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.

The community pharmacist who phoned me about a medication review told me he was attached to my surgery and calling me from there. He was not from a shop. In fact, our village has a pharmacy, with its own pharmacist.
Apparently the community pharmacist comes to our GP surgery once a week. Goodness knows why. Nobody knows his name, you can't book appointments with him, and the chemist's shop is apparently sick of him.
I know this because I phoned the shop to find out if they knew who he was, and they sighed and said he was basically a nuisance who had been foisted the village for no discernable reason.

Foisted ON the village.

@TheShellBeach The term “community pharmacist” (or in America retail pharmacist) describes someone who works in a dispensary, usually in a pharmacy on the high street like the one in your village - their pharmacist would describe themselves as a community pharmacist, it just denotes what sector of pharmacy they work in.

Maybe the one in question has an atypical variety of roles, or works in the GP surgeries dispensary idk but they clearly work in primary care so I don’t personally understand why they would call themselves a community pharmacist.

The receptionists and various other staff members at my work have often referred to me as a community pharmacist to patients despite me correcting them repeatedly. I’ve given up now.

Having said this, like lots of healthcare roles that are expanding year on year in terms of potential scope, words like “pharmacist”, “nurse”, “paramedic” etc. are becoming increasingly less useful for the public to understand what the clinician actually does within their remit, as it will vary enormously depending on their exact training, experience and support and the sector within which they work. I had this conversation yesterday with a colleague who agrees with me on this.

I know pharmacists that work in the pharma industry in clinical trials of new cancer drugs, pharmacists that work in stroke units in hospital, pharmacists that work in warehouses supplying medicines through an online pharmacy, pharmacists that work on the high street, or pharmacists that write policies for GP surgeries for the NHS commissioners, and more. This is why extra descriptors do matter IMO, but I also understand that you and in fact most people probably aren’t that interested!

GP *surgery’s dispensary

There is no surgery dispensary. There is no need for one. We have a pharmacy in the village with a pharmacist based there, who never intrudes into our lives the way this community pharmacist has done.

I am not happy that an unqualified person can read my GP notes. It is an invasion of my privacy.

The so-called community pharmacist apparently goes to other GP practices in different villages, all of which have their own chemist's shops with their own pharmacists.

I am still absolutely puzzled about the role of this community pharmacist. He does not work in a shop - he is employed by the Health Board (we're in Scotland) to rock up at various GP surgeries and phone people up uninvited, and without an appointment.

I was actually having lunch in a restaurant with my family when this busybody phoned me to do a medicine review. I wish I'd told him that I only want to discuss my medication with the GP or Advanced Nurse Practitioner. I was kind of caught on the hop, though, so I had a quick word with him. He claimed he would arrange blood tests but never did.

In short, he was a nuisance and I think he had a cheek.

The term “community pharmacist” (or in America retail pharmacist) describes someone who works in a dispensary, usually in a pharmacy on the high street like the one in your village - their pharmacist would describe themselves as a community pharmacist, it just denotes what sector of pharmacy they work in

I wish you'd stop saying that. He does not work in an actual pharmacy, shop, or other retail establishment.

As you can tell, I was really, really put out by this person.

When I collected my next month's prescriptions (for me and my husband) some of my husband's usual medication was missing. I queried this with the pharmacist in the shop and she said that the community pharmacist had stopped the medication. Her hands were tied, apparently.

My husband had no opportunity to talk to the community pharmacist so he didn't know that the medication was going to be stopped. In fact, it was immediately reinstated when I asked the Advanced Nurse Practitioner about it.
The actual village pharmacist is obviously annoyed about this "community pharmacist", who is treading on her toes (for no reason) and annoying her customers into the bargain.

Anyway, I asked the women who work in the chemist's shop about the community pharmacist and they were thoroughly pissed off with him, too.

They were quite professional about their annoyance but it was obvious

And before you ask, I actually like the real village pharmacist. I do not get medical advice from her because she hasn't got my notes, so how would she know about my medical conditions?
But she is a pleasant person and if I had a question about dosages or medicine interactions, I would ask her. You know. Things which is qualified to tell me about.

@TheShellBeach I can see you’re annoyed and it seems I’m perhaps not helping this. I intended to write generally about the term community pharmacist, as it’s been incorrectly used about me when I am a GP surgery pharmacist. I wasn’t trying to antagonise you.

The problem here @TheShellBeach is you are tarnishing a whole profession based on a bad experience with one pharmacist.

I look at peoples medical notes in the GP surgery as a pharmacist and I am qualified to do so.

I do not believe that pharmacists are qualified to look at patients' notes and I think people would be horrified to know about this. It's an invasion of privacy.

@PlatypusFarmer thank you for your informed information on the difference between pharmacists and where they might work - very interesting and clarifies some things I’ve wondered about. I understand that you can only give general information.

I was at a conference a few weeks ago, and one of the lunchtime workshops was a presentation by a pharmacist regarding the importance of medication reviews, especially as we get older when we might have several comorbidites where we’re on several different meds with potential interactions/impact on liver etc.

I have a question if you’re able to respond…I do some online volunteer work for a health condition and we sometimes see women who’ve been prescribed medication by their GP which is then refused by the clinic pharmacist even though the medication is within guidelines and with no good reason to refuse. In this scenario whose is the ultimate decision making and responsibility?

You say that like gp's never make mistakes.
My pharmacist noticed a funny looking mole on me and advised I get it checked by the GP. I was told by Three different doctors on Three different occasions that it was fine. It was absolutely not fine and turned out to be melanoma. Thankfully I could afford a private consultation or I wouldn't be here to tell the tale.

@TheShellBeach it sounds like the pharmacist you dealt with is employed by a PCN (Primary Care Network), which is a group run by a number of surgeries who collaborate to get government funding to provide extra services.

You say the pharmacist isn’t qualified to read notes and it’s an invasion of privacy. They are highly trained and has others have said, have had several years training. A brand new receptionist with no medical training has access to those notes and everyone who works in a surgery is bound by confidentiality.

You also say the village pharmacy hasn’t got access to your notes and doesn’t know your medical conditions. She will know from the drugs dispensed what conditions you suffer from.

Well you might not believe it but that doesn’t mean it isn’t true. I speak to patients everyday, they know I have their notes in front of me. They are not horrified.

And absolutely GP’s can (and do) make mistakes or errors in judgment. I had a friend who had previously had breast cancer who had terrible back pain - to me there were so many red flags. I told her to see her GP who turned her away three times insisting she had a pulled muscle. Eventually after I keep telling her to go back she got an MRI - her spine was riddled with bone metastasis. Sadly she didn’t survive much longer.

But that doesn’t mean I say all GP’s are useless, don’t bother seeing a GP as they’ll just fob you off. No, I recognise that one GP one occasion didn’t refer when perhaps he should’ve.

A lot can change in 5 weeks, if something doesn’t clear up then get it rechecked. Some illness such as sepsis and cancer can accelerate very quickly and go from trivial to serious extremely quickly, it doesn’t mean that the person who initially examined you was wrong, it’s tricky being any healthcare professional and I dont think anyone will have a 100% track record.

lol at pharmacists not being able to read medical notes😆

@over50andfab nobody will be able to answer as without patient notes it’s unclear whether there’s ‘no good reason to refuse’. Presumably there was a reason. Ultimately it’s the prescribers responsibility and up to their clinical judgement, no difference whether pharmacist, nurse or GP. No prescriber is duty bound to continue a prescription started by someone else. Lots of people are on medication that’s ineffective/ potentially detrimental and each clinician must make their own decision

Generally the pharmacists near me are pretty good but are now being overwhelmed if they can't get a GP appointment.

That said, when I was pregnant one wouldn't dispense the opioid pain killers I was prescribed by my consultant as "it's not safe as babies have a high chance of being born addicted. The doctor who prescribed this was wrong to do so". I asked for my script back and they wouldn't give it back (this was before they were sent electronically) so I then had to go through the rigmarole of getting hold of my consultant, who then got the hospital pharmacy to dispense it for me. I had to travel 40 mins each way on the bus though just to get to the hospital for this. And being in as much pain as I was this was awful, I ended up in hospital the next day due to the pain. Consultant was horrified they wouldn't dispense it and didn't call her to confirm it was ok.

They can't refer patients to hospital consultants or social workers or anything useful like that.

They do have safeguarding responsibilities - so, say to a 12 year old girl came in, asking about contraception and they suspected, she was a victim of CSA? Likewise, pharmacies take part in the Ani campaign - whereby victims of domestic abuse can go in and ask for ANI, a code word for help? (Action needed immediately, iirc)

Then, they have to watch out for signs of addiction - so, they shouldn’t sell people codeine, if they are asking for it too often? Ditto other OTC, which can be abused.

Someone collapsed in a supermarket - the pharmacist went and gave CPR, although the customer died from a head injury.

They have to check prescriptions are legal - ie the correct name, address and dosage. What if a GP prescribed the adult dose of a drug to a baby? It’s the pharmacy, who are supposed to pick that up.

Some supply methadone and/or a clean needle exchange. Which is more cost efficient for the NHS - give out clean needles to addicts; or have to treat diseases like HIV, hepatitis, etc passed on by dirty needles?

These are just a few examples of what pharmacists do…..However, they are not GPs. It’s like asking the garage to fix your gas boiler, then complaining they haven’t done it right!

In terms of being qualified to look at patients records - you would not believe the amount of times I picked up on prescribing errors and had to refer back to GP. Either because the dosage was incorrect, or because the medicine prescribed was contraindicated with a drug already being used by the patient.

@fedupandtiredmum23 Although I appreciate your predicament, you could argue the pharmacist was being responsible. He is responsible for anything he dispenses, although I agree he probably should have contacted the consultant for clarification.

@Riverlee but it was prescribed by a highly qualified consultant at the hospital. It allowed me to get to full term of pregnancy rather than having a termination or having a pre term delivery.

Sadly DC was born addicted and had to withdraw which was hell but is almost 9 and didn't ever have any health side effects from it

@fedupandtiredmum23 Regardless of who prescribed the medicine, the pharmacist has a professional duty as well. Yes, they should have contacted the consultant and discussed their concerns. Had they dispensed it and something gone wrong, they could have been legally responsible as well.

I’m sorry your son was addicted when born but glad he is well now.

Some of the responses on here are absolutely disgusting!