Mar 11

gwbap

Once a brief guided tour of the dispensary, led by pharmacist Shafeeque Mohammed, was over,Mr Murdock’s first task of the day was to check the repeat prescriptions that had already been prepared by a dispenser.

Most of it was “pretty standard stuff” and, with the exception of one incomplete prescription, the job was finished without any major problems. The help of the BNF was only needed on a couple of occasions.

As the pharmacy is directly opposite a health centre and near a hospital, plenty of prescriptions soon started coming in and Mr Murdock and Mr Mohammed were suddenly extremely busy.

Getting into the swing

Mr Murdock seemed to find his bearings very quickly and was soon turning round prescriptions quite rapidly. There was some Calpol to be measured and poured into a bottle, and 84 Deltacortril tablets to be counted up.

“We used to do a lot more counting in my day; that has changed quite a lot with the introduction of patient packs, and rightly so,” said Mr Murdock.

He would like to see the introduction of patient packs speeded up, estimating that the current split is about 60 to 40 per cent in favour of packs. He put the blame for the delay firmly on the current Government.

“The last Tory Government was going to fund conversion to patient packs, but when Labour came into power they said `no way’ and insisted that the industry paid for it,” he explained, adding that no agreement on the subject had been reached with the Pharmaceutical Services Negotiating Committee either.

“It is a huge investment on industry’s part, but one that would allow us to automate a lot more,” he explained.

Mr Murdock seemed quite at ease counselling patients and explaining the medication, but acknowledged that it would be almost impossible to check and counsel every patient. “You tend to concentrate on the acute prescriptions where the patient is waiting. This is what makes it so difficult to see how pharmacists are going to manage all these new roles,” he said.

One particular customer certainly put Mr Murdock’s communication skills and imagination to the test. The lady in question, originally from Italy, did not speak any English, but was about to receive some antibiotics.

Having tried in vain to explain to her when and how she was supposed to take the tablets, and that she should avoid alcohol, it was time to resort to a different tactic.

Mr Murdock picked up a notepad and started drawing a clock showing 8 o’clock. Arrows pointed to a picture of either the sun or the moon with `1x’ written next to the two images.

This seemed to do the trick and the patient indicated that she had understood the instructions. Objective achieved!

“I think at the end she did understand how to take the medicine, but I cannot be quite as confident that she understood not to drink alcohol. It does highlight the problems associated with working in a multi- cultural area and shows how flexible pharmacists have to be in terms of their communication skills,” he said.

He felt that company educational promotions in foreign languages had an important role to play in this respect.

In the relatively quiet period that followed, and despite his initial hesitation, Mr Murdock took the opportunity to try out the PMR system.

While he was giving Mr Murdock a quick masterclass on using the Lloydspharmacy IT system, Mr Mohammed told him about problems with endorsing and various products being downgraded to zero stock-level whenever a pack is dispensed.

However, while trying his hand at the PMR system himself afterwards, Mr Murdock ran into problems of a different kind.

The prescription he wanted to endorse ran over two pages. Not recognising this fact the system endorsed all products on the first page. To his astonishment, Mr Murdock found that there was no option to introduce a page break. “There is certainly an issue regarding the dispensary IT system and in particularly the way it handles the endorsements,” he said, and promised to have the matter looked into.

To add a little variety to Mr Murdock’s day, Mr Mohammed asked him to check the NOMAD deliveries for a residential home. He seemed to recognise most of the drugs by their shape, markings and colour, but we decided to test his cognitive skills.

We gave him an unlabelled NOMAD box filled with nitrazepam, Adalat and atenolol 50 – and he identified them all correctly.

So what was it like to go back to the floor?

“It took a little while to get into it but once I started to hit my stride it was not as bad as you might think,” he said.

Relevant information

Having experienced a situation only too familiar to many locum pharmacists, Mr Murdock reiterated the importance of retaining as many records on the computer as possible. He also saw the urgent need for pharmacists to be given access to other relevant information in order to be able to make informed decisions.

“Pharmacy often works in isolation and this is absolutely ridiculous,” he said.

At no point had he felt uncomfortable and he would have been quite happy to supply EHC if it had been requested. He did admit, however, that if the store had offered diagnostic services, he would not have been entirely comfortable doing them.

Mr Mohammed was definitely impressed. “His counselling was very good, his knowledge seemed up to scratch and it was good to see him use the BNF as well,” he said

He was, however, very surprised to find that the superintendent pharmacist was not familiar with the Lloydspharmacy IT system.

While neither of the two pharmacists had been rushed off their feet, it had been a busy day, emphasising the difficulties pharmacists face in terms of finding time for any new roles.

“There is a shortage of pharmacists, the number of scripts is rising and there are all these new roles. We do need to address the skill- mixing issue and train technicians to take over some of the pharmacist’s roles under protocols. There is no reason why that time cannot be freed up,” said Mr Murdock.

His solution would be that community pharmacy follows the practice in hospitals, where technicians, rather than the pharmacist, are responsible for checking prescriptions.

Mr Murdock accepted that there would be a time gap and that it might take two to three years to train a checking technician.

“It is imperative that we start addressing this issue seriously now, otherwise we are holding those new roles back,” he said.

He was adamant that the cost issue should not come down to just the company or pharmacy proprietor.

“The paradox we have got is that the Government wants pharmacists to deliver a greater pharmaceutical service, but when it comes to funding it, they are unwilling for the NHS to provide the resources,” said he said. He added that the Government had got to recognise that the funding needed to run the new services may not be insubstantial and that some of it at least should come from the NHS.

So, how would he feel about going back to the dispensary full time?

Mr Murdock admitted that boredom might have played a not insignificant part in his decision to seek a career change. He insisted, however, that “if I had to go back I think I could. There is enough going on in pharmacy now for people to get involved in all the challenging things. I’d survive”.


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