An Aussie Pharmacist in England – Advanced Role for Pharmacists

Part 3) Advanced role for Pharmacists in Australia and the UK

G’day everyone! This is my third post in a series looking at pharmacy practice in England compared with Australia. I’m registered as a pharmacist in Australia, but have been working as a dispensing assistant during my ‘working holiday’ in England. Because my experience is mainly in hospital work (in both countries), my first and second blogs largely focused on hospital pharmacy practice. I compared common medications used, and the role of pharmacy technicians in each country. However, being ever curious about the profession as a whole, I’m also interested in the different and extended pharmacist roles currently being practiced.

In this post, I’d like to explore some of the ‘advanced’ or ‘non-traditional’ roles pharmacists are undertaking in each country. These observations have been formed largely through interaction with colleagues, continuing education, pharmacy news and participation in professional organisations, so please forgive me if there’s less direct experience.

Firstly, I was surprised and delighted to learn that pharmacists can study to become independent prescribers in the England. From one colleague’s description, this qualification can take a year and is very “hard work”. It involves university teaching, examinations and many hours spent with a prescribing mentor in the clinical setting. Once qualified, a pharmacist can prescribe anything within their area of competence. Unfortunately pharmacist prescribing is simply not an option in Australia, nor does it seem it will be any time soon. Which is a huge shame, given that nurses, midwives, dentists and optometrists can all become prescribers in Australia.

I was also interested to learn about the pharmacy-led anticoagulation (in particular warfarin) monitoring clinics in England, which were well utilised in the region where I was working. The manager of the warfarin clinics explained to me that prescribing decisions (e.g. initiating, switching or discontinuing therapy) are all made by the patient’s GP. However the pharmacist-led clinics provide warfarin INR monitoring and dose adjustment, and monitor response to treatment and adverse effects. Close contact is maintained between the clinic and the GP. In Australia, virtually all anticoagulant/warfarin monitoring remains the responsibility of the GP, or in hospital, the doctor on duty. A good model for pharmacy-led warfarin monitoring also exists in Australia’s close neighbor New Zealand, but currently Australia has not managed to adopt this into practice.

A recent and exciting area of development in both countries is pharmacist-provided vaccination, which has huge potential primary health benefits. In Australia, based on a very successful flu-vaccine trial, every state has now enabled pharmacists to vaccinate, with appropriate extra training. Flu vaccination remains the main focus, but some states are also beginning to trial whooping cough immunisation. Beginning in the 2015 flu season, England also introduced pharmacy-based flu vaccination under the NHS. If I understand correctly, these vaccines are also given by specially-trained pharmacists.

Both countries also have services for pharmacist medication reviews for community patients. I note that in England this “Medication Use Review” is conducted within the pharmacy, and can be initiated by the patient or pharmacist. In the last few years a similar service has been started in Australian pharmacies (“Medschecks”), but I’m not sure what the uptake has been. For 15 years though, Australia has also had a public-health funded “Home Medication Review” service. Pharmacists undertake extra training to be accredited for this service, which is conducted in the patient’s home or residential care facility. All aspects of the patient’s medication regime are reviewed, including administration process and adherence, enabling a very detailed and thorough review. However, a GP must refer patients for this process, so some may not have access.

I’ve personally found it exciting to see the extended pharmacist roles in place in many areas, providing huge benefits for patients across all levels of healthcare. There are also many I haven’t mentioned e.g. pharmacists working in GP practice. Australia and England are sometimes taking similar directions, but there are also key differences in the roles available to pharmacists. In particular, England has progressed much further in areas like prescribing and anticoagulation monitoring.

Nevertheless, each country has a lot of experience the other can draw on.

Eleanor Kelly


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