I am a consultant pharmacist in addictions and have been prescribing in this field of medicine for approximately 14 years. Initially, I was a supplementary prescriber until the regulations changed to allow for independent prescribing of controlled drugs.
I am currently the clinical lead for the specialist addiction service in north Birmingham and am also the national non-medical prescribing (NMP) lead for a charity called Change, Grow, Live.
The Birmingham service currently oversees more than 6,500 people who are accessing support for a variety of drug and alcohol problems. While it is a consultant-led service, the majority of prescribers within the service are NMPs. At my hub, I see patients of varying complexity in terms of their drug or alcohol use combined with challenges with respect to their physical and particularly their mental health.
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The recent changes, both in the pharmacy undergraduate course and with the extra support to encourage current pharmacists to become independent prescribers, are of great interest to me.
Perhaps it is because I have spent a significant period of my career in community pharmacy. Or maybe it is due to my ongoing regular contact with the pharmacists across Birmingham.
To me, prescribing feels like a natural evolution of a pharmacist’s role. The very nature of our training already provides a good grounding for prescribing. Pharmacists already understand how medicines work and how they interact, and they know how to spot warning signs of more serious disease.
Of course, prescribing is a lot more than understanding pharmacology. One of the key strengths of the prescribing curriculum is about learning and honing consultation skills. In my own specialism of substance misuse, I have been keen to focus on the person not the drug. Active listening is key.
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Sometimes I don’t have all the answers in clinic, but it never ceases to amaze me how well people progress with their recovery just because someone has taken the time to listen to them and truly understand their situation. There have been times when patients have asked me if I have had a history with illicit drugs because I seem to “get it” or “understand what’s happening”. For the record, I haven’t used illicit drugs – but I have spent a long time listening to and learning from the people I see in clinic who do. Building rapport on this level is invaluable.
In my own field, I can see a time approaching when I will be able to work closely with prescribing community pharmacists to support my patients, perhaps as a kind of shared care. For people who use drugs, there is a mountain of evidence to inform us that patients on scripts are safer than those who are not.
To have a cohort of prescribing community pharmacists that can more closely monitor my patients and who have the training and authority to assess and respond to titration needs (including restarts if necessary) would be amazing. It would help to bring treatment to where people really need it, and I have no doubt that it would improve engagement and further support recovery.
For those pharmacists out there that are looking to become prescribers, you will hear two words very often: confidence and competence. Know your stuff, certainly, but also know your limitations and where to go for help when you don’t know the answer.
The best advice I can offer is to make sure you have a good support structure behind you. Having access to a good clinical supervisor who is an expert in the field you choose to practice in is essential. Being engaged in a good peer support network is very helpful. Having both is best.
Being a prescriber is demanding, not just on your time, but intellectually and emotionally. But from a personal perspective I would have to say that it is the most rewarding role I have ever done.
Kevin Ratcliffe is the national NMP for the charity Change, Grow, Live
