Dr Jenny Scott is a Senior Lecturer in Pharmacy Practice in the Department of Pharmacy and Pharmacology at the University of Bath.
Pharmacy as a profession has long suffered from an image problem. The days of pharmacists hiding away in dispensaries packaging up medicines have long been replaced by a multidisciplinary team including accredited checking technicians and, in some cases, robots assembling medicines, while the pharmacist deals with clinical issues.
However, the perception of what pharmacists actually do has been slow to change. In part this is because their work is not always visible. Identifying an inappropriate choice of medicine, a drug interaction, a wrong dose, recommending an over-the-counter medicine safe to take with a raft of prescribed ones – these are all potentially life-saving interventions, but not as easy to convey to the public as listening to a chest with a stethoscope, inspecting an x-ray, or performing CPR. For pharmacists, most patients on multiple medications tend to be older, and interventions are kept confidential - it is against the ethics of practice to undermine patient confidence in their prescriber, rightly so. This does mean pharmacists tend not to be able to amplify the contribution that their work makes to patient care.
Community pharmacy has the most engagement with the public, with an estimated 438 million visits for health-related reasons annually in England. Last year each pharmacy dispensed on average over 87,000 prescription items and the profession as a whole administered 1.4 million flu vaccines. Most of the population live within a 20-minute walk of a pharmacy, and pharmacies provide a range of locally commissioned public health services including drug misuse care, stop smoking services and sexual and reproductive healthcare. Data published in 2016 showed 48% of adults had taken at least one prescribed medicine in the past week, rising to 90% of those over 75 years; 24% take three or more medicines with prevalence higher in deprived areas.
In the current COVID-19 pandemic, pharmacists and their teams have had a turbulent time. Clearly ‘frontline’ workers, community pharmacy teams are continuing to support people to receive their regular medications. In the early weeks of the pandemic unfolding, pharmacy teams saw their prescription workload increase, some report tripling, as people panicked to stock pile their regular medications. Not only did this increase dispensing volume, but also the associated clinical screening, checking and resolving of problems.
Pharmacy teams also find themselves responding to ‘walk-ins’ from the public concerned about their health. GP practices operate a triage system behind closed doors, but this pushes greater numbers to seek help in pharmacies. Pharmacists of course are used to responding to symptoms and where needed, signposting patients to GPs or other healthcare services. This work is not new, but following COVID-19, the unprecedented amount of work is. Anecdotal reports of increased GP referrals to pharmacies, and responding to visits from people exhibiting COVID-19 symptoms afraid or untrusting of advice to stay at home, understandably creates anxiety amongst pharmacy teams about their own risks of exposure.
There are also challenges around having discussions confidentially with social distancing rules in place, and many pharmacy consulting rooms are too small to utilise. Pharmacy teams continue to struggle to access supplies of PPE to protect themselves and others, and have expressed concern about being unable to access free PPE through NHS England. There are also reports of increased aggression from the public, who are frustrated at longer waiting times and requests to keep a social distance. Not to mention, all of these challenges, frustrations and incidents are against the backdrop of high levels of staff absence due to necessary self-isolation. Pharmacy teams have never felt so undervalued, and the government’s descriptor, ‘distributors of medicines’, used on the Essential Worker list has done nothing to sooth their feelings.
Yet there is positivity in this challenging situation. Advances in NHS practice have been made at an unprecedented rate - change can happen and pharmacy is part of that. Public Health England (PHE) have issued a standard operating procedure for pharmacies in response to COVID-19, and the government has also announced a COVID-19 pharmacy funding package of £300 million - though there is some debate whether this will be enough to ease pressures.
Change is also happening on a broader scale. Temporary law changes proposed will give pharmacists - traditionally bound by the legal framework of the Misuse of Drugs Act - some freedom to exercise professional judgement to act in the patient’s best interests. The use of telemedicine - using the phone for guidance and advice - has also increased, which plays its part in reducing walk-ins. Although at present we do not know if some of these changes will remain, we are at least testing them, allowing them to develop and finding new ways of working.
The Royal Pharmaceutical Society and others have also campaigned for greater recognition of pharmacists’ contribution to the COVID-19 response. Consequently we have seen the PM and the secretary of state for Health and Social Care acknowledge their contribution, which was welcomed by many.
Local efforts have also played a part. PPE manufactured and supplied by the Faculty of Engineering and Design at the University or Bath has ensured that all pharmacies in the Avon area have received free PPE supplies of face shields and goggles. This has given local pharmacists an increased sense of safety to continue with their jobs.
Will pharmacists be viewed in a new light in a post-COVID world? When we get through this, pharmacy teams and pharmacy as a profession will be faced with the same challenges as the rest of us - figuring out the new normal, and what positive steps forward we can hold onto and develop as a result of this pandemic.
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All articles posted on this blog give the views of the author(s), and not the position of the IPR, nor of the University of Bath.