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‘From community pharmacy to primary care – why I made the move’

A want to be involved in prescribing decisions and to have a more immediate impact on patient outcomes helped convince Danny Bartlett to make the move to primary care, he says

With increasing pressure and publicity on community pharmacies, and the apparent increasing lack of community pharmacists, I was asked about why I made the move in 2019 from community pharmacy to become a primary care network (PCN) pharmacist.

I think there were two factors behind my decision – variety and impact. I had been a community pharmacist for five years or so and had various roles, including relief manager, store manager and also a locum.

It was valuable experience for me to adapt and move between different branches and patient cohorts to see and explore a variety of avenues that community pharmacy could offer. I had roles in pharmacies with warfarin walk-in clinics, and also pharmacies that had a substantial drug dependency patient population, with services such as needle exchange and supervised consumption.

Although the community roles offered some form of diversity and deviation from an everyday dispensary role, it still wasn’t clinically fulfilling enough for me to feel that I was making enough of an impact on the health sphere as a whole. I was keen to become a prescriber, and through that be able to take more of a front seat in making shared decisions with patients about their care.

I found the feedback loop between community pharmacy and primary care services clunky and not always accessible – and that was even the case in the last pharmacy I managed before making the transition, which was within a GP surgery! Making active decisions in conjunction with GPs, rather than a back-and-forth mechanism of clinical queries and feedback really appealed to me and I truly believed that community pharmacy had a long way to go to be able to make the role more active in decisions to do with prescribing.

 

“Limitations” as a community pharmacist

 

I felt all of the useful and proactive work I did in community, such as audits on our patients’ anticoagulant dosing, overprescribing of opioids and others, just seemed to have limitations. I wasn’t able to speak to key decision makers in the surgery to change prescribing patterns, or to even get fast outcomes from queries that arose.

There is definitely a disconnect, as pharmacies and GP surgeries are always going to be separate entities, so the move to primary care seemed like the best option for me. I could upskill and use my clinical knowledge, and hopefully affect real change in prescribing patterns by taking my observations and using them effectively and proactively.

I don’t discredit community pharmacy in any way, as I enjoyed it for years. But when I compare my base clinical knowledge and the actions I took in community, I was limited to a very select set of outcomes. Since my transition to primary care, I have become a prescriber, work closely with GPs and other clinicians to proactively target and impact patient groups and have been immensely fulfilled in championing the role of pharmacists within a primary care system to help take us forward to key roles in the new NHS long-term plan.

I work with the local clinical commissioning group as a mentor to other healthcare professionals and hope to start collaborating with the Royal Pharmaceutical Society to give my opinions on the ground within the primary care system.

All of this, I believe, has come from me making the switch. Although there are new services coming through community pharmacy, such as the Discharge Medicines Service (DMS), I think a lot more work needs to be done to link community pharmacists to pharmacists within the primary care system to create a more interwoven pharmacist network for joined-up patient care.

Services like the DMS, in my opinion, only work well when there is a pharmacist at each end of the process – from community to general practice – otherwise the disconnect and back-and-forth system that I have experienced trying to get queries and concerns answered in a streamlined fashion will simply happen again.

I guess to summarise, my decision to move to primary care was based on my want to broaden my clinical knowledge and expand the variety of patient contact I was able to have, but it was also to be able to have a complete feedback influence loop in prescribing decisions. I felt I wasn’t achieving what I knew I could in community pharmacy in terms of patient outcomes and today I still believe it was the right decision for me.

I don’t deny that community pharmacy is an essential part of our healthcare model, and definitely needs an adequate supply of pharmacists to be able to achieve its purpose, but I personally feel that as a primary care pharmacist, I am having a much more immediate impact when it comes to the safety of prescribing and in the improvement of patient outcomes.

Danny Bartlett is a senior clinical pharmacist for the Coastal & South Downs Care Partnership PCN

 

Is there a shortage of community pharmacists?

 

Pharmacists were added to the government’s ‘shortage occupation list’ earlier this year – a decision that was welcomed by the Association of Independent Multiple pharmacies (AIMp), which at the time told C+D that “community pharmacies continue to lose experienced pharmacists to primary care network (PCN)-related activity”.

Catch up and contribute to C+D’s latest Big Debate, which asks: Is there a shortage of community pharmacists?

 

 

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