There is no limit to what pharmacists north or south of the border can do for patients, says Bernadette Brown. The Pharmacy Business of the Year winner talks to Neil Trainis…
“At the moment yes, especially as an independent family business as it is challenging times,” Bernadette Brown says when asked if she is glad she is a community pharmacist in Scotland and not England given the trials and tribulations being endured by pharmacy south of the border.
Her honesty is refreshing but you get the sense the Pharmacy Business of the Year award winner would love to get her teeth into the health challenges of any English town or city. She is, after all, passionate about health.
As it is, she and her team at Cadham Pharmacy Health Centre are there for their local community in Glenrothes, a town embedded in Fife which has its own healthcare challenges.
“In the UK pharmacists, especially in the community sector, are having to look beyond prescriptions now to sustain and grow their businesses. I offer many private services including a yellow fever travel clinic and skincare as well as an enhanced minor illness service and chronic medication service (CMS).”
Bernadette, or Berni as she refers to herself and how her patients no doubt know her, has spent the last few years channelling her energies into creating a healthcare hub people from all over the area can go to for their health-related problems.
When you walk through the doors you instantly realise a great deal of work has gone into making Cadham a stand-out pharmacy. Bernadette not only oversaw its evolution to a health centre but transformed the way people access pharmacy services.
It has a futuristic feel to it. Innovation does not so much embrace you but screams at you. There is no over-the-counter stock on the shelves but if that is enough to get the category management obsessives tearing their hair out in exasperation, what exists instead is enough to grab the attention.
Patients are guided towards a series of virtual screens from where they select a product and are invited to talk about their purchase with a member of Bernadette’s team. There is a lot to admire about Cadham’s use of technology including its robotic dispensary but Bernadette talks about those virtual screens with particular enthusiasm.
“I wanted to create a health centre feel to my pharmacy and space became an issue once my robot was installed. The screens are a wonderful addition to us and offer so many advantages,” she says.
“The main ones I am finding are they help us to start up more conversations with people and we can identify who would benefit from a consultation with our pharmacists or nurse.
“We also sell retail health products linked to our robot and can do a lot of health and wellness education with videos and NHS health posters. We can promote our services and skills of the pharmacists and it all helps promote a clinical feel and health feel rather than retail.”
The robot was made possible largely through funding from the Prescription for Excellence fund but the robotic dispensary and the virtual screens are not where Cadham’s technology ends. Bernadette also invested in a FeNO (fractional exhaled nitric oxide) machine to assess patients’ response to respiratory treatments. This helps her decide whether to recommend stepping up an individual’s treatment.
Community pharmacists across Scotland, indeed England, may want to install the kind of technology used to great effect at Cadham but probably find the cost prohibitive.
“I can only share my experience and my advice is to be proactive,” Bernadette says. “I invested in my first robot after finding that there was a gap in the service level in my town and this has been a very wise investment and we are now able to help more people stay at home longer and be discharged from hospital more quickly with care packages in place with compliance aids.
“Investing in the pharmacy environment, technology and people may seem challenging at this time and yet this leads to investing in your community and the health and wellness of the people you serve. People value this and in turn it leads to loyalty to you as a practitioner and your business will prosper.
“Investing in your pharmacists, especially their education with assessment skills and prescribing, can lead to your community choosing pharmacy first for minor illness and long-term conditions consultations. Any systems in place to release the pharmacist’s time has been the key to success as well as the new online booking system I have introduced which has been very popular with the public.”
It is easy to see why. The online booking system is easy to use. When you log on to Cadham’s tidy-looking website it is pretty simple to locate the appointments section where you can log in a time to have a consultation.
Yet education is as important to Bernadette as technology. She is keen for her staff to develop new skills. Her independent prescriber is qualified to triage all common clinical conditions and prescribe and treat where necessary. It allows Bernadette to run NHS clinics to triage patients to the local surgery. Her team includes a nurse who comes in two afternoons a week to provide support and guidance around the triage system.
“The biggest factor in cultivating loyalty has been the investment in staff training and development which has led to every level of staff being more skilled,” Bernadette says with pride.
“My pharmacists are both undertaking the clinical diploma and achieving distinction grades. They are shadowing GPs nurses and being supervised with their assessment skills including being able to do chest examinations, using an otoscope to examine ears, CRP (C-reactive protein) testing, HBA1c and lipid profile, oxygen saturations, peak flow to name a few.
“This has led to a very different approach to minor illness triage and long-term conditions consultations. The public value this in particular when it is so difficult to access a GP or nurse in our NHS at this time. We can see over 300 people with face-to-face confidential consultations in a month now.
“Recently we saw 22 people for face-to-face triage in one day showing that the public really does value this in the heart of their community, improving access to a highly trained healthcare professional in the NHS.
“The feedback we got after doing this triage clinic with my nurse Margaret Cowan, who has supported this process, is that a pharmacy is easy to access and we have made it even easier now with the online booking service on our website.”
Nothing, not even technology, makes Bernadette feel as good as seeing the results of her and her team’s work on the lives of the people who depend on them.
“The concept of wellness and helping people with long-term conditions to be fit again and regain their quality of life with their families and friends and having the health to enjoy life and be a more active member in our community is for me the biggest factor in spreading the word about my pharmacy.
“This is leading to more families choosing to be a part of our community. We have pharma companies investing in our education also which helps to keep our skills up to date.
“Community Pharmacy Scotland have been wonderful along with support from our government in helping us with the infrastructure of national minor ailments, the Chronic Medication Service, urgent care services and recently making it easier to do gluten-free scripts and urinary tract infections and impetigo.
“This enables us to offer NHS services nationally. Universities have offered us the opportunity to go on courses such as for common clinical conditions. That was where I personally gained a new assessment skill-set that helps me to provide more excellence and care in my community. Both my pharmacists will be going on this course once they complete the clinical diploma.”
Listening to Bernadette talk, it feels as though Scotland is light years ahead of England when it comes to health systems making the most of community pharmacy. Yet where England has moved ahead of Scotland is patient records. Community pharmacies in Scotland do not yet have access. Bernadette is unperturbed.
“It is wonderful that in England they have this access already and in some parts of Scotland some community pharmacies are being piloted to have this access.
“I am hopeful that my own pharmacy can get access from a patient safety perspective and I know that it is being discussed at all levels, so this helps me feel more positive it will become a reality for us in our pharmacy practice.”
In Bernadette’s eyes, however, there are no limits to what community pharmacists can do for local communities whether north or south of the border.
“We are looking at going beyond prescriptions and medicines in 2018 and have made a start with tackling loneliness and isolation. We are looking at ways our community can support each other to gain a sense of physical, emotional and mental well-being.
“Our walking club is under way to encourage 30 minutes a day of exercise and a chance to meet up with other people of all ages for a chat.
“The potential to be a part of the solution in the NHS is there in every community pharmacy in the land and I for one am very proud to wear the badge of community pharmacist.”