0: Welcome to the AJP podcast,
a podcast for pharmacists by pharmacists where we discuss current
events, relevant topics, and emerging issues. I'm your host, Carlene McMaugh,
and together with the AJP,
I'm bringing you the opinions and expertise of different pharmacists to discuss
their views and insights on topics relevant to pharmacists.
Please like and rate each episode and subscribe to the podcast so you don't miss
an episode.
1: But I might start off by asking you, is it okay to introduce yourself?
2: Sure. So my name is Jess Burrey.
I am a rural pharmacist in Central Queensland.
I have been a pharmacist for almost 20 years and
I thoroughly am enjoying every part of being a
community pharmacist and most recently have become a
prescribing pharmacist and joined as the central Queensland
representative for the Queensland Pharmacy Guild.
So I am wearing lots of different hats and loving it as I go along.
1: Thank you.
Because I understand that you've recently completed the prescribing course in
Queensland,
so I wondered if you could tell us a little bit about the prescribing course.
2: Yeah, so I was in cohort two,
so thank you to the people in cohort one that ironed out a few creases for us
in cohort two,
and I think we've then subsequently done that for the following cohorts.
So it's been a bit of a journey.
It took me close to 18 months to finish the training,
but now that it's been streamlined,
the aim is people will be finished between a nine and 12 month period.
So it's been streamlined,
much more rigorous and a lot more clinical component at the
moment,
but it has been an incredible journey and I think it's really changed the way
that I practise regardless of whether I'm providing consultations directly
or just in my general day-to-day role as a pharmacist.
I think it's really changed the way I approach my patients.
1: Can I pick your brain about what the course content might've looked like,
what the requirements were for the course,
what some of the subjects even might've been, and you mentioned practicals.
2: Yeah, so it has changed obviously since I have done it and there are
also multiple
providers delivering the course and hopefully that will continue to
evolve as we see more states pick up and adopt full scope.
For myself,
we did prescribing components through QUT and
then the clinical component through JCUI probably can
comment more on the JCU course, which is now offering both of those.
So for people coming through JCU where cohorts three and
four and soon to be five have been going through and it's
two subjects.
The first one primarily on the prescribing process,
so a lot more of the governance history,
taking consultation and writing the prescription.
And then the second part of the course is all of the clinical content.
Now as part of that clinical content,
you attend face-to-face workshops to develop those clinical skills.
For my group that went through, we had four days of clinical content,
now you get two five day workshops.
So it's improved in terms of the delivery and I think that will be a really
valuable experience for those that are coming through now to
get much more hands-on in the training.
With the training, there's exams throughout,
some of those are face-to-face OSCEs and then some written online
components as well.
1: Brilliant. Did you have to do practical placements and things like that as well?
2: Yeah,
I did and I was really fortunate to have been very well
supported by one of our local GP practices and to have an amazing
mentor,
or mentors I should say because quite a few of the GPs in the practice actually
took me under their wing.
So I structured my practical component where I did a
combination of doing or I guess stepping into the consult
room more often in the pharmacy and just kind of working with my
general patients and doing a little bit more and then having discussions with my
supervisors and then also going in and working half a day a week at
the general practise,
which was really outside of my comfort zone.
I think I developed a respect for how many patients we actually manage in a day
compared to general practise,
but helped me really cement my skills.
So for me what that looked like,
I developed the training plan with my supervisor.
Initially I just sat in, watched them deliver consultation,
kind of get a feel for how to really connect with patients and
then fast forward,
kind through a few steps and by the end I
was going through the wait list where I live,
we have a six week wait to see a GP.
So I was going through the wait list trying to pick out patients that looked
like they fell hopefully within my scope and I would ring those patients,
see them at the general practice,
and then my supervisor would come in at the end,
review all of my work and then decide, yes,
I've made the right decision about what I would like to treat and prescribe,
and then they would just finalise off the consultant and write the prescription
when I was not able to do so.
1: Thank you. So basically with your new qualifications,
how do you see yourself using them?
2: So I am using them consistently all the time. As I said,
it has changed the way that I'm practising just day to day on the floor,
but I am regularly delivering consults,
so I move around some pharmacies and I've
tried to make a regular one day a week where I am accessible and people know
where they can refer into me.
But what I've been finding is that the patients that I'm
seeing a lot of the time is really opportunistic identifying
patients on the floor who maybe otherwise
wouldn't be getting treated.
And I think realistically,
a lot of the patients that I'm seeing either don't have a regular GP would've
ended up in emergency or just wouldn't have been treated at all.
So there's a whole range of
presentations that we're having. I had a mom,
I was walking out the door the other day,
a mom with a child with fevers and she said, oh,
my other kids get ear infections. I'm a bit worried that my daughter has an ear
infection as well. I said, I'll come and I'll look after you come in.
And she had four kids. I'm looking at one doing the consultant,
checking in the ears and noticing at the same time another one has impetigo.
So I actually ended up seeing two of her children just off her walking in to ask
for some help with the fevers that her child was having.
So it's really, I think in this initial stage,
not going to be patients that are booking in advance to come in at a
structured time in terms of how we're capturing those patients.
It's the ones that are coming in and whether we can see them then or whether we
say, can you come back in an hour or two and I can see you,
you there. So it's been very,
very interesting to see all the different presentations and the relief from
patients when they realise actually there's a solution that I can do for them
straight away.
1: So have you set aside time to do consultations?
Do you charge for the consultations? Do you advertise?
2: So I guess just to give some
perspective,
I started delivering consults in December and I have done a
really soft rollout.
The extent of my advertising has been one or two posts on social media
and a quick little message on our embr mums Facebook group
just to make people aware that I'm doing it,
absolutely charge for the consult. I'm a big believer,
someone walks through my consult room door, they are paying for my time,
and we really try and implement that across our teams that we are
providing service. Our time is valuable.
So absolutely under the pilot there are set fees that we
need to charge for our consultations and they are controlled while
it is still under pilot.
So minimal advertising at this stage.
I do allocate time every Wednesday
when I have another pharmacist with me for consultations. That being said,
I have worked on a weekend where patients have been in need and I have been the
only pharmacist and have coordinated it into my workflow with the help of my
very well-trained support team to be able to see those patients. So
one Saturday that I worked,
there was a five hour wait at our emergency department.
Patients were happy to sit in the pharmacy and wait for me for an hour,
hour and a half until I could kind of juggle things around to fit them in
because that meant a saving of quite a lot of time for them than sitting up at
the hospital.
So I think it's about us rethinking our workflow,
rethinking the way that we train our team and utilise our team,
making sure that we are delivering really good quality safe services that we're
not trying to check scripts in the middle of a consultation,
but we felt like this when we started vaccination,
we felt like how could we possibly step away from the dispensary to vaccinate
someone and now that is part of our workflows.
So it is obviously not really realistic that I'm going to sit in a
consult for half an hour,
an hour to do travel health while I'm the only pharmacist on duty.
But acute situations where you've got a child with impetigo
or an ear infection, those consultations are 10 to 20 minutes.
The vast majority of them are falling into that standard consult
territory that
we are more than able to work that into our workflow if we need to support these
patients. And like I said, people are really happy if you say, look,
I can't see you now,
but I know it's a bit quieter in the afternoon if you want to pop back in the
afternoon.
1: So would you say for workflow it would be more advantageous to have two
pharmacists or would you say that you can work it in your workflow I guess?
2: So an ideal situation,
absolutely ideal situation is that you have multiple pharmacists on duty and
that you can dedicate time to delivering consultation.
As a rural pharmacist, I am working with reality.
Most of us don't have two pharmacists.
So it's about us making sure that we are meeting the requirements
of consultation service and the standards that are required,
but looking at how we can support our communities in the
situations we have and that is about training up our team.
I have in my team intern pharmacists and pharmacy assistants
that do the initial,
get all of the patient data just like a receptionist or a practise nurse with.
They take all the observations. So when I walk into the consult,
I am straight into that, connect with the patient, do the clinical.
I'm not there asking what their date of birth is and getting their phone number
in. And that helps to kind of streamline things and mean that I'm just really
focusing on clinical work.
1: So what I might ask is you may know, you may not know,
but are similar pharmacists that completed the course,
how have they also implemented it into their practise?
2: So I think we're all very vastly spread and all doing
very, I guess approaching it in different ways.
My colleague Lucy Walker at her pharmacy,
she actually has multiple pharmacists that have gone through the training and so
she's creating a service where there's more than one pharmacist a day
and that they could offer services every day of the week.
And I think that is the ideal place we want to get to.
I think then the rest from people that I have spoken to are doing a real
mix of things and we all want to help and we are so
used to not being able to help.
So we've got all these great new skills that I think many of us are going,
right, okay, yes, I've got this patient here,
they've got potentially an ear infection and so I'm going to try and fit that in
now. But ideally,
we're all trying to have time where we are allocated as consultation
and I think that is the best case scenario we can have.
While maybe not the easiest to implement in smaller,
more remote locations where this will be game
changing for those communities to have someone that can deliver care
in a town that has no other primary healthcare provider.
If we can get those pharmacists skilled to be able to deliver this,
that will change the way their community's health is looked
at after and how their health outcomes are.
So I think it's really about us creating
nuances to our own practises to make sure that we are putting patients
first,
supporting our practitioners to deliver it and then making the practise adapt
to how we can do that.
1: Brilliant.
So I guess you're finding your role a lot more rewarding and you're finding that
your patients are a lot more satisfied and even with the time waiting
and the cost considerations of paying for the service,
the patients really value the opportunity to have you providing those services
now.
2: Absolutely.
I hope you could hear the excitement in my voice that I am absolutely loving it.
I feel like even while I was doing the training where I was
practising on my patients, they were wanting to pay me and I was like, oh,
I'm not sure whether I should be charging or not because I'm still on training
so people I'm not finding are having any concern
or help being held back about paying for our time,
they're paying for the doctors more often than not.
There's very few bulk filling doctors these days,
so people don't seem to be worried about paying for that.
One of the barriers at the moment is that we don't have access to PBS
prescribing, so that becomes a cost implication.
And I think as pharmacists we are very conscious of the hip pocket of our
patients, and so we sometimes are rationalising, is this the right, yes,
I can do this. Yes, I can write a prescription,
but is this going to be fair and cost effective for the patient or should I be
looking for ways that I can manipulate
the health system to support them better?
I think if we can get access to PBS prescribing, which
thanks to the announcement of the women's health package where from
1st of July we'll be able to do that.
That is the stepping stone to having full PBS prescribing
rights and that will change everything dramatically. But in short,
no, patients do not care about paying. In my experience,
they are so thankful.
If you think about a busy mom,
their child is not allowed to go to daycare because they've got impetigo,
they have to be treated for 24 hours before they can return.
They're losing sometimes two or three days before of work before they can see
the GP.
So if they can come into me back to work quicker,
their child is getting better, quicker,
it's really a no brainer and people are so thankful
and relieved to be able to access the service.
1: I'd ask you what are some of your favourite skills that you actually acquired as
a result of the course?
2: My favourite skills,
I think it's really cool to have a stethoscope and to be able to use it.
It is something that I find still challenging and you
have to listen and I guess my piece of advice if you're going through the
training or considering the training is just get your stethoscope on as many
lungs as many hearts and just really start to hear the differences because
it's very difficult, what sounds normal.
You have to then start hearing what does not sound normal.
So I think that's been really cool. And I love when my kids,
I have two young children, my little one likes to say,
I'm very sick mom and I can't go to school.
And so now mom can pull out this stethoscope and say, oh no,
your chest is all clear, you're fine.
So I think that's probably what I've enjoyed the most,
but just being able to examine my patients to be able to
identify where there might be problems.
I did a abdominal examination on a patient coming in for hormonal
contraception the other day and she had a massive increase in her
endometriosis symptoms, which was very evident from the abdominal exam.
So that sort of, as soon as I did that was very clear, nope,
I need to refer on and I got her back in contact with her gynaecologist and GP
and to have the skills to be able to do that is really comforting, I think,
to know where we can look after people.
1: So with the services providing in Queensland and the pharmacist prescribing
course,
what do you see as coming next potentially for pharmacists or what would you
like to see coming next?
2: I think number one really important that we cement and make sure that
patients are aware of what we can do now or what we're becoming able to do now
and to see the extension of this across other states.
And we are starting to see that uptake and that is really, really positive.
The conditions that have been selected in the pilot have been done very
strategically to reduce hospital admissions and to
support in that primary healthcare.
And I can only see that that is going to continue to increase.
I don't think it really matters in what direction we head as long as
we're following what our patients need.
And so we're delivering patient-centered, really safe quality healthcare.
We are capable to do this and what we can do to contribute to improving the
delivery of primary health services is where we need to be.
1: Brilliant. Can you tell me about the pharmacist services provided in Queensland?
So you probably provided some of the services before you did the course. Yes.
How's that all going?
2: So there's quite an array of services that we can do.
The vast majority of those excitingly in Queensland will no longer be pilot.
They'll just be business as usual from 1st of July.
Thanks to Minister Nichol's announcement when we were at APP.
So that is super exciting to give a very brief overview.
And there is a full list available in the Queensland Community Pharmacy
pilot information page,
but we can do things that we are already doing with a little bit of extra scope
in them. So things like reflux and hay fever or allergic rhinitis.
We can treat nausea and vomiting, minor skin conditions, so things like eczema,
acne, impetigo and shingles,
and then we can do wound management.
We talk to glue wounds and remove sutures and
things like that, and a bit of musculoskeletal.
And then there is a whole section on chronic disease management,
so cardiovascular risk reduction, asthma management,
COPD management. So all of that is done as part of a
collaborative healthcare model so that we are working with patients and their
gps to manage their symptoms better.
And then there is a lot of wellbeing services,
so helping people to quit smoking,
to manage their weight and things like travel health
and what is beyond just the fullscope pilot now is the
hormonal contraception.
And we're seeing really excellent uptake of that and very passionate about
women's health.
And it is so nice to be able to see and support women and them
not feel like I have to plan my life weeks or months in advance to make
sure that I have access to contraception.
So we're seeing really good uptake and feedback from those services.
1: Brilliant. Have many pharmacists,
has the uptake been quite positive?
Have many pharmacists in Queensland with regards to the services and
with regards to pharmacists prescribing, how has the uptake been?
2: Can you just clarify? Do you mean from patients or from pharmacists? Taking up.
1: From pharmacists, sorry.
2: Pharmacists taking up. So look,
I think it's been a slow burn. The first couple of cohorts,
it is rigorous training. There was a lot of work to put in.
We need to be realistic. We are upskilling and changing the way we practise.
So this is not a quick, I'm going in for a couple of hours,
course this is nine to 12 months of training.
I think as long as you're approaching it that you are prepared to put
in that effort to really make sure you've got good quality clinical
skills, then we will be fine.
We have seen one and two,
we've had quite a number now graduate cohort
three has just finalised and a large number of pharmacists have come through
there. And then post APP,
there seems to be this explosion of interest that I absolutely was not
expecting.
I think those very strong announcements from
Minister Nichols and also from a federal level in terms of expanding women's
health services is seeing a real interest. And I know within our pharmacy
group drug chemist outlet, I sort of put a bit of a, Hey everyone,
if you've got questions, here's our little chat group.
And it's really exploded with people just wanting to find out more.
So I really see this as the way of the future.
There is intention that within the next decade there is an intention that we
have 80% of the workforce that is able to deliver these
services and we will start to see graduates coming out of the doctor
of pharmacy programme with these skills.
So I think it's only going to be an exponential growth from here.
What's been a slow burn is just going to, it would be great.
1: And now you've made me want to ask the question,
what has the uptake been from patients as well on the other side?
2: Yeah, so uptake from patients, like I said,
with very little advertising to date,
I have delivered over 60 consultations.
On my busiest day I saw eight patients and I'm not
delivering on a daily basis.
So it's really positive uptake and
feedback from people.
And I think the more pharmacists we have delivering services,
the more awareness there is.
Even just since the announcements in the few news articles and things that have
been out in the last couple of weeks post a PP have certainly
had more people asking.
I had the local ed nurse actually come to me for an appointment the other day
because she said,
this is so great and I can't wait when we are busy in the ed department to know
that you are there and we can just send any low acute stuff straight
over to you so that we can alleviate time in the ED.
And that's what this is all about.
1: So can I ask you what advice you might have for pharmacists who might be a
little bit hesitant, I guess? So this is a lot of change for people, and yes,
it is upskilling and learning and taking on new skills if someone is hesitant or
wondering where they fit in or what advice might you have for them.
2: So I think number one,
don't be afraid to kind of jump in feet first because the reward is
so significant. I already loved being a pharmacist,
but I feel like this has taken me next level.
I think really important. Speak to people that are already delivering services.
Reach out, find yourself a mentor.
All of us are really happy to share our experiences and try and help others to
come along the pathway. Be prepared to commit the time.
Half a day to a day a week is probably realistic to commit to doing the
training.
And then don't be afraid to trust in the skills
and the
quality of your service already and to recognise that your time is so
valuable. There's nothing to stop us now charging people for our time.
Just what we are delivering is going to change,
but we can start seeing patients and charging for consultations and delivering
services now and build your confidence when you have
someone coming in for a contraceptive pill,
start pulling them in and asking them questions.
Practise your skills and then start jump in if you want to dip your toe
in the water, start with hormonal contraceptive.
If you don't want to go to the full scope,
that's a nice little taster to see whether it's for you or not.
1: Thank you.
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