Feb 29, 2024

Datapharm interviewed John Hoyte, a prescribing pharmacist, to offer an inside look into how pharmacists engage with medicines information. We learnt about John’s work with medicines information and factors that influence prescribing decisions in the UK.

What makes Ashburton unique in the area of pharmacy?

In a nutshell, our care is patient-centred but our clients are GP surgeries.

A lot of our pharmacists are specialists in their own field, so the knowledge here has really struck me. Even with a lot of the PCNs (Primary Care Networks), they don’t always necessarily know what can be achieved with pharmacists, but when I joined Ashburton there was a wealth of experience and vision here already.

Collaboration is another strong point here. There are very few places where you can work in the same building as other pharmacists and bounce ideas and knowledge off each other. If we get stuck, we don’t just pass it back to GPs, we work it out together. In fact, our model is built on quality, improvement, exceptional patient care and alleviating burdens on GP surgeries. They don’t have the time or resources to manage medicines on top of the quality patient care they already provide. Our expertise is in end-to-end medication-related care so that GPs can focus on seeing their patients and improving health outcomes.

We work autonomously to make and influence prescribing decisions, systems and processes, and we are able to manage these for GP surgeries and PCNs in their entirety. Alongside this, that Pharmacy degree has now changed so that students reading in Pharmacy will graduate as independent prescribers, which I think will be game-changing.

Tell me about your journey to becoming a prescribing pharmacist

When I was applying for places at university, it was a bit scary in that it was a time of real economic uncertainty. I applied for a Pharmacy course at Liverpool John Moores University, as they demonstrated a 100% employment rate in the field of study – not always a given! I went on to complete my degree and this was a pivotal period in my journey to becoming a pharmacist.

After graduation, I entered a pre-registration pharmacist programme and joined an independent group of community pharmacies. I loved my time there, which taught me a lot about the real world and about pharmacy, while I made some lifelong friends there.

Following that year of training I built up experience from a combination of locum pharmacy, Rowlands and another independent group, a total of around three and a half years, before looking to move into a General Practice (GP) position.

Even at that time, pharmacists in GP surgeries had still been something of a rarity, but that year (2019) the Additional Roles Reimbursement Scheme had just been introduced – it was an new funding stream available to Primary Care Networks (PCNs) to support recruitment of Allied Health Professions and workforce diversification and has accelerated the presence of Clinical Pharmacists.

Before I joined Ashburton and before I had my Independent Prescribing qualification, I was worried that I wouldn’t be suitable - ‘How could I go into a GP role without being able to prescribe?’ But as I was being interviewed for a role at Ashburton, I was given assurance about my capabilities, and I then undertook a week of information-intensive training before working in a surgery.

What does a typical day look like for you?

In the beginning I was splitting my time between two GPs. I would only be in the surgeries then, but that has changed since the pandemic as we now often work remotely alongside this.

It can be very variable, as there are often things like clinical audits, projects, quality improvement work, practice meetings and more that don’t always fit into the day-to-day. On a routine day, typically, in the morning I might review the outstanding prescription requests and decide whether we were able to authorise each one and whether further interventions would be needed.

In the afternoon I may then have a clinic, either face-to-face or remotely via telephone. As a case in point, it could be a complex patient on, say, 15-20 medications with swallowing difficulties, and we might advise that they stop taking something if it’s not appropriate for them, i.e. deprescribing. For example, if they need a lactose-free tablet, or they’re vegetarian so should avoid capsules with gelatine.

What are the biggest challenges you’ve had to overcome as a pharmacist?

When you first start there’s a lot of information to take in and you might be worried about missing something. Added to that, it’s a very fast-paced job which keeps you on your toes.

You are also in an environment with people who have different expertise to you, so you have to break down the barriers of fear about not knowing something, or that you’re behind where you should be as a professional, and bring your individual areas of expertise together as a multidisciplinary team.

Tell me about your journey to finding medical information, starting from the patient’s need

I would look for a range of information such as posology, method of administration, dosage, pregnancy and lactation, potential impairments affecting the operating of machinery and allergies. This would often end up with me reading the SmPC – I might use a formulary website for more essential information, and emc for something more detailed or specific. If the information I’m looking for isn’t found within the regulated document, I might look to the guidelines.

Other things I look for include information around PEG (Percutaneous endoscopic gastrostomy) feeds, swallowing difficulties, dose forms or ability to crush tablets, which might not be directly answered within the SmPC.

Sometimes the patient’s treatment needs more monitoring. For example, with antibiotics for acne, the treatment may be three months but I’ll need to think about what interventions to make if the patient has gone over the monthly limit, and speak with them over the phone if needed.

What challenges do you face in sourcing this information?

Particularly with all the channels we use, we have a lot of different information to deal with. At times you’ll feel a sense of product fatigue, for example, because the alerts by a particular system become overwhelming. So it’s really important to be selective about the updates pharmacists receive, and it’s also important for us to have everything in one place, like a one-stop shop for medicines information.

There can also be risks when dealing with dose combinations. One example was a medicine which is historically a diabetes drug, but is also used for weight loss. When putting the patient on a particular course, they would start with 3mg doses, then 7mg then 14mg. But you’re not supposed to combine two 7mg tablets to make a 14 mg dose – it would have been much easier and quicker to learn of this if the information was made available on a widely used and trusted resource.

When do you go to the manufacturer directly for medicines information?

I don’t often phone the manufacturer’s Medical Information department as they very rarely have the information I need. I never go to the manufacturer’s website – I need a centralised source where everything is easy to find because otherwise I’d be trawling through.

Tell me about the prescribing process, and what factors influence prescribing decisions.

As we’re a collaborative workplace, there are times when we reach a consensus together that something is a first-line drug before making the prescribing decision.

How clear the recommendations are in guidance and policy is also a significant factor. I’ll also take into account the risk with interactions and health economics, assessing what would be the most cost-effective option for the patient.

If you were to recommend emc to a colleague, why would you recommend it?

I use emc for detailed, regulated, up-to-date information, such as risk of interactions. It’s a centralised resource which I trust, where everything is in one place and I can quickly find what I’m looking for.

Interested in learning more about how HCPs engage with your medicine information?

Datapharm, the providers of emc, support Pharma with making their medicines information engaging, accessible and up to date. As this resource is used by millions of HCPs annually, Datapharm can support you with insights about how your information aids prescribing decisions.

If you would like to understand more about how emc can support your engagement with HCPs, get in touch with our team.