Working in a community pharmacy can be a rollercoaster ride and my preregistration year with The Co-operative Pharmacy has been no different. Every day brings a new adventure and no two days are ever the same.
The pharmacy I am based at has three GP surgeries upstairs and a variety of nurse and specialist care services in the building. Accordingly, “busy” is a word quickly followed by the word “understatement”. However, this environment is a brilliant place to learn and a great place for any preregistration trainee.
I had met the staff of this pharmacy during my third-year summer placement and, although it was through luck that I ended up doing my preregistration training there, I would advise those going into community pharmacy to try to get a summer placement with their (hopefully) forthcoming employers. Knowing the staff, the building and the business systems before I began proved a huge benefit.
The beginning
Starting the year was a daunting prospect. Trying to take hundreds of hours of science lectures and converting them into practical knowledge to answer queries such as what is the best painkiller for an elderly patient taking every medicine under the sun while a queue rapidly forms is no easy task.
As seems to be the case with most placements, I started the year with the counter staff, learning the ropes and practising answering various queries from the public. Unsurprisingly, this is also where I achieved many of my training standards for dealing with conflict. Patients seem to vary from incredibly appreciative to anything but (usually depending on the weather).
Regardless, this process gave me time to find my feet and get used to a full working day all week long. University seemed to involve studying all the time, but preregistration training feels a lot more intense. Community pharmacy is definitely a patient-facing job. If you cannot maintain a bright and cheerful attitude in the face of the public then you might need to reconsider your options.
Moving around the pharmacy, I learnt about various aspects of the job, from the basics of stock control (arguably one of the most important parts of the job) to dispensing and organising repeat prescriptions. Eventually, I arrived at the “pinnacle” of the pharmacy process: the front bench of the dispensary.
Some “walk-in” prescriptions seem to be complicated, confusing and, not uncommonly, wrong. This was where my learning of the intricacies of community pharmacy took off. Becoming confident with Controlled Drug prescriptions came about from seeing many incorrectly written ones, which I then advised the doctor on how to amend.
Similarly, common doses for drugs become ingrained when you spend time correcting the wrong ones. Indeed, I think I owe the doctors and nurses who wrote the incorrect prescriptions a big thank you for their unknowing contribution to my training!
It seems, however, that, time after time, I find myself called out of the dispensary to examine an infected eye or to decide if a rash requires a doctor’s attention. Within my primary care trust, the minor ailments service is hot on the agenda. The PCT is always adding more prescription only medicines to the formulary.
Consequently, this forms a significant part of the extra services our pharmacy provides. Of course, given the strict criteria of patient group directions, this service cannot be used indiscriminately and I found a significant part of my time was spent as the “gatekeeper to the pharmacist”, a role that I have grown to love.
As expected, as the year progressed, the involvement of my tutor has become more of a legal requirement than an actual need for his expertise or advice. However, having his support and knowledge on hand is something I will definitely miss when I become registered.
Making a difference
Pharmacists have their own style of running a community pharmacy. This is evident from my observation of various locums over the year. However, something I have developed with pride is an ability and desire to interact with patients as frequently as possible. Often, the advice you give is not earth-shattering but nonetheless it is useful and appreciated by most. On some occasions, you can make a real and noticeable impact.
There are many episodes that stand out in my mind as successes or failures that shaped my time this year. One example of making an impact is when I helped a patient suffering from severe drug reactions to gabapentin. Through a series of discussions and trips to the doctor, we changed his medicines at least four times before he was able to experience pain relief. However, the conclusion of this episode was a happy patient experiencing a normal life and a satisfied preregistration trainee.
Dealing with queries
Sometimes, doctors telephone us direct. On one occasion, a doctor wanted an alternative for a particular drug for a patient with swallowing difficulties. The liquid preparation was a “special” and far too expensive. He asked if I could advise. Unsurprisingly, I was a little caught out by this because I had no knowledge of the patient or the condition being treated.
It turned out that, with a quick flick through the British National Formulary, the answer was incredibly simple and a brand change allowed a capsule to be opened and poured into a drink. I found it exciting, if a little scary, to be put on the spot in such a way. It also highlighted to me some of the contributions pharmacists can make in the community, as well as the respect that other healthcare professionals have for our profession.
Management
Another key aspect to community pharmacy is the business and management side of the role. This is something I was slightly apprehensive about since I have always focused on the clinical parts of the job. However, learning from my tutor, I was able to pick up many ideas for managing people in an effective way.
On occasions, I have even managed to solve staff problems, which is possibly the most sensitive area of the job. I also took a role in the training of healthcare assistants who had not been working much longer than I had. This gave me great experience being involved in a different type of task.
Conclusion
This preregistration year has been a fantastic experience where I really learnt to put my knowledge to use. University cannot completely prepare you for the realities of practice. There is a huge pressure to provide the correct answer, with a patient depending on your decision and actions. I am aware of the responsibility of the role. A single mistake might have disastrous consequences.
It still sometimes surprises me how often patients will come to the pharmacy rather than the doctors because they trust us and want our opinions on treatment options. There is an opportunity to influence patients’ treatment in a positive way and gain great satisfaction from doing so.
I would advise new trainees to keep their calculation skills up to scratch so there is no last-minute panic. It is also vital to make use of other staff members, not just your tutor. Technicians often have a wealth of knowledge to learn from. It is also important to get involved in every aspect of the job. Some jobs are not particularly interesting but they are a learning experience and you might be asking someone else to do it one day so you need to know how it is done.
Finally, grasp every single opportunity available to you. If there are not any, make some. During this year, you might have the opportunity to run health promotion campaigns, meet doctors and go on training courses. Use your time wisely.
Nicholas Thayer is a preregistration trainee at The Co-operative, Church View, Nantwich
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