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Independent prescribing: Don't throw the baby out with the bathwater

Will the profession's focus on independent prescribing (IP) training put some prospective pharmacists off, wonders Toni Hazell

There is a lot of discussion in primary care about how additional roles reimbursement scheme (ARRS) staff, including pharmacists, can be integrated into practices and work as part of our team. The help that someone can add is often as much about the person as it is about the role.

I’ve seen discussions where one GP is singing the praises of a particular type of healthcare professional, while another has had someone of the that same profession in that practice and it hasn’t worked.

However, there is usually one thing we all agree on – healthcare professionals who can prescribe are vastly more useful than those who can’t.

The cavalry isn’t coming in terms of GP numbers and so it is inevitable that other healthcare professionals are going to be seeing patients, sometimes unfiltered and sometimes in a specific area such as asthma or diabetes.

The model where one GP supervises a variety of other professionals is becoming more common, which leads to the knock on the door and the question: can you just put a quick squiggle on this script?

Read more: 'The push for independent prescribing must not just be a tick box exercise’

This can be problematic.

The person who signs the script is medicolegally responsible for it. So if a nurse, pharmacist or other professional asks me to sign for some amoxicillin for a child, I’m saying that I trust their assessment that the child needs the antibiotic – even if I wonder if they really do or they just have a cold – and that they aren’t sick enough to need to be in hospital.

If it goes wrong, I’ll be responsible, even if I didn’t see the child. If the healthcare professional is someone I’ve worked with for years and I trust their judgment, that’s fine. If they’ve just arrived at the practice yesterday, not so fine – and I’ll probably need to see the child myself, negating the point of the other professional.

So it is good news from my perspective to hear that the General Pharmaceutical Council (GPhC) now has a stated aim for all new pharmacists to be able to prescribe by 2026. But is it good news from the point of view of someone entering pharmacy training?

Read more: GPhC scraps 2-year experience rule for independent prescribing training

Is there the workforce out there to train them? I’m on a variety of GP social media groups and it’s common for the call to come out from a pharmacist who wants to become a an IP and is looking for someone to supervise them.

Very often there is no funding attached to this supervision, which will take at least 90 hours of a GP’s time. If it costs at least £100 to replace an hour of a GP’s surgery with a locum, this request is effectively asking the GP to give £9,000 worth of supervision for free.

If all new pharmacists are going to be IPs, it’s vital that this time is planned for in their course, that professionals are identified to train them, and that this is funded. It isn’t fair for the pharmacist to be left to find their own trainer, particularly if they can’t fund the time needed.

Leaving aside the workforce issues, do all prospective pharmacists want to be prescribers? The trend within primary care is clearly that it is useful for those pharmacists who work in practices, but even the Royal Pharmaceutical Society (RPS) acknowledges that "not all pharmacists will…want to be become prescribers".

If all pharmacy degrees now include the ability to prescribe, will that put some people off from becoming pharmacists? I wanted to be a doctor from early in primary school, and I wanted to be a GP from about the fourth year of medical school. So that’s what I am.

Read more: Will independent prescriber changes leave trainee pharmacists behind?

My ability to prescribe is underpinned by years of training about how to take a history, examine, investigate, make a diagnosis and then prescribe. Pharmacists have a unique skill set – their detailed knowledge of pharmacology has got me out of trouble on a few occasions when they have gently pointed out an issue with a prescription of mine.

They have a clear and specific role in pharmacies, both within hospitals and in community pharmacies, and that role is still needed. It’s arguably even more important now than it ever was, with patients in the community on ever more complex meds. What is wrong with a pharmacist wanting to continue in that role, and not to acquire the skills needed to prescribe?

I have blogged before about the increasing trend of government to try and fill holes in the health service by getting different professionals to cover each other’s roles – but this shifting of the deckchairs inevitably just leaves a hole somewhere else.

Read more: Is getting an independent prescribing qualification worth it?

I wish the very best of luck to those pharmacists who want to become IPs and expand their skills, and I hope it works out for them.

But I really hope that in the rush to expand roles, we don’t throw the baby out with the bathwater and lose the important work that pharmacists do now, day in and day out, working in pharmacies.

 

Toni Hazell is a GP based in a practice in London

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