Fiona Burns, lead pharmacist at Pharmacy Plus Health in Alwoodley, Leeds , West Yorkshire, gives her personal reflections on the Independent prescribing pathfinder work. Her pharmacy has been live as a pathfinder site since March 2024, and the team has experienced both positive outcomes for patients and for themselves in terms of being able to develop their clinical skills.

Our pharmacy has been live as a pathfinder site since March 2024, initially reviewing referred patients from our local GP practice with diagnosed high blood pressure (hypertension) and on lipid treatment to lower cholesterol levels, adjusting and increasing medication as needed.

We then expanded the cardiovascular disease support model to include diagnosing hypertension and direct referrals from the Hypertension Case Finding Service to assess CVD risk. We would identify individuals from the pharmacy setting and patients continued to be referred to us by our local GP practice following a hypertension diagnosis.  Four months in we also added extended minor ailments, again accepting referrals and also walk in patients.  We also do a QOSP (quality outcome and safety protocol) for medicine shortages and deprescribing, saving GP practice colleagues time by changing prescriptions where medicines are genuinely out of stock and stopping medicines no longer needed.

Measuring the impact of the pathfinder project

This service has an incredible impact on our patients.  Within a GP practice you will often see different clinicians for different issues, so I feel there is something special about the community pharmacy environment. For many it can be a less formal, more personalised service as our team know our patients really well.

As community pharmacist IPs we are excellent at identifying compliance issues – seeing patients return medication after a cupboard clear out or giving us back dossett boxes with medication still inside them.

With the way the pathfinder project is currently set up, the service is offered face-to-face, and this often makes it easier to resolve these and other issues before they escalate.

For example, one of our patients was referred to cardiology and a consultant advised they go on Beta blocker, statin and aspirin.  This was actioned by the pharmacy team at the surgery remotely and a regular prescription was issued. The patient didn’t collect and take their medication so we worked together with the GP practice team to realise why – the patient simply hadn’t understood why it was needed.

That’s the other strength we have within community pharmacy – educating, communicating and explaining to patients why medicines are needed, how they work and how they can help.

Patients can potentially be seen more quickly and easily by the pharmacist independent prescriber – we offer another safe space for the patient to open up which enables us to take a full history. Working together with general practice colleagues, patients can be identified earlier with more complex concerns.

For example, one patient received an early cancer diagnosis after being referred for resistant hypertension – they had an abdominal mass caused by renal lymphoma.  Another patient presented with low BP so I arranged blood tests and a GP follow up appointment. Upon seeing the GP with their blood test results they were referred for a colonoscopy where damage was later discovered.

If patients wonder if our skills in community pharmacy can cope with more difficult and urgent issues, they can be reassured. I also correctly identified a patient with suspected sepsis on an afternoon when the surgery was closed for training.  I swiftly arranged an ambulance, they were later diagnosed with pneumonia, given IV treatment and discharged a few days later on oral antibiotics.

Meeting the needs of clinicians and the system

There was a strong “what am I” feeling when we began the pathfinder work as I navigated this new role and experienced perspectives from the pharmacy teams, surgery teams and patients but I soon changed their view through showing them what a great service we offer.  Patients have returned with their relatives after giving me positive feedback about their consultations.

Historically, as community pharmacists we have felt quite isolated as we are often the only most qualified healthcare professional on site.  In order to develop our clinical skills, reflect and build safety in our prescribing, we need to build local networks learning from one another and tapping into the wider primary care team.

I trained to be a Designated Prescribing Practitioner (DPP) just before we launched pathfinder and have mentored 6 students to upskill from pharmacists to IP pharmacists.  We also collaborated with our local GP practice on this – swapping our students so they experience a broader range and shadow different clinicians in different environments

Collaboration is definitely key here.  Pathfinder has brought different organisations and businesses together, meeting the needs of our local neighbourhoods more effectively and efficiently.

Pharmacist Independent Prescribers working in community pharmacy as part of the primary care team has to be something that continues.  There may even be a role for prescribing pharmacists in community pharmacy as there are in hospitals and GP practices. The pathfinder work has opened the door to these type of possibilities.

Opening up even more care to patients

Our site has been hugely successful and I am fully booked for CVD consultations for up to 2 weeks ahead. At our site we now have the equivalent of 2 IPs working full time allowing us to offer extended hours too. Some of the Pharmacist IPs I have mentored during the pathfinder programme that have now qualified are going to be working alongside me so we can offer CVD and Extended Minor Illness checks simultaneously across our 3 consultation rooms, creating even more access to primary care for our patients.

I have absolutely loved this pathfinder journey.  I have gone from considering other career options to loving my job and being able to develop and utilise my clinical skills within the community pharmacy environment.

I’m looking forward to seeing how the IP Pathfinder programme influences the community pharmacy contractual framework and integrates community pharmacy further as a vital part of the primary care team.