INDEPENDENT PRESCRIBING: THE NEXT CHAPTER
This year more than 200 newly qualified pharmacists in Scotland will graduate from university with an independent prescriber qualification. It is a landmark moment for the profession and could help to cement Scotland’s position as leaders in independent pharmacy prescribing, with almost half of the existing pharmacist workforce already qualified as prescribers. So what can the new cohort of prescribers expect when it comes to putting their skills into practice? Scottish Pharmacy spoke to pharmacists at different stages of their prescribing journey to get their thoughts.
Leanne Carey was one of the first independent prescribers in Scotland and has been co-owner of Barnton Pharmacy in Edinburgh for over 16 years.
“I completed the supplementary prescribing course back in 2004, I decided to do it as I had been wanting to do more clinical work and then we got this course dangled in front of us which sounded like the answer. But there was no backfill finding or funding to practice so I decided to do a prescribing diploma to keep me focused on prescribing which I completed in 2006. I then converted to independent prescribing in 2007.
When I first qualified there was no plan and so we had to find our own way. Funding was an initial barrier because at that point it wasn't possible to prescribe on the NHS in community pharmacy, that was introduced in 2020, 13 years after I qualified as an IP.
Funding was offered to prescribers in 2005 to do sessional review and prescribing work in GP surgeries. So I started with GP respiratory clinics (which was my clinical topic in my SP course) spending half a day a week running asthma review clinics which I did up to 2022. In 2014 I started prescribing privately as a travel pharmacist having used PGDs for the services for three years previously. I still run that clinic
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today and it is really successful for us. Then in 2017 my business partner and I started a common conditions pilot in the pharmacy funded by the local GP surgery and then continued with GP sessional work funding.
The surgery had a funding pot available aimed at easing the pressure on GPs. There were four 15 minute appointments per day which we offered late morning and which the surgery could book patients into directly. We weren’t alone in doing this, there were other pharmacies who were running similar sorts of things. The work we did became a pilot for Pharmacy First Plus that we have in place today.
While we now have Pharmacy First Plus, we are still currently restricted in community pharmacy by the numbers of prescribers. Independent prescribing cannot be a core service until every pharmacy has a prescriber in place. But we also need to be mindful that, even then, each pharmacy will operate differently to stay safe. The dispensing still needs done safely and the funding isn't enough to provide double cover every day. Today it is basically an ad-hoc service, although we can book patients in to be seen later if needed. I don't see it being all booked appointments unless funding increases and there will always be an element of ad-hoc work as that’s what patients like about Community Pharmacy.
I have an IP pharmacy manager so we always make sure we have a prescriber in the pharmacy six days a week. We don't get patients referred to us to prescribe for unless the surgery is struggling due to lack of clinicians and even then we are sent patients to triage and we can still get them a GP appointment. We will tell the surgery if we are at capacity, or have staffing issues and we sometimes book the patient in to come back later as we only have so many hours in our day. When staff triage patients under Pharmacy First, we can then consult and prescribe if needed. If it's more complex however we do more reassurance with our clinical skills than we do prescribing and we will still refer if needed, including sending some patients urgently to A&E.
There are other barriers that remain too including access to notes and only handwritten prescriptions. Today I spent over thirty minutes on hold to the surgery trying to find out the surgery email to send the consultation notes to, which I wouldn’t have to do if we had systems in place that allowed us to communicate with the NHS and access patient records. The consultations themselves take at least 15 minutes and then we need to add the time to do all of the administration including dispensing and recording comprehensive consultation notes on top of that.
There is a lot of work involved to ensure great governance. We need adequate staffing, SOPs, protocols, formularies and training as well as a private consultation room and using peer review and Teach and Treat sessions. We record detailed consultations and decision making and we need someone else to dispense or check our work for safety. We need to send the prescribing information to that patient’s GP for continuity. Auditing our prescribing is also a must.
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