THERE has been a huge movement towards pharmacists working in general practice. I applaud these efforts and have enjoyed watching as things develop. However, in this series of articles I am going to lay out how I feel pharmacists can stretch their practice in community pharmacy. A safe, patient-centred approach is the key to success here.
I’m not sure how many pharmacist independent prescribers are actively prescribing, but I bet the figure is quite low. In community pharmacy it can be quite daunting to extend your practice, because we work for much of the time in isolation. Oh and yes we are mega busy too!
I think structure, especially in the early years as a prescribing pharmacist, is really important. Making sure you do the correct checks before writing a prescription are obviously vitally important. With complications like trying to learn all about consultation skills, things can be missed. For this reason, I have stayed close to areas that I already know well and where I feel competent.
The simple uncomplicated urinary tract infection patient group direction (PGD)
One such example in Scotland is the treatment of simple uncomplicated urinary tract infections (UTI) in community pharmacies. The PGD leads the practitioner through the process for diagnosis, and after questioning, and occasionally urine testing, if treatment is appropriate community pharmacists may make a three-day supply of Trimethoprim 200mg tablets on a community pharmacy urgent supply prescription (CPUS).
I think this service is excellent and I use it frequently in my day-to-day practice. Patients and my local GP team find the service very acceptable too.
The trouble for me has been on several occasions as my pen has hovered over the CPUS form and I asked the final question: “Are you allergic to trimethoprim?” and the answer has come back as a yes.
So on these occasions as a non-prescribing pharmacist the only option is to refer the patient to the GP to get some nitrofurantoin 50mg capsules. Although not usually an issue in the younger patient it would be prudent to check renal function for Nitrofurantoin. HAving access to the patient record in the pharmacy would make this easier. Given that the patient has usually been directed to the community pharmacy with high hopes of treatment, this in my experience is not exactly welcome news.
However, as an independent prescribing I can write a prescription for this second-line treatment. This decision is often right for that patient at that moment, but as with any prescribing decision it should take into account many factors. The approach is evidence-based and in line with SIGN 88.
Any prescribing pharmacist must work safely and within their sphere of competence. But, in the correct circumstances, prescribing pharmacists can take the structured approach as far as possible before making a decision as a prescriber. I think this cautious, structured approach is possibly a really good way to safely develop prescribing practice in community pharmacy.
The decision here was evidence-based, my GP colleagues once informed were very happy not to be contacted for a prescription/consultation late in the day and most important the patient received the correct medicine for her UTI in a timely fashion.
- SIGN guideline number 88
- Community pharmacy UTI patient group direction
- NICE Clinical Knowledge Summary for UTI