Pharmacist in practice: Sharing your struggles opens up a conversation

The Pharmacist caught up with Melissa Dadgar, the Primary Care Network (PCN) clinical pharmacist behind the @MelsMedicines social media channels.

@MelsMedicines has over 15k followers on Instagram and 3000+ on Twitter. What was your vision for those social media channels?

I actually started it off as a kind of public awareness of what pharmacists do, because I always felt that when I was in community pharmacy, there were a lot of stereotypes and ideas of what a pharmacist does, which doesn't necessarily translate to the truth of what goes on behind the scenes. My aim really was to show the world and the public what goes on behind the scenes: to raise awareness on how busy pharmacists are and what happens behind the counter.

That evolved to a bunch of pharmacists following me, and now it's kind of moved on to advocating for pharmacists, talking about daily challenges and getting views and opinions on pharmacy news, and also just providing a support network for pharmacists.

I like to talk about issues that we have in pharmacy, because a lot of the time we will have problems, but we think that we're the only one and we kind of get on with it. We're good at putting on a brave face and getting through the day even if we're really struggling.

And I think that when you speak to other pharmacists, it provides a little bit of reassurance that actually maybe it's not me: I'm not the problem. Maybe it's just the environment, and I can voice my concerns and help to advocate for other people to work in a healthy and as a safe environment as possible.

Seeing other people sharing their concerns opens up a conversation: it’s positive and really powerful.

What would you say the big things people are talking about at the moment within your audience?

I think just the lack of support that there is across the board: it’s really difficult at the moment for pharmacists.

And when they’re seeing nurses go on strike; junior doctors go on strike; paramedics go on strike; dentists going on strike – pharmacists have sent messages to me saying, you know, are we next?

What about the Pharmacy First proposals announced last week?

The public often don't realise that there are strict criteria in order to be able to fulfil PGDs, and we can only give out the medications in very limited cases and only in the short term.

I’ve worked in both sectors [community and primary care]. As a community pharmacist, you don't know what's going to walk through your door; patients themselves don't know where to go all the time. But in a lot of cases, you're seeing the same patients anyway. And [the proposed national PGD-based service] gives you more equipment to be able to deal with it there.

So, you would have to meet all the criteria in order to be able to get antibiotics. I do think that in a lot of cases [if they don’t meet all the criteria], patients will still be referred. It's definitely a case of educating the public that it's not just ‘handing out sweets’.

Maybe it will help in terms of the patients that maybe themselves don't know whether this is a simple UTI, or whether it needs further investigation.

From speaking to pharmacists, and getting their views, they feel that the public can sometimes be very, very unaware of just how busy they, how common it is for pharmacists to go 10 hours without sitting, to eat lunch at the checking bench.

Often because we're so accessible, it means that we're so busy.

It's not that pharmacists don't have the clinical knowledge. They absolutely do. Community pharmacists absolutely have the knowledge and the clinical experience to be able to prescribe in certain circumstances. But in order to do this safely and effectively, community pharmacy needs a massive overhaul in resources.

I saw you tweeted about the proposed GPhC fees increase this week. What do you think about that?

I'm not happy about that. I think it's just sad, because I don't think many pharmacists would have got a pay rise at 7.5%. And so to do that to pharmacists and pharmacy technicians is quite unfair.

At this particular time, where pharmacists are burnt out; they’ve got low morale; they’re having problems with staffing; they're having mental health problems because of the lack of support; panic attacks at work – we're not setting pharmacists up to succeed. Even though it's just a small amount of money for some, it's more the principle of it.

And there's a lack of appreciation for pharmacists on both sides. When you look at the public, a lot of them view pharmacists in a certain way, because they genuinely don't know what happens behind the scenes.

Then there’s GPhC, who do know how valuable pharmacists are, and still, they're not valuing pharmacists. So, it's a kind of double edged sword.

I hope more and more people will speak out [on the consultation], because I view it as if you don't speak out against this, then what you're effectively advocating is that pharmacists should be paying even more.

We just don't want to get to that stage where, where pharmacists are having to pay that much just to stay on the register to work to provide services for patients. We need to make sure that we're doing everything we can to retain pharmacists, rather than divert them away.

Tell us about what you do in your role as a PCN clinical pharmacist

I run sessions every day. I run clinics: mainly chronic disease management. So, things like asthma reviews, COPD reviews; a blood pressure clinic. We might do medication changes, and then making sure that those same patients are booked in for blood tests and the monitoring that's required. Plus we're doing general medication reviews, pill checks, and making sure that we fulfil our [ICB] targets as well.

Last year, we did structured medication reviews, and that was really looking into high-risk patients and making sure that they're on the correct medication. If any changes need to be made, I would suggest that to the doctors. And that's really what I do today as well. And I’m answering any queries that the doctors might have; if there's any prescribing queries that they might have, they usually come to us.

We work closely with the ICB - they really support us in the work that we need to get done, and ensuring that we're prescribing the most cost effective medications across the PCN.

I also run women’s health clinics - so things like HRT and contraception - making sure that the patients are on the correct medication and that they're followed up correctly and they don't have any issues with their medication.

Have you had to do much work around HRT shortages and having to switch patients on to different medications?

Absolutely. It was a big part of the work and it’s still ongoing, it’s been such a nightmare.

I really feel for these patients. There's such a stigma with even taking HRT, and it's difficult for women who are just going back and forth, and becoming really symptomatic. Not all women are okay switching brands, but some of them haven't had a choice and it's been tricky trying to get people stabilised - and then once they're stabilised, trying to get alternatives for them.

But I'm hoping with the support of community pharmacists, and myself and PCN pharmacists who have an interest in women's health, that we overcome these challenges together.

How do you work to manage shortages across the PCN and work with community pharmacies?

I use the British Menopause Society as a guide. They provide really useful tools as to what alternatives there would be, so I would pick the correct one for that patient and then I'd call the pharmacy who the patient is registered with, and liaise together to see when the next available HRT brand would be in stock, making sure that the patient doesn't run out, and making sure that that patient is kept under close monitoring and getting any follow ups that are needed booked in as well.

Do you find that that minimises the hassle around navigating shortages for the patients?

Definitely. I think it also provides that continuity of care and gives patients that confidence that that they aren't being forgotten.