The patient was here when we opened the doors at 8.30am. It was a Saturday in the summer, a pleasant morning. He'd been coming in for two weeks for the same weekly prescription, but this was the first time I’d met him.
He was a homeless man who received his prescriptions via the Violent Patient Scheme – now the Special Allocation Scheme. For these patients, most of the dealings with the doctor are over the phone. If they really do need to see a GP, the surgery gets extra security for the appointment.
However, there’s no protection for the pharmacy staff when the patient is then sent down to the pharmacy with their prescription. Normally, there are no problems. But occasionally, things go wrong.
This time, the patient came in for his prescription and we didn’t have it. On a Saturday, there’s no way of contacting the prescriber. In addition, the Violent Patient Scheme prescriptions don't go onto patients’ summary care record (SCR). Nobody could see his full record except staff at that patient’s surgery. That makes you so vulnerable.
As soon as I said: “We haven’t got the prescription,” he went berserk. He said: “You’ve got to give it to me, I’m gonna slash myself.” After a while he disappeared outside.
Five minutes later, he came back in. He’d slashed his arm and blood was squirting all over the place. He said: “What are you gonna do about it? Are you gonna give me my medication now?”
I phoned an ambulance and told the patient: “They’ll sort you out with a prescription at the hospital.” He ran out again, came back with some broken glass and stabbed himself with it. He was screaming at the top of his voice.
The police turned up and managed to calm him down. He collapsed on the floor and another guy who was in the pharmacy helped to quieten him. About an hour and a half later, after paramedics had treated him, an ambulance took him to the hospital. Then we had to clean up.
The floor of the pharmacy was covered in blood. The patient had seemed quite capable of slashing his throat, or he could have hurt someone else. It was a very disturbing experience for the patients and five staff members who were there. A young locum, who had walked into the pharmacy in the middle of the episode, looked shell-shocked.
At the end of it all, I felt really sorry for the patient. This man didn't hurt anybody but himself, he just caused a lot of inconvenience and scared the other patients. This was a very unusual incident and we all survived. With most patients on the scheme there are no problems.
People on the Violent Patient Scheme need their medication, which is often antipsychotics, but there’s got to be a way to make sure they get it that doesn’t put pharmacy teams at risk. The most important thing is protecting your staff.
Afterwards, I wrote to the patient’s surgery explaining what had happened and shared my thoughts on preventing incidents like this in the future. I think there needs to be some sort of safe haven, a halfway house where we can deliver medication for the patient to collect.
Ideally, it would be a police station. There needs to be something because these patients desperately need ongoing medication. In this case, I even suggested we could deliver the medication to the surgery and they could give it to the patient but, unsurprisingly, they didn't like that idea, because he was on the Violent Patient Scheme.
This issue really needs addressing. We wouldn't really want him coming back again after that sort of incident, but we recognise that he does need treatment and passing him on to another unsuspecting pharmacy is not the answer. Your typical pharmacy is not an ideal place for handling someone who’s violent.
I also wrote to the commissioners and said: “You're commissioning this service, but there's actually no provision for what happens in pharmacies.” Patients get their prescriptions under security in a GP surgery and then they're sent down to the pharmacy, sometimes with daily prescriptions, without any consideration for the possible consequences.
Now this patient is in prison. I think he needs psychiatric help; hopefully he gets that while he’s there.
These incidents are very isolated, but pharmacies do need something a bit more substantial in terms of protection, along with sensible prescribing policies that avoid starting medication when the prescriber can’t be contacted and ensuring up-to-date information is added to the SCR.
The anonymous pharmacist works in the north of England