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10/12/2011
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Resisting the sands of time
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Four decades after qualifying as a pharmacist, Pharmacy Business Prescriber of the Year, Kaushik Patel, is breathing new life into deprived Jaywick, writes Neil Trainis...
I've won three awards in my career,” Kaushik Patel says with an almost self-effacing aversion to recounting his achievements during the course of a career as a pharmacist that has stretched four decades. Modesty carries with it a determination to resist the sands of time. A 69th birthday will arrive in December and the Pharmacy Business Prescriber of the Year award winner is preoccupied with adapting to the demands of a changing National Health Service rather than bathe in the celebration of his own longevity. His qualification as a pharmacist in 1970 seems a long time ago. “Pharmacy has changed quite a lot in that time,” he muses. “It was once purely dispensing in the old fashioned way. You would stick labels on with your mouth. There were no machines. You would count the tablets in bulk and there was lots of mixing medications.
“It was a different world then. It was a much more time-consuming world. It's much easier now. I'm able to do more clinical things. That's my speciality. I'm an independent pharmacy prescriber.” There seems little this wily old clinician could learn about patient care but he has had to undergo a journey of self-improvement and discovery, even if he has found that age is no barrier to enlightenment. His advancing years have not sapped his appetite to help people.
In 2008 he opened a pharmacy on Jaywick seafront but an area once renowned as a holiday getaway destination for Londoners bogged down by the pressures of city life now encapsulates deprivation. “It's the most deprived area in the country,” Kaushik volunteers. His pharmacy caters for a mostly elderly clientele but younger people with “mental problems” also come to him for treatment and advice. “They come with depression, broken marriages, there are unmarried mothers. I point them in the right direction, to their GP,” he says. Younger people with psychological issues represent “a small proportion” of those who walk into his pharmacy.
Kaushik has his hands full but he gives the impression he would not have it any other way. He combines his duties as a pharmacist with work in the local GP practice two days a week, where he dispenses 2,500 items a month from the surgery despite it being located three miles away. He looks after almost 600 patients at the surgery each year. “The work allows you to use your brain,” he says. “Counting tablets is one thing but helping people is more beneficial to my way of thinking.”
For the last six years he has undergone an annual assessment with a GP to ensure he is up to scratch with his techniques in patient care. The GP watches intently as Kaushik handles a patient. “No, no, no, I never get nervous (when the GP watches and examines him),” he says. “It's about proving that your knowledge is up-to-date because you're dealing with patients. You demonstrate how you deal with the patient. The doctor will watch you, he will watch how you write the prescription. It's interesting. Doctors are assessed too. They are assessed by other doctors. It's all part of the health service.”
Doctors are not the only ones reassured by Kaushik's expertise. As Pharmacy Business's roving judge Richard King observed during a visit to his pharmacy last year, “many patients seeking a same day appointment ask to see Kaushik instead of a GP. Such is the trust GPs have in him, there are no restrictions to who he sees, with the exception of females with gynaecological problems.” Like all modern, forward-thinking pharmacists working in an NHS fit for the 21st century, Kaushik is unrepentant at breaking with the past. “Counting tablets is not my interest,” he asserts. “I'm more interested in public health and playing a more important part in public health.” He has perfected the art of holistic service provisioning. He conducts regular clinics at the surgery, including his speciality, spirometry testing, which he uses in his stop smoking clinics and for patients who arrive at his pharmacy with coughs and chest-related problems. The pharmacy itself provides for diabetes, smoking cessation, hypertension, ECG testing, asthma, minor ailments, flu and travel vaccinations, health checks, medication reviews and MURs. It has one large consultation room which is used to see 25 patients a day. “All for different things,” Kaushik says. “You need a proper consultation room with a clinical atmosphere and proper clinical information, otherwise there's no point in having a consultation room.”
Over the last eight years he has developed a particular interest in chronic obstructive pulmonary disease (COPD). He raises the concern that many pharmacists are too scared to give patients advice about a disease that kills 30,000 people a year in England in Wales. That fear may have it origins in the statistic, proposed by www.emphysema-copd.co.uk, claiming that of the three to four million people suffering with COPD in the UK, one million are correctly diagnosed. “COPD is either under-diagnosed or misdiagnosed by the doctor,” Kaushik insists. “Up to now, nobody took a serious interest in COPD. It's only been the last two or three years that GPs took it seriously.” More interesting is his observation that “not much is done about COPD in pharmacies. A lot of pharmacists don't have the confidence to give clinical advice about COPD.”
Jaywick Pharmacy is a monument to his devotion to help patients fight COPD. “We do the early diagnosis so we can start to devise the medication at the right time and monitor their compliance,” he says. “If the medication doesn't reach your lungs, it's not going to help. It's very interesting and challenging. My speciality is COPD. It is the number two chronic disease in this country. Most smokers will get it and 50% of smokers will get it by the time they are 55, 60 years old. It's a very dangerous disease.” He says that of those patients who come into his pharmacy, “40 to 45% have breathing problems.”
Kaushik barely has time to pause for breath. Pharmacists have to engage and be proactive to survive and he is not prepared to fall by the wayside. Nor is he sympathetic towards procrastinating pharmacists who are resistant to change. “(Pharmacists are valued by commissioners and Government ministers) provided they can prove it and show their benefits,” he says. “I'm accepted by the secondary and primary care (health) team. If I'm accepted, anyone can be accepted. Pharmacists must be accepted as part of a team, not as individuals. They must be part of the primary and secondary care team.
“They must engage, not in a stupid way but in a sensible way. They mustn't engage where they don't know what they're talking about. If you go to a GP's surgery you mustn't just discuss what issues they face or what issues pharmacy faces. You need to talk about how you integrate the two (professions). It's vital for the future of pharmacy, it's vital for it's survival.
“The future is bright. As long as you can provide the services and show what is beneficial to the population, that's an important thing.” The notion of competition within health service commissioning continues to be a source of anxiety to pharmacists, despite the Government's promise to water down the role of Monitor, under which competition will only be introduced where it clearly benefits the patient.
“I can provide the same service as GPs. I'm not worried at all. Competition is good. You can use your clinical knowledge,” Kaushik says. “Some pharmacists are not confident in providing their service. If you're confident in dispensing and providing your services, there's no competition there. People will come to you more and more.”
"Not much is done about COPD in pharmacies. A lot of pharmacists don't have the confidence to give clinical advice about COPD."
In the last year, he insists, his customer base has increased by 30%. “It's all to do with better healthcare services. We are ready for what the NHS wants.” He works alongside a small staff of four at his pharmacy. “I trained all four,” he exclaims with a certain pride. “Three of them are in their 30s, one is about 20. I've taught them communication skills, patient care, how to signpost patients in the right direction and I've encouraged them to read up on what's going on.” Are his staff worried about their future? “Not when I'm here,” Kaushik says firmly. He finds the concept of retirement almost too much to bear. “I'll still be involved in healthcare (after I retire), more to advise pharmacists and GPs how to make the most of their relationship. I want to work the rest of my life on the clinical side.”
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