When not at Xrayser Pharmacy, I work in a GP surgery as a clinical commissioning group (CCG) practice support pharmacist. To anyone outside of medicines management, this seems a rather nebulous role – not helped by the fact that some colleagues continue to refer to me as a “medicines optimisation pharmacist”.
Even describing myself as a “prescribing advisor” wasn’t clear enough for one nurse this week. “So the doctor asks you what to prescribe for their patient?” she suggested, as I tried to explain my job. “Well, not exactly. Not for individual patients. Well, sometimes.” “So you stop them poisoning the patients?” she went on. “Ah, I’m not sure I’d put it quite like that..!” I stammered, gathering she had an image of Harold Shipman behind every consulting room door.
But it’s not the Harold Shipmans who are a problem for me, it’s the profligate prescribers. For example, our CCG spends £750,000 a year on emollients, so we’ve recently tried to stop our GPs prescribing bath and shower products, due to a lack of supporting evidence. But despite our best efforts, they still cave into pressure from parents, who want to feel that they’re treating their scaly sprog correctly by pouring NHS-funded oils into the bath.
One advantage of straddling the pharmacy-surgery interface is that I can support the formulary changes. “You won’t get that on prescription now,” I say, as a patient hands over a request for bath products. “Why not? I always have!” comes the reply. Knowing that the surgery’s senior GP partner supports our stance, I explain why. The staff raise their eyes – they know any amount of explanation isn’t going to stop the expectation of “what I’m entitled to”.
I, however, work on the “teach a man to fish” principle: “Teach a man to buy his fish, instead of looking to the NHS to prescribe it for him.” Meanwhile, the patient starts their own tirade along the lines of, “What the bloody hell’s it got to do with you!” and proudly walks in the next day with another fifty quid’s worth of bath oils and shower gel they got from the locum GP.
Never mind. At least my pharmacy obtained eleven pages of signatures for the petition against the pharmacy cuts last week. And what’s more impressive is the range of services that patients mention when we explain the petition needs to show the Department of Health that pharmacy is so much more than dispensing drugs.
It’s reassuring to see that pharmacy patients recognise the meaning and value of what we do beyond our dispensing function. “If the NHS wants to save money, they should start by prescribing less,” proclaimed one lady after she’d signed the petition. “I could probably get my lactulose on prescription,” she continued, “but I can afford to buy it.” “How about shower gel?” I asked her. “Shower gel on prescription? Outrageous!” she replied. At least someone seems to understand.