Joe McAleer helps NIHR capture a day in the life of a community pharmacist by illustrating both the challenges and rewards associated with his job running Erne Pharmacy in Fermanagh.
Community pharmacists work at the heart of the community, dispensing medicines and advice to hundreds of thousands of patients each day across Northern Ireland. We work on the front-line and are the first port-of-call for patients needing immediate advice on a range of conditions, from minor ailments, to more complex conditions when the patient can be managing several different medications daily.
My day starts at 6am when I either try to fit in some exercise or catch up on paperwork when the house is quiet. Things change quickly at 7am when four primary school children get up and all hands are on deck to get them ready and off to school. I get to the pharmacy just before 9am to start work. It might sound a bit cliché but given that so many people visit a pharmacy every day, no two days are ever the same.
My first job, before patients start arriving, is to complete any outstanding paperwork from the day before which can include completing orders for medicines, reviewing emails, or reading new circulars and advice that is sent out from the Department of Health.
On any one day I can dispense around 600 items to 200 different patients. On average I will need to speak directly to 50-to-60 of these patients who may have more complex conditions or when I have concerns. This may involve providing advice and directions on how to manage their condition or multiple medications, supporting and reassuring patients diagnosed with a new condition, such as type 1 diabetes, signposting to other services, and referral to GPs or A&E when necessary.
My pharmacy is one of three designated palliative care pharmacies in Fermanagh and hence we care for a higher than average number of patients who need extra support and interventions. This involves consulting with the patient on how they are coping with their condition and medications, ensuring that they are on the right dosage, managing interactions with concurrent medications, advising on minimising side-effects, and resolving adherence problems. We also liaise with GPs when queries arise, such as medication or dose changes and compliance issues. We provide compliance support to approximately 100 patients weekly who need assistance taking multiple medications or are at risk of overdose or medication abuse.
Preventative care is also a core part of our service. Heading into winter we offer a private flu vaccine service and are due to offer flu vaccines to healthcare staff as part of a new pilot. We run a very important and popular smoking cessation programme. Other services include lifestyle advice, weight loss management, interventions around drug and alcohol dependence, and involvement in community health promotion events.
Working in health and social care at this very challenging time means that we have many other issues to deal with that make our job more difficult. Funding challenges have meant that we have had to reduce our work force to minimum levels which is now one pharmacist and four staff. This makes it very difficult to manage holidays, sickness, family commitments, and means little time for breaks during the day and puts extreme pressure on the team.
In addition, working in a rural area close to the border means that I find it hard to source locums to cover holiday periods. In recent years we have lost many community-based pharmacists to the Republic where wages and working conditions are much better, as well as to hospitals and GP surgeries, again due to better working hours and conditions. Unfortunately, even with the evidence of the current work force pressures in community pharmacy recruitment to GP surgeries still continues.
A daily recurring theme involves multiple calls to suppliers or other pharmacies sourcing medicines that are out-of-stock. This can often result in a dead-end and requesting the GP to prescribe a suitable alternative. This is a very time-consuming process for everyone involved, causing delays in treatment for the patient and the need for additional consultations with the patient when the alternative medication is prescribed.
My day usually ends at around 10 or 11pm. The pharmacy closes at 6pm but then all my other jobs start. There are a lot of responsibilities to be met in terms of staying up-to-date with new advice on medicines; dealing with paperwork, such as twice-monthly preparation of prescriptions for submission to BSO, invoices, GDPR, Quality Assurance, Health & Safety, complying with audits, paying bills and staff wages.
The reality of working 16-hour days, juggling finance, staff shortages, medicine shortages, and dealing with increasing paperwork is a common theme in community pharmacies, whether it’s a small independent or the bigger chains. Realistic funding would enable a resolution to many of these challenges and provide a proper life balance for our community pharmacists.
Despite the challenges, I still enjoy the rewards of being a community pharmacist, which are getting to know my patients and providing an accessible health service that makes a real difference to their lives and the community I live in.