing checkers.
- Investing in robotics and all things high-tech as part of the strategy on how to maximise the time all my pharmacists can have to offer minor illness consultations and chronic medication service (CMS) reviews.
- Investing in the environment and equipment with two custom-built private large consultation and treatment rooms. I only sell self-care medications in the pharmacy, so the whole feel of my pharmacy is a healthcare transaction, and not a retail one, which is influencing how the public use us for the clinical care and services.
- Independent prescribing incorporated into both acute and long-term conditions consultations and all outcomes and prescribing are fully audited with robust safety and communications to all practices I work with. An enhanced common clinical conditions clinic is being established now and the public campaign to use pharmacy first, saving valuable appointments in GP, out of hours and A&E.
- I have two NHS nurses who assist me with clinics. One for respiratory, and one for common clinical conditions, and I am so proud that this collaboration is such a success with the public and has helped build trust and rapport between the professions.
You are an IP – are you able to make full use of that in your pharmacy?
The NHS Education for Health (NES) course with Robert Gordon University (RGU) and Ninewells Hospital has been the most valuable learning for me as an IP. It has changed the way I am prescribing, using these new skills for more detailed assessments and using the SBAR (situation, background, assessment and recommendation) tool to communicate all prescribing with GP practices.
Working with my nurse, Margaret Cowan, who is highly skilled and works for NHS Fife in out of hours’ clinics at Victoria Hospital and Glenrothes hospital is wonderful. I am gaining more confidence and shadowing my GP in his ear, nose, and throat clinic, with individual training and case study learning also improving my skills, knowledge and expertise to prescribe safely and to improve the outcomes in both acute and long-term conditions.
NHS Fife have been wonderful and supporting me through pain training, and the award-winning RIVERS [pain management] programme. I am proud to be taking part in this and this allows me to do pain consultations to a higher standard with a greater knowledge and understanding of not just prescribing but alternative pain strategies such as TENS, magnets and coping strategies such as distraction techniques. Deprescribing and optimising medications in pain can improve cognitive function and quality of life and it is very rewarding to help people in this way.
Respiratory is a wonderful way in community pharmacy of using both IP skills and improving quality of life. Sometimes it is just taking the time to help people to use their current inhalers properly, and having regular follow ups. In other cases, getting devices they can use and being able to reduce steroid doses over time, or stop unnecessary medicines improve their care.
Margaret has 30 years’ experience as a respiratory nurse and drawing on this working with her is a privilege and before she retires next year completely, she is training both myself and Kara, my daughter and also a pharmacist, how to perform spirometry safely.
What is your next move in terms of applying the IP skills in your pharmacy?
Building on the acute care to provide an enhanced minor illness triage walk in clinic for my community. This will include prescribing in urinary tract infections (UTIs), skin, eyes, ear, nose, throat and acute exacerbations of chronic obstructive pulmonary disease (COPD) and asthma where action plans are in place.
Increasing caseloads in respiratory and pain next year when more time is released for me when my fourth pharmacist starts in January and our huge dispensing robot is installed in March.
My goal is to do consultations all day in my pharmacy and support NHS Fife by reducing the number of minor illness consultations going to GP practice, out of hours or A&E.
Do you think it is appropriate to prescribe and dispense under the same roof?
Yes. My professional role in my clinic is the same in my community pharmacy as it is in my GP practice pharmacist role, with all the same rules with accountability, recording and clinical practice governance.
Every consultation is different and some after assessment will require only self-care advice, others will need treatment and in some cases, onward referral.
How would access to the full patient record help your day to day practice?
Very helpful especially if I want quick access to recent blood results to check U&Es [urea and electrolytes), LFTs [liver function testes], eGFR [estimated glomerular filtration rate], PMH [past medical history]. I can still get this information with patient consent, so it does not act as a barrier to using IP in the pharmacy to prescribe safely. I do hope that this will become a reality for IPs working in the community setting to help communication and ultimately make it easier for us to prescribe safely.
Is community pharmacy in Scotland right now in good shape?
It is going in the right direction and I am so pleased to hear that an enhanced minor illness service may become national with funding available. I would like to see more IP’s in community pharmacy throughout Scotland with a payment structure in place to reward high quality outcome based clinics being offered.
Do you think contractors are adequately and fairly remunerated in general?
The remuneration for supply of medicines is fair in general.
I would like to see an outcome remuneration for CMS rather than a flat rate for registrations. Those pharmacists who are actively engaging with CMS with clinical outcomes, which could be recorded on specific PCR screens, I would like to see rewarded somehow.
I am gathering all my data and hope to show that the huge savings to the NHS overall in terms of cost per consultation and in some cases stopping medications are worth investing in IPs in the community setting as well as in GP practice.
If you qualified again would you choose community pharmacy, hospital pharmacy or GP practice pharmacy?
Community Pharmacy
I can help more people in more ways from the community setting, and there has been no better time in my career than now to be a community pharmacist in Scotland. Community Pharmacy Scotland (CPS) and the Royal Pharmaceutical Society (RPS) and our leadership are working hard to champion the wonderful work that goes on all over Scotland in many community pharmacies. The pressure on the NHS system is very high especially on GPs in primary care.
There is so much potential as I am discovering especially with minor illness to educate the public and to serve them better with high quality assessments and offering a wider range of conditions to treat. We are ideally placed and if the public trust us and believe in our skills they will use us first, as I am discovering.
I think that a session a week in a GP practice should be standard for community pharmacists to gain invaluable experience in general practice, and for me it has been wonderful training and learning with my nurse and GP colleagues. It also builds trust rapport and a mutual understanding between professions. I will continue my weekly session indefinitely if this can be funded at Leslie Medical Practice and I am forever grateful that they have been so supportive of my role over the years.
Should we be making more use of technology in pharmacy?
In my opinion, we must do this if we have any hope of enabling change. Efficiencies and better use of our core staff is crucial for me getting time to offer IP clinics. A pharmacy will always be somewhere that we need to dispense safely and our clinical role will always be so important in an ever-increasing ageing population.
My pouch dispensing robot, affectionately known as Mr MAC (medicines and care) named by the public, has made a huge difference in only one year. By March next year I am installing a huge pack dispensing robot with two dispensing arms for maximum efficiency savings.
Do you have a 10-year plan? What does that look like?
My pharmacy will have four IPs. They will all have clinic time daily and will offer a session in local GP practices weekly if this can be funded.
We will install digital platforms for all self-care purchasing with healthcare information on touch screen platforms. P-medicines will also be on digital screens and stored in the robot. A touchscreen facility will be interactive with healthcare staff with good information about benefits of the products.
My 10-year dream is that all my community will choose pharmacy first, trusting us to look after and care for them for all common minor illness complaints. They will not view my pharmacy as a shop but as a healthcare facility and walk in clinic.
They will choose to come to us for long-term conditions annual reviews and follow-up appointments as part of CMS where we can report to NHS all findings and assessments.
Every member of my pharmacy team will be dispensers and we will, also have three accuracy checkers as well as four pharmacists.
We will have more staff available to offer self-care advice with the digital aids and some of my dispensers will skill up and be offering some assessment skills just as healthcare assistant in GP practice can now offer phlebotomy, my team will skill up to assist with healthy heart consultations, diabetic testing, blood pressure and cholesterol testing.
All my staff can have work life balance with the help of robots and technology, including me.
Are you an RPS member?
Yes
What would you like the RPS in Scotland to focus on in the coming year?
I would love to see them continuing to showcase the wonderful work my colleagues are doing to inspire change, not just with more IP colleagues in community, but with national level mindset changes educating MSPs and the public on what is there in the heart of their communities.
Changing the publics’ behaviour takes time and building trust takes time and experience of getting high level care.
If there is a way to influence legislation to have community pharmacists who are skilled and qualified to assist in the flu vaccinations I would welcome this.
I would like all IPs to have access to the NHS portal for safety.
Continue to work with CPS and leaders to influence remuneration for IP in community and better ways of recording clinical data to capture all this work and outcomes.
That we could encourage as many community pharmacists to become IP with a way to remunerate them and incentivise them. We are already working very hard for the NHS. If we can add in clinical payments this would incentivise and increase I would hope the uptake for IP not just to GP practice but to retain our skilled pharmacists in the community sector.
How can we make community pharmacy in Scotland world-class?
For every member of the public to have the opportunity to access person-centred, high quality healthcare advice and compassionate care and treatment from a community pharmacy where the pharmacists are trained to a minimum standard skill set.
To offer all community pharmacies funding for one IP per pharmacy to increase the uptake and all to be additionally trained in consultation skills, core clinical skills and common clinical conditions.
If we can standardise the level of advice and consultations and availability by rewarding pharmacies to offer this high level clinical care we can become world-class
The way we are valued in the NHS must change so that community pharmacy can flourish and reach its true world-class potential. Trust is earned, and so we need to up-skill now nationally, and show our nurse and GP colleagues what we can do to help them.
To help young graduates feel they can have a clinical career in community pharmacy by having IP mentors and shadowing sharing and actively helping our colleagues keen to learn and progress.
To give them consultation practice when they first qualify and as a minimum standard all newly qualified community pharmacist just like hospital after 2 years must get their clinical diploma. This would also mean that over time, there would be gradual increase in the numbers of IPs and the future of pharmacy can sustain this world-class vision.
This would also mean a pay grade scaling and feeling rewarded not just professionally but also financially for the education effort and ability to offer high quality care.
My two younger pharmacists both with 2 years’ experience start their clinical diploma in January 2017 and I will fund this so that they can help me to try to build this vision into a reality for Cadham.
Every pharmacist I know is hard-working and dedicated yet to build world-class we need to nurture that energy and redirect it to achieve the goal.