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Welcome to the AJP podcast,
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a podcast for pharmacists by pharmacists where we discuss current
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events, relevant topics, and emerging issues. I'm your host, Carlene McMaugh,
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and together with the AJP,
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I'm bringing you the opinions and expertise of different pharmacists to discuss
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their views and insights on topics relevant to pharmacists.
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Please like and rate each episode and subscribe to the podcast so you don't miss
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an episode.
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But I might start off by asking you, is it okay to introduce yourself?
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Sure. So my name is Jess Burrey.
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I am a rural pharmacist in Central Queensland.
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I have been a pharmacist for almost 20 years and
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I thoroughly am enjoying every part of being a
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community pharmacist and most recently have become a
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prescribing pharmacist and joined as the central Queensland
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representative for the Queensland Pharmacy Guild.
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So I am wearing lots of different hats and loving it as I go along.
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Thank you.
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Because I understand that you've recently completed the prescribing course in
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Queensland,
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so I wondered if you could tell us a little bit about the prescribing course.
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Yeah, so I was in cohort two,
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so thank you to the people in cohort one that ironed out a few creases for us
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in cohort two,
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and I think we've then subsequently done that for the following cohorts.
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So it's been a bit of a journey.
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It took me close to 18 months to finish the training,
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but now that it's been streamlined,
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the aim is people will be finished between a nine and 12 month period.
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So it's been streamlined,
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much more rigorous and a lot more clinical component at the
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moment,
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but it has been an incredible journey and I think it's really changed the way
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that I practise regardless of whether I'm providing consultations directly
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or just in my general day-to-day role as a pharmacist.
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I think it's really changed the way I approach my patients.
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Can I pick your brain about what the course content might've looked like,
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what the requirements were for the course,
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what some of the subjects even might've been, and you mentioned practicals.
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Yeah, so it has changed obviously since I have done it and there are
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also multiple
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providers delivering the course and hopefully that will continue to
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evolve as we see more states pick up and adopt full scope.
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For myself,
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we did prescribing components through QUT and
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then the clinical component through JCUI probably can
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comment more on the JCU course, which is now offering both of those.
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So for people coming through JCU where cohorts three and
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four and soon to be five have been going through and it's
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two subjects.
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The first one primarily on the prescribing process,
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so a lot more of the governance history,
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taking consultation and writing the prescription.
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And then the second part of the course is all of the clinical content.
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Now as part of that clinical content,
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you attend face-to-face workshops to develop those clinical skills.
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For my group that went through, we had four days of clinical content,
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now you get two five day workshops.
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So it's improved in terms of the delivery and I think that will be a really
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valuable experience for those that are coming through now to
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get much more hands-on in the training.
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With the training, there's exams throughout,
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some of those are face-to-face OSCEs and then some written online
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components as well.
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Brilliant. Did you have to do practical placements and things like that as well?
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Yeah,
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I did and I was really fortunate to have been very well
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supported by one of our local GP practices and to have an amazing
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mentor,
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or mentors I should say because quite a few of the GPs in the practice actually
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took me under their wing.
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So I structured my practical component where I did a
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combination of doing or I guess stepping into the consult
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room more often in the pharmacy and just kind of working with my
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general patients and doing a little bit more and then having discussions with my
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supervisors and then also going in and working half a day a week at
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the general practise,
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which was really outside of my comfort zone.
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I think I developed a respect for how many patients we actually manage in a day
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compared to general practise,
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but helped me really cement my skills.
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So for me what that looked like,
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I developed the training plan with my supervisor.
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Initially I just sat in, watched them deliver consultation,
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kind of get a feel for how to really connect with patients and
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then fast forward,
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kind through a few steps and by the end I
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was going through the wait list where I live,
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we have a six week wait to see a GP.
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So I was going through the wait list trying to pick out patients that looked
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like they fell hopefully within my scope and I would ring those patients,
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see them at the general practice,
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and then my supervisor would come in at the end,
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review all of my work and then decide, yes,
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I've made the right decision about what I would like to treat and prescribe,
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and then they would just finalise off the consultant and write the prescription
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when I was not able to do so.
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Thank you. So basically with your new qualifications,
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how do you see yourself using them?
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So I am using them consistently all the time. As I said,
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it has changed the way that I'm practising just day to day on the floor,
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but I am regularly delivering consults,
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so I move around some pharmacies and I've
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tried to make a regular one day a week where I am accessible and people know
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where they can refer into me.
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But what I've been finding is that the patients that I'm
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seeing a lot of the time is really opportunistic identifying
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patients on the floor who maybe otherwise
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wouldn't be getting treated.
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And I think realistically,
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a lot of the patients that I'm seeing either don't have a regular GP would've
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ended up in emergency or just wouldn't have been treated at all.
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So there's a whole range of
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presentations that we're having. I had a mom,
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I was walking out the door the other day,
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a mom with a child with fevers and she said, oh,
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my other kids get ear infections.
I'm a bit worried that my daughter has an ear
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infection as well. I said, I'll come and I'll look after you come in.
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And she had four kids. I'm looking at one doing the consultant,
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checking in the ears and noticing at the same time another one has impetigo.
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So I actually ended up seeing two of her children just off her walking in to ask
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for some help with the fevers that her child was having.
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So it's really, I think in this initial stage,
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not going to be patients that are booking in advance to come in at a
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structured time in terms of how we're capturing those patients.
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It's the ones that are coming in and whether we can see them then or whether we
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say, can you come back in an hour or two and I can see you,
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you there. So it's been very,
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very interesting to see all the different presentations and the relief from
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patients when they realise actually there's a solution that I can do for them
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straight away.
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So have you set aside time to do consultations?
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Do you charge for the consultations? Do you advertise?
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So I guess just to give some
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perspective,
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I started delivering consults in December and I have done a
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really soft rollout.
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The extent of my advertising has been one or two posts on social media
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and a quick little message on our embr mums Facebook group
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just to make people aware that I'm doing it,
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absolutely charge for the consult. I'm a big believer,
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someone walks through my consult room door, they are paying for my time,
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and we really try and implement that across our teams that we are
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providing service. Our time is valuable.
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So absolutely under the pilot there are set fees that we
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need to charge for our consultations and they are controlled while
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it is still under pilot.
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So minimal advertising at this stage.
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I do allocate time every Wednesday
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when I have another pharmacist with me for consultations. That being said,
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I have worked on a weekend where patients have been in need and I have been the
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only pharmacist and have coordinated it into my workflow with the help of my
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very well-trained support team to be able to see those patients.
So
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one Saturday that I worked,
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there was a five hour wait at our emergency department.
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Patients were happy to sit in the pharmacy and wait for me for an hour,
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hour and a half until I could kind of juggle things around to fit them in
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because that meant a saving of quite a lot of time for them than sitting up at
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the hospital.
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So I think it's about us rethinking our workflow,
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rethinking the way that we train our team and utilise our team,
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making sure that we are delivering really good quality safe services that we're
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not trying to check scripts in the middle of a consultation,
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but we felt like this when we started vaccination,
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we felt like how could we possibly step away from the dispensary to vaccinate
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someone and now that is part of our workflows.
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So it is obviously not really realistic that I'm going to sit in a
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consult for half an hour,
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an hour to do travel health while I'm the only pharmacist on duty.
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But acute situations where you've got a child with impetigo
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or an ear infection, those consultations are 10 to 20 minutes.
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The vast majority of them are falling into that standard consult
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territory that
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we are more than able to work that into our workflow if we need to support these
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patients. And like I said, people are really happy if you say, look,
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I can't see you now,
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but I know it's a bit quieter in the afternoon if you want to pop back in the
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afternoon.
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So would you say for workflow it would be more advantageous to have two
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pharmacists or would you say that you can work it in your workflow I guess?
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So an ideal situation,
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absolutely ideal situation is that you have multiple pharmacists on duty and
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that you can dedicate time to delivering consultation.
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As a rural pharmacist, I am working with reality.
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Most of us don't have two pharmacists.
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So it's about us making sure that we are meeting the requirements
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of consultation service and the standards that are required,
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but looking at how we can support our communities in the
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situations we have and that is about training up our team.
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I have in my team intern pharmacists and pharmacy assistants
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that do the initial,
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get all of the patient data just like a receptionist or a practise nurse with.
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They take all the observations. So when I walk into the consult,
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I am straight into that, connect with the patient, do the clinical.
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I'm not there asking what their date of birth is and getting their phone number
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in. And that helps to kind of streamline things and mean that I'm just really
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focusing on clinical work.
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So what I might ask is you may know, you may not know,
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but are similar pharmacists that completed the course,
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how have they also implemented it into their practise?
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So I think we're all very vastly spread and all doing
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very, I guess approaching it in different ways.
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My colleague Lucy Walker at her pharmacy,
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she actually has multiple pharmacists that have gone through the training and so
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she's creating a service where there's more than one pharmacist a day
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and that they could offer services every day of the week.
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And I think that is the ideal place we want to get to.
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I think then the rest from people that I have spoken to are doing a real
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mix of things and we all want to help and we are so
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used to not being able to help.
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So we've got all these great new skills that I think many of us are going,
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right, okay, yes, I've got this patient here,
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they've got potentially an ear infection and so I'm going to try and fit that in
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now.
But ideally,
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we're all trying to have time where we are allocated as consultation
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and I think that is the best case scenario we can have.
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While maybe not the easiest to implement in smaller,
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more remote locations where this will be game
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changing for those communities to have someone that can deliver care
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in a town that has no other primary healthcare provider.
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If we can get those pharmacists skilled to be able to deliver this,
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that will change the way their community's health is looked
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at after and how their health outcomes are.
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So I think it's really about us creating
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nuances to our own practises to make sure that we are putting patients
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first,
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supporting our practitioners to deliver it and then making the practise adapt
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to how we can do that.
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Brilliant.
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So I guess you're finding your role a lot more rewarding and you're finding that
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your patients are a lot more satisfied and even with the time waiting
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and the cost considerations of paying for the service,
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the patients really value the opportunity to have you providing those services
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now.
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Absolutely.
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I hope you could hear the excitement in my voice that I am absolutely loving it.
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I feel like even while I was doing the training where I was
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practising on my patients, they were wanting to pay me and I was like, oh,
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I'm not sure whether I should be charging or not because I'm still on training
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so people I'm not finding are having any concern
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or help being held back about paying for our time,
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they're paying for the doctors more often than not.
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There's very few bulk filling doctors these days,
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so people don't seem to be worried about paying for that.
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One of the barriers at the moment is that we don't have access to PBS
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prescribing, so that becomes a cost implication.
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And I think as pharmacists we are very conscious of the hip pocket of our
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patients, and so we sometimes are rationalising, is this the right, yes,
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I can do this.
Yes, I can write a prescription,
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but is this going to be fair and cost effective for the patient or should I be
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looking for ways that I can manipulate
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the health system to support them better?
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I think if we can get access to PBS prescribing, which
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thanks to the announcement of the women's health package where from
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1st of July we'll be able to do that.
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That is the stepping stone to having full PBS prescribing
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rights and that will change everything dramatically. But in short,
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no, patients do not care about paying. In my experience,
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they are so thankful.
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If you think about a busy mom,
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their child is not allowed to go to daycare because they've got impetigo,
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they have to be treated for 24 hours before they can return.
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They're losing sometimes two or three days before of work before they can see
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the GP.
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So if they can come into me back to work quicker,
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their child is getting better, quicker,
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it's really a no brainer and people are so thankful
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and relieved to be able to access the service.
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I'd ask you what are some of your favourite skills that you actually acquired as
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a result of the course?
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My favourite skills,
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I think it's really cool to have a stethoscope and to be able to use it.
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It is something that I find still challenging and you
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have to listen and I guess my piece of advice if you're going through the
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training or considering the training is just get your stethoscope on as many
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lungs as many hearts and just really start to hear the differences because
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it's very difficult, what sounds normal.
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You have to then start hearing what does not sound normal.
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So I think that's been really cool. And I love when my kids,
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I have two young children, my little one likes to say,
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I'm very sick mom and I can't go to school.
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And so now mom can pull out this stethoscope and say, oh no,
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your chest is all clear, you're fine.
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So I think that's probably what I've enjoyed the most,
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but just being able to examine my patients to be able to
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identify where there might be problems.
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I did a abdominal examination on a patient coming in for hormonal
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contraception the other day and she had a massive increase in her
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endometriosis symptoms, which was very evident from the abdominal exam.
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So that sort of, as soon as I did that was very clear, nope,
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I need to refer on and I got her back in contact with her gynaecologist and GP
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and to have the skills to be able to do that is really comforting, I think,
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to know where we can look after people.
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So with the services providing in Queensland and the pharmacist prescribing
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course,
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what do you see as coming next potentially for pharmacists or what would you
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like to see coming next?
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I think number one really important that we cement and make sure that
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patients are aware of what we can do now or what we're becoming able to do now
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and to see the extension of this across other states.
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And we are starting to see that uptake and that is really, really positive.
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The conditions that have been selected in the pilot have been done very
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strategically to reduce hospital admissions and to
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support in that primary healthcare.
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And I can only see that that is going to continue to increase.
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I don't think it really matters in what direction we head as long as
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we're following what our patients need.
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And so we're delivering patient-centered, really safe quality healthcare.
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We are capable to do this and what we can do to contribute to improving the
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delivery of primary health services is where we need to be.
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Brilliant. Can you tell me about the pharmacist services provided in Queensland?
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So you probably provided some of the services before you did the course. Yes.
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How's that all going?
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So there's quite an array of services that we can do.
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The vast majority of those excitingly in Queensland will no longer be pilot.
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They'll just be business as usual from 1st of July.
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Thanks to Minister Nichol's announcement when we were at APP.
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So that is super exciting to give a very brief overview.
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And there is a full list available in the Queensland Community Pharmacy
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pilot information page,
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but we can do things that we are already doing with a little bit of extra scope
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in them. So things like reflux and hay fever or allergic rhinitis.
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We can treat nausea and vomiting, minor skin conditions, so things like eczema,
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acne, impetigo and shingles,
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and then we can do wound management.
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We talk to glue wounds and remove sutures and
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things like that, and a bit of musculoskeletal.
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And then there is a whole section on chronic disease management,
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so cardiovascular risk reduction, asthma management,
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COPD management.
So all of that is done as part of a
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collaborative healthcare model so that we are working with patients and their
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gps to manage their symptoms better.
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And then there is a lot of wellbeing services,
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so helping people to quit smoking,
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to manage their weight and things like travel health
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and what is beyond just the fullscope pilot now is the
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hormonal contraception.
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And we're seeing really excellent uptake of that and very passionate about
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women's health.
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And it is so nice to be able to see and support women and them
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not feel like I have to plan my life weeks or months in advance to make
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sure that I have access to contraception.
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So we're seeing really good uptake and feedback from those services.
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Brilliant. Have many pharmacists,
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has the uptake been quite positive?
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Have many pharmacists in Queensland with regards to the services and
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with regards to pharmacists prescribing, how has the uptake been?
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Can you just clarify? Do you mean from patients or from pharmacists? Taking up.
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From pharmacists, sorry.
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Pharmacists taking up. So look,
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I think it's been a slow burn. The first couple of cohorts,
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it is rigorous training. There was a lot of work to put in.
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We need to be realistic. We are upskilling and changing the way we practise.
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So this is not a quick, I'm going in for a couple of hours,
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course this is nine to 12 months of training.
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I think as long as you're approaching it that you are prepared to put
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in that effort to really make sure you've got good quality clinical
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skills, then we will be fine.
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We have seen one and two,
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we've had quite a number now graduate cohort
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three has just finalised and a large number of pharmacists have come through
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there. And then post APP,
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there seems to be this explosion of interest that I absolutely was not
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expecting.
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I think those very strong announcements from
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Minister Nichols and also from a federal level in terms of expanding women's
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health services is seeing a real interest.
And I know within our pharmacy
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group drug chemist outlet, I sort of put a bit of a, Hey everyone,
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if you've got questions, here's our little chat group.
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And it's really exploded with people just wanting to find out more.
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So I really see this as the way of the future.
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There is intention that within the next decade there is an intention that we
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have 80% of the workforce that is able to deliver these
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services and we will start to see graduates coming out of the doctor
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of pharmacy programme with these skills.
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So I think it's only going to be an exponential growth from here.
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What's been a slow burn is just going to, it would be great.
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And now you've made me want to ask the question,
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what has the uptake been from patients as well on the other side?
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Yeah, so uptake from patients, like I said,
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with very little advertising to date,
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I have delivered over 60 consultations.
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On my busiest day I saw eight patients and I'm not
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delivering on a daily basis.
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So it's really positive uptake and
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feedback from people.
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And I think the more pharmacists we have delivering services,
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the more awareness there is.
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Even just since the announcements in the few news articles and things that have
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been out in the last couple of weeks post a PP have certainly
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had more people asking.
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I had the local ed nurse actually come to me for an appointment the other day
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because she said,
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this is so great and I can't wait when we are busy in the ed department to know
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that you are there and we can just send any low acute stuff straight
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over to you so that we can alleviate time in the ED.
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And that's what this is all about.
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So can I ask you what advice you might have for pharmacists who might be a
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little bit hesitant, I guess? So this is a lot of change for people, and yes,
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it is upskilling and learning and taking on new skills if someone is hesitant or
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00:25:55.010 --> 00:25:58.970
wondering where they fit in or what advice might you have for them.
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00:26:00.200 --> 00:26:01.730
So I think number one,
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don't be afraid to kind of jump in feet first because the reward is
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so significant. I already loved being a pharmacist,
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but I feel like this has taken me next level.
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I think really important. Speak to people that are already delivering services.
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Reach out, find yourself a mentor.
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All of us are really happy to share our experiences and try and help others to
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come along the pathway. Be prepared to commit the time.
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Half a day to a day a week is probably realistic to commit to doing the
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training.
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And then don't be afraid to trust in the skills
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and the
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quality of your service already and to recognise that your time is so
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valuable. There's nothing to stop us now charging people for our time.
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Just what we are delivering is going to change,
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but we can start seeing patients and charging for consultations and delivering
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services now and build your confidence when you have
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someone coming in for a contraceptive pill,
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start pulling them in and asking them questions.
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Practise your skills and then start jump in if you want to dip your toe
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in the water, start with hormonal contraceptive.
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If you don't want to go to the full scope,
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that's a nice little taster to see whether it's for you or not.
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Thank you.
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We hope you've enjoyed this episode of the AJ P Podcast.
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