Journal of Pharmacy Management - Jan 2022

Journal of Pharmacy Management • Volume 38 • Issue 1 • January 2022 35 GB: Is there educational support? AM: About every two to three months, we have a network evening in North Wales, and colleagues in other health boards have various other forms of suppor. We've got a GP coming to talk to us about lesions in February, and he did a talk on rashes in late 2021. Sometimes it's case presentations. They're an hour and a half to two hours on Teams, and we talk about operational stuff, but we also talk about clinical matters. We get quite good turnout there. We've actually started inviting the pharmacists who work in the 111 service in North Wales as well, because we look at the same sort of patients. The main challenge that I have at the moment is that I’d like there to be more clinical leadership in community pharmacy or in primary care that those pharmacists can get support from. If you think about other settings where there's prescribers working, there's a clinical hierarchy. If you're an ANP working in primary care, you can refer to your GP colleagues and you can talk cases through with themand get feedback from them. And you can do that in real time while the patient is still with you. Community Pharmacy doesn't have that luxury. They do have a WhatsApp group but that's not really appropriate for use in a live consultation and is more for general discussion around cases. In a perfect world, the local GPs would provide this sort of support, but recognizing that they're both independent contractors, we shouldn't expect the GP to do it for free, because it won't always be their patient either, and you can't have that sort of working relationship with five different clinicians, if you've got five practices locally. What do you do when patients come in from outside? That's probably my biggest challenge that we've got to overcome in Wales; how do we get that ongoing clinical mentorship? The professional isolation of community pharmacy is my biggest concern. GB: One of the charges levelled at pharmacist prescribing is that in some way it might be riskier. There are definite benefits, but also some risks. Have you a view on that? AM: It's a very tight balance to be struck, but having pharmacist prescribers really does open some doors for us to support patients and I know of at least one case where a pharmacist had gone to the nth degree to try to sort something out for an MDS patient and had failed. Having tried everything she decided to just prescribe the meds herself. We had a conversation about it and I said, you know, I recognize this is very exceptional. You've got a clear trail of what you've done and why you've done it. I'm not unhappy with what you've done there. I wouldn't expect to see it very often, but it opens some avenues for a situation where you are sat there with a patient thinking I know exactly what to do for you, but I'munable to act, which is where community pharmacy has been for decades. I think back to the days when I'd send somebody with conjunctivitis to their surgery for the receptionist to print a prescription out and get somebody to sign it, nobody having seen the patient and then come back two hours later with a piece of paper for me to give him chloramphenicol. That isn't a good use of anyone's time and pharmacist prescribers are in a really good position to manage the risks around prescribing as I think training for prescribing changes your mindset and coupled with pharmacist's basic training, they are really well placed to made decisions on which drugs and forumlations are safe and appropriate.. GB: When chloramphenicol for pharmacists first came in a number of GP's were upset about it. One of our GPs said “Look, none of us would do any different towhat the pharmacists are going to do. We may say we would but actually we don't, because if you're lucky, we’ll look at it, but we might not. And if it doesn't resolve within 48 hours or so, we'll have a second look at it, and then we might think, oh, it's actually dendritic ulcer. But the chances that we would spot that on first pass are negligible, so why should we hold somebody to a higher standard than we are going to provide ourselves?” AM: Good safety netting advice is probably the biggest thing I keep talking to community pharmacists about and they they're using it very well actually because of the Open Access.