‘From community pharmacy to primary care – why I made the move’ :: C+D

With increasing pressure and publicity on community pharmacies, and the growing apparent lack of community pharmacistsI was asked why I left community pharmacy in 2019 to become a pharmacist in the primary care network (RCP).

I think there were two factors behind my decision – variety and impact. I was a community pharmacist for about five years and held various roles including back-up manager, store manager and also locum.

It was a 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’ve held positions in pharmacies with warfarin walk-in clinics, as well as in pharmacies that had a large drug 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 was still not clinically fulfilling enough for me to feel that I was having a sufficient impact on the health sphere in his outfit. I was looking forward to becoming a prescriber and, through it, being able to take more of a role in making shared decisions with patients about their care.

I found the feedback loop between community pharmacy and primary care services clumsy and not always accessible – and that was even the case at the last pharmacy I ran before transitioning, which was in a general practitioner’s office! Making active decisions in collaboration 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 has a long way to go to be able to make the more active role in decisions to do with prescribing.

“Limits” as a community pharmacist

I felt that all of the useful and proactive work that I did in the community, such as auditing our patients’ blood thinner dosages, overprescribing opioids and the like, seemed to have limits. I was unable to speak to key decision makers in surgery to change prescribing habits, or even to get quick results from the queries that arose.

There is definitely a disconnect, as pharmacies and doctor’s offices will always be separate entities, so moving to primary care seemed like the best option to me. I could hone and use my clinical knowledge and hopefully effect real change in prescribing habits by taking my observations and using them effectively and proactively.

I am not discrediting community pharmacy in any way, as I have enjoyed it for years. But when I compared my basic clinical knowledge and the actions I took in the community, I was limited to a very narrow set of results. Since my transition to primary care, I have become a prescriber, have worked closely with GPs and other clinicians to proactively target and influence patient groups, and have been extremely pleased to champion the role of pharmacists within a primary care system to help us move forward on key goals. roles in the new NHS long-term plan.

I am working 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 opinion on the ground within the primary care system.

All this, I believe, comes from the fact that I made the change. Although there are new services through community pharmacy, such as the Discharge Medication Service (DMS), I believe there is still much to be done to link community pharmacists with pharmacists in the primary care system to create a more interconnected network of pharmacists for -up patient care.

Services like DMS, in my opinion, only work well when there’s a pharmacist at each end of the process – from community to GP – otherwise the disconnect and back and forth system that I I’ve experienced trying to get questions and concerns answered in a simplified way will just happen again.

I guess to sum it up, my decision to move into primary care was based on my desire to broaden my clinical knowledge and expand the variety of patient contact I could have, but it was also so I could have a loop full of feedback influence in prescribing decisions. I felt like I was not 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 do not deny that community pharmacy is an essential part of our health care model and that it certainly needs a sufficient number of pharmacists to be able to achieve its objective, but I personally believe that as a pharmacist of primary care, I have a much more immediate impact on prescribing safety and improving patient outcomes.

Danny Bartlett is Senior Clinical Pharmacist for the Coastal & South Downs Care Partnership PCN

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