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During my recent travels in the UK I visited a number of prescribing
pharmacists and I would like to share with you their journeys, stories and
learnings. Here is the story of prescribing pharmacist No 1, Rachel Hall.
Rachel is a partner, as well as the clinical
pharmacist, in her GP practice in Bristol.
She diagnoses, prescribes and monitors
patients, as well as contributing much
to the everyday running of the busy
After a few years as a community
pharmacist, Rachel was employed part
time in 2002 by the local Primary Care
Trust (PCT) as a practice pharmacist,
allocated to a general practice,
initially for four hours a week. In 2013
Clinical Commissioning Groups (CCGs)
replaced PCTs and were established
to commission a range of healthcare
services to meet the needs of the local
population. They slightly resemble our
Primary Health Networks. The local CCG
continued to fund Rachel for a total of
eight hours a week due to the increase
in practice population. In 2006 her value
was recognised by the practice so the
partners created and funded a full-time
position for a clinical pharmacist.
Rachel’s role is an extremely busy one.
Her day can include seeing patients,
managing practice systems and
procedures, assisting GPs with clinical
audits, writing practice protocols,
overseeing drug usage and answering
queries from patients, GPs and nurses.
Rachel’s responsibilities include managing
patients with long-term conditions,
medication reviews, reconciling medicines
when patients are discharged from
hospital and liaising with community
pharmacy and secondary care. She also
helps the practice achieve Quality and
Outcomes Framework (QOF) targets by
reviewing patients who are not achieving
the national clinical indicators.
Rachel is also involved in monitoring
enhanced services for anticoagulant
therapies and disease monitoring
anti-rheumatic drugs (DMARDs).
She also assists the practice by
delivering education and training to
all staff, improving systems, designing
clinical templates and facilitating weekly
In 2007 Rachel became an independent
prescriber after first qualifying as a
supplementary prescriber the previous
year. She produced a portfolio which
evidenced 87 competencies and an oral
exam to assess her skills
Rachel was mentored by the
prescribing lead within her practice,
Dr Carole Buckley.
Dr Buckley said: ‘Pharmacists are highly
trained and skilled professionals with
a lot to offer patients as part of the
primary healthcare team. We have
found Rachel to be a huge asset to the
practice. She is popular with patients
and staff and increases both access and
choice to patients for management
of their chronic diseases and ongoing
prescribing. She also improves the
medicines management systems at
the surgery, taking repeat prescribing
decisions away from the busy doctors,
freeing them for more clinical work.
Making Rachel a full-time member of
» RURAL PHARMACY
Pharmacist prescribing in
BY LINDY SWAIN
Lindy Swain was the 2014 PSA Pharmacist of the Year.
Opinions expressed in this column are not necessarily
those of the Pharmaceutical Society, its Board or staff.
the team has been a very positive move
for this practice.’
Being able to prescribe means that
Rachel can amend dosages and
treatments as well as initiating new
She said: ‘Working within the practice
means I have full access to patient
histories and notes which is so
important to help inform my decision.
I can also refer patients to secondary
care for specialist input, or back to the
GP if I feel the patient’s condition is
beyond my competence.’
Rachel’s areas of prescribing include
type 2 diabetes including the initiation
of insulin, hypertension, cardiovascular
disease, renal disease, asthma, COPD,
obesity, dermatology and some
‘Pharmacists are the medicine experts.
It makes sense that they can assess,
prescribe, and monitor patients.
In fact, it makes perfect sense for
pharmacists to prescribe, as they
have the pharmaceutical knowledge
which enables them to choose the
most appropriate drug for a patient.
They understand differences between
drugs, even within a class, and are
always mindful of contraindications,
drug interactions and adverse effects,’
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