akram sam

On my first day as a Practice Pharmacist, I was shown the ropes by another pharmacist who was experienced in the practice role. Fresh from having completed my diploma and with as much motivation as a January weight-loss fanatic, I was raring to go. I was introduced to the computer system, the doctors, support staff, practice manager, and anyone else who was available. I was shown the features of the clinical system and told about the screen messaging tool: ‘That’s where you order a cuppa.’ After a couple of hours I was left to my own devices.

Since that first day, I have worked at many practices in many CCGs. I’ve met lots of new staff (both clinical and non-clinical) and have had some memorable experiences. 

I remember arriving at my practice one afternoon and being told to use another consulting room as the regular one was in use. I sat down and noticed a button icon in the middle of the computer monitor. It was quite annoying, so I dragged it to the top corner. Still disturbed by its presence on my screen, I proceeded to double-click it to see if there was a hide or delete option. It only turned red. Doing my best to ignore it, I continued to switch between programs and perform my daily ritual of checking emails. A moment later the door swung open, the Practice Manager put her head in and asked if I was okay. ‘I’m fine,’ I replied. Next, a doctor appeared. And then another one. It transpired that the seemingly innocent icon I had double-clicked was the electronic panic button. The shock on each of their faces was due either to not knowing who I was, or wondering where the violent patient had escaped to, or if indeed I was the violent patient who had now buried the doctor that they expected to see and then sat in their chair. On the bright side, I got to meet all the doctors in 1 minute flat and got the savings authorised; beat that for efficiency!

Another time there was a full clinic booked. One young patient in particular seemed very pleased towards the end of his consultation, in contrast to his demeanour at the start. From his history it was apparent that he was a regular user of the healthcare system. As I was wrapping up, he was already on his way to the door. He did however stop halfway along the long corridor and shouted jovially (for everyone else to hear): ‘That was the best doctor’s appointment I’ve ever had.’ I received a pay rise shortly after.

As the prescribing advice and endless prescription switches took their toll, I received further training in advanced minor illness. This exposed me to further clinical scenarios in an urgent care centre, some of which were very serious: a 5-year-old child with breathing difficulties who needed nebulised salbutamol while waiting for a ‘blue light’ to arrive; an elderly gentleman who presented with symptoms of transient ischaemic attack; and a middle-aged man with a severe cough, which turned out to be an asthma exacerbation requiring immediate treatment with a nebuliser. These are definitely different scenarios to my days of working in non-dispensing pharmacy stores: putting nappies through the till and not forgetting to ask for the all-important loyalty card. 

Things are different now to when I first started as a Practice Pharmacist: new practice pharmacists have 2 weeks of shadowing, and there is a nationally available distance-learning programme that explains how the job should be done (despite the fact that you’ve already been doing it for 20 years)—not to mention the all-important KPIs, and a target of face-to-face medication reviews.

Having the pleasure of teaching non-medical prescribers, I also get a chance to go out and observe soon-to-be prescribers consulting with patients alongside their designated medical practitioners. This gives a great insight into the way things work in different settings, especially at a time when most patients have already consulted with Dr Google. Non-medical prescribers are playing a vital role and will definitely help alleviate some of the current pressures on healthcare services. Following further training in clinical assessment skills, pharmacists can be effective clinical practitioners, assessing appropriately, and prescribing efficiently. 

Sam Akram, MRPharmS IPresc FHEA