Pharmacists

[1mabon]

Five weeks ago I asked the pharmacist about a spot on my face, He told me it was nothing to worry about. At the time of writing, I am in recovery after having a wedge cut from my lower lip and chin as the spot was cancerous. Never will I visit a pharmacist for advice instead of thinking I would be wasting my GP's time.

I have not been near that pharmacy. The only time I will ever go to any pharmacy again is to collect a prescription. Pharmacists are highly qualified but they are not medical doctors who have seven year training before they can become GP's and then GP's are what is says on the tin General Practitioners, however, they are in a position to refer on to a consultant unlike the pharmacist.

Exactly.

Ridiculous comment. Pharmacists train for 5 years - 4 in university and another as a pre-registration pharmacist. From next year all newly registered pharmacists will also have a prescribing qualification.

It's true.Australia can offer more attractive packages because they aren't training enough doctors eg not footing the bill! There model is to not train enough and save money there but then use the money to incentivize our doctors. We spend a lot on training, only for the doctors to be nabbed by other countries.

What kind of cancer, OP, what is your follow up treatment?
5 weeks is fast, how long was it after you saw GP that you got the excision?

I've cut to the end- the huge issue with pharmacists not within the NHS is they have a vested interested in flogging you stuff they sell in their shop.

It is probably an amazing profession, but how on earth can they be qualified to do on-the-shop-floor diagnosis?

They're not, and therein lies the problem.
They think they know more than they do and that is unsafe.

It's the government pushing this work onto them.

They dont want it. They are leaving in their droves due to their current workload, and the government is pushing work onto them that they are not qualified for.

Where I work.

I'm seeing loads of pharmacists leaving community pharmacy and they are moving into primary care or hospitals because of how bad it is in the community pharmacies. And the government is pushing more work onto them.

Also the young professionals are not being nabbed.

They are being pushed towards moving abroad they really dont have a choice.

Again it's all in the governments hands to make working in the NHS more worthwhile.

@Mrsjayy Getting to see my GP is harder than getting an appointment with God. After the pandemic I was still quite pragmatic about the surgery's inability to cope with simple organisational tasks but I've had enough and we've changed to another practice. So when I hear adverts telling me to go to my doctor I want to laugh hysterically. They've still got strict COVID precautions in place and a telephone queueing system that takes 30minutes to get through, only to be told I have to use the econsult form on line. Makes me want to scream

Pharmacists really are doing their best, and they do a great job in what they have actually studied pharmacology. They clinically check that each medication a patient is on is suitable, and can be taken with all the other medications they take.

Just today working in a pharmacy, the pharmacist was asked by 3 separate patients to look at their rashes, because the patient can't get through to their doctors. They then try to see that patient while they have 10 prescriptions to clinically and accuracy check in the next 10 minutes, they also have 2 methadone patients waiting to collect.

I'm sorry that pharmacist didn't refer you to your doctor, but they are not dermatologists, they would just listen out for any warning signs.
A spot that wasn't healing would be something that a pharmacist should tell you to see your doctor about, but if that spot had only just appeared then they wouldn't necessarily be too concerned about it yet.

So you had problems with one surgery.

You've moved surgeries and still having issues.

Do you stop and think- Hang on, theres a pattern here why are GP surgeries so difficult to access right now?

There must be a reason other than what gets repeated in the media- how they are work shy and overpaid for what they do? If that's true why us there such a shortage of GP's?

Whilst I sympathise OP, I doubt that pharmacist had training on cancerous whitehead spots to have been able to diagnose you. Your situation, whilst unfortunate, is rare so it’s not like the pharmacist fell short. There were many medical explanations of your symptoms before arriving at potential cancer, the advice given may have been appropriate for the presentation.

Ultimately pharmacists are great at giving advice for minor things ie where treatment can be bought without a prescription. But anything more that requires a prescription or further investigation such as biopsy or skin lesion removal is beyond their remit. All they can do signpost you to your GP or urgent care.

three weeks

@Rowthe Misunderstanding I think. I was talking about my (ex)GP practice - only the one. The pharmacy do a good job. My beef is with the organisation of one surgery. I did some research and several people said how good X was, so we've moved. I don't expect any more trouble

I finally had a medication review a few weeks ago (11 months late) with a clinical pharmacist attached to my surgery, but all she could do was check I was having no adverse reactions. She could not order the blood tests I need to check that the dose is correct. To do that I have to call over 100 times at 8am and make a telephone appointment with a GP.

Having the pharmacist do the medication review means I will have to have a number of interactions with the surgery - medication review, telephone appointment with GP to request the annual blood test I should have under the guidelines, telephone appointment to discuss blood test results.

What they should have done was send me the blood test form before the review and then schedule the review with someone who could change the dose if necessary, but no. They just make more work for themselves.

I had exactly the same experience, except the "community pharmacist" said he would arrange the blood tests, except he never did, and I had to waste a lot of time, finding it when they were, which was never, because he hadn't arranged them, then going back to the GP so that she could do a proper medicine review and ask me relevant questions which he knew nothing about. Then SHE arranged the blood tests.
My friend works in the village pharmacy and she says she's sick of hearing stories from patients who have similar experiences.
It's a joke. Nobody wants or needs a community pharmacist.

Who should be dispensing medication then?

Pharmacists.
That's their job.
Not pretending to be doctors or nurses.
A GP knows all your medical history and your family background when you consult them.
A pharmacist knows none of this. It's pointless consulting one.

That’s not the fault of the pharmacist, but of the surgery procedures. At my surgery, they’ll always book the necessary blood test, and blood pressure check (for hypertension med reviews etc) prior to booking the medication review.

Forgot to say, one of my jobs in the surgery was to book med reviews when due. The procedure was that if they haven’t had a review for a year, then I’d phone the patient or send them a message to book the relevant tests, and then to book an appointment with a gp or pharmacist a week after these tests (to ensure the results would be in) for the review.

I’m a Pharmacist. I’ve never pretended to be a GP or nurse - I don’t need to, I have my own set of skills.

I work in General Practice. I can order bloods, if I want bloods. Usually a patient will have had bloods done before they get to me, but if they haven’t for whatever reason I’ll order them and if I want further monitoring I’ll request that too.

@TheShellBeach A community pharmacist is a pharmacist that works in a high street pharmacy, e.g. Lloyds, Boots, Well, etc.

There are pharmacists employed in GP practices (sometimes referred to as clinics pharmacists, although all pharmacists are clinical so a strange name tbh) who can be directly employed by the GP practice, or under a government scheme that funds the role. The latter group have 2 years of extra mandatory training to complete that enables them to write prescriptions within the scope of their competence (on top of the 4 years masters degree plus one year foundation training in a real setting e.g. pharmacy, hospital pharmacy, industry or GP surgery followed by final professional exams to register as a pharmacist in the first place).

OP I’m so sorry that you were falsely reassured about this lesion that was in fact cancerous. I hope you are receiving the best treatment and care now.

Unfortunately pharmacists are not equipped to diagnose skin cancer. Even consultant dermatologists can’t necessarily do this at a glance; they have lengthy, specialised training and equipment and histopathology is needed to assess a biopsy to confirm the diagnosis. Pharmacists can absolutely signpost to the GP if they see a lesion that looks obviously unusual/untoward, but unfortunately doctors, nurses and other healthcare professionals miss cancer signs and symptoms too. It’s certainly not just pharmacists.

I’m a pharmacist working in GP surgeries, and I am very careful to only do what I am competent in as I carefully and gradually increase my skills and experience. It’s interesting that judging from this thread, this can be perceived as wasting time and floundering and being inefficient, but it’s better than being really cavalier and straying from my expertise. There are lots of routine things for the management of chronic conditions that I can do, and do well. This then allows the GP to spend their time on the other things that I can’t do, without also trying to squeeze in a (poor quality) medication review on top.

Medication reviews are often underestimated in their importance. I see people every day taking something at the wrong dose because of their age/kidney function/other medicines etc. etc. This is just one tiny example but there is so much that needs to be looked at in a medication review.

Like most things in GP surgeries, it varies from one to another how things run as they are individual businesses with different clinicians and managers and priorities. I am lucky to be able to spend 40 minutes talking to someone about their medicines if needed, and the feedback is very positive about these. Other pharmacists have more pressure to churn out poorer quality reviews to make the GP practices more money which is a shame.

Once again OP I wish you all the best. I understand that your trust in the profession is gone. If you feel able at some point to give feedback about what happened to you then I would encourage you to do this, as it could help someone else.

And this, is why I moved to the regulatory side and got away from community pharmacy. It's a thankless shit show.