As part of our Pharmacist in practice series, The Pharmacist speaks to Shilpa Patel, lead prescribing pharmacist and partner at Brighton Health and Wellbeing Centre
How long have you been working in general practice and what were you doing before? What attracted you to working in general practice?
I’ve been working in general practice for seven years. I was a community pharmacist before that for probably about 15 years. I did lots of different roles within community pharmacy, worked for all the different companies, locums, managed, and exhausted that area.
It got to a point where I was supporting the area managers, but I didn’t feel like I was fulfilling my purpose. I felt like something was wrong and I needed a change, so I self-funded the independent prescribing course and that gave me some confidence to look around, I felt like I needed to do something with that. This opportunity came up when NHS England was funding pharmacists to work as part of a pilot trial in surgeries, so I applied for the two-year pathway, and I was in the first cohort.
I’ve been on quite a journey since then. I was told it was going to be two years and it might work but it also might not, and I might not have a job at the end of it, but I was quite ready for that. I’d got to a point in my life where my kids had grown up a bit and I was in a better place financially to take more risks.
I was taken on as a medication review pharmacist, but at the time, practice managers didn’t really know what to do with us, and I didn’t know what I could do for them. I didn’t understand GP surgery at all. I used to do travel vaccines in community pharmacy, so they said, ‘why don’t you run a travel clinic as well as the med reviews?’ I did that for probably a month or two, but I wasn’t happy with the prescription process at the surgery, I didn’t feel patients were being monitored correctly. I spoke to the practice manager and said I felt like I could help in this area, and I spent two years learning and putting together a whole protocol for our surgery and changed the whole way that prescribing was done.
In the beginning there wasn’t much trust, they didn’t really know what I was doing, but by the end of the two years they totally got it. I’d made so many changes and I hadn’t really taught anyone else how to do these things so I was kind of leading the whole prescribing process, so at the end I was almost indispensable and knew they weren’t going to get rid of me.
The first two years when I should have spent a lot more time running clinics, I became more part of the spine of the surgery. I got much more involved than I should have, probably. At the end of my two-year review, they offered me partnership at the surgery, which I initially hesitated to take, but decided to take it and see what happened. Since I became partner five years ago, I now have more decision-making power, I’ve made so many changes and been involved in every single pharmacy aspect of the surgery.
I’m involved in the clinical side, but I’m also involved in the management side. Anything I’m interested in I can get involved in and I just love my job now, I can’t stop. I want to work all the time; I find it so fulfilling. I run whatever clinic I want but I also look at the QOF data, I apply for new services, I help with the LCS, to the point where I’ve become the LCS lead, the QOF lead, and I led the Covid vaccination service. I’ve reached a stage where I feel like the sky is the limit. I can literally get involved in everything and anything I want to.
We merged with another surgery, and I was the lead for the merger, so I spent about five months doing a merger project. When that finished, we reopened a practice that had been closed for two years and I led that project and learned how to actually set up a surgery. At one point our practice manager retired and we couldn’t find anyone, so I stepped into that role for about a year, managing the whole practice – we’re quite a big practice, we’ve got 25,000 patients.
What does your job look like day-to-day?
My days are so, so varied. We’ve just taken on our tenth pharmacist, which I’m really excited about. Over the years, I’d set up a clinic, we’d get it up and running, and then once it went well, I could take on another pharmacist and they’d carry on the clinic, and then I’d start another and get someone else trained up. I’ve been doing that for the last seven years, so we’ve now got six full-time pharmacists, three part-time pharmacists and one volunteer for one day a week, so I’m managing these 10 pharmacists. I’m obviously looking after our QOF, our LCS; we’ve got a CQC inspection coming up, so I’m very heavily involved in making sure we meet our CQC standards.
I probably do on average a day a week in clinical work now, stepping in whenever someone’s off, and the rest of the week is more management. That’s something I’ve chosen to do; I really enjoy the organisational side of things. But to be able to do that, I have to keep my foot in clinical work as well. Sometimes I might do 3-4 weeks of clinical work, it depends what I feel like I need to do next and the needs of the business.
We look after a refugee home with 125 patients who have been with us for a year and a half and I was asked last week to prescribe them all vitamins. I’ve been able to take it a step further – I’ve contacted a dietician, I’ve got the CCG involved, and we’re all going to this home to assess the food. Rather than just prescribing them vitamins, we’re going to go in and see if we can change or review their diet and why they’re all ending up malnourished. I feel like I can look at the bigger picture and have a bigger impact.
How do you work in a team with your practice colleagues?
I’m obviously very involved with the pharmacy team, we’ve got the 10 pharmacists and four technicians, and I meet with them every morning at 9 o’clock. We’ve got three branches, we’re all quite spread out, so it’s pretty much always virtual, and we do 12 minutes of meditation. It’s quite unusual, but I’m quite spiritual and we started doing this every day just over a year ago. Then we do a check-in and resolve any issues. We have a clinical meeting with the whole surgery once a week for an hour, we also have operational huddles every day for 15 minutes. I’ve tried to cut down my meetings, but they’re the main ones.
How do you work with community pharmacists?
We’ve got really good links with our closest pharmacies, and I’ve been really trying to encourage communication between GP practices and community pharmacies. We’ve done loads of work this month on the CPCS scheme, trying to understand where it’s going wrong and why the uptake isn’t as good as it should be, because it’s a brilliant service. We’ve gone to every single pharmacy in the area to try and understand what’s holding things back on their side. It’s about trying to understand and fix any process issues. And my aim for this year was to go through their services one-by-one and try to use them a lot more.
We’ve got a WhatsApp group with the four pharmacies that we use a lot, that we set that up a couple of years ago, which has been amazing. All queries can be discussed on that, because it’s so hard to phone each other and emails don’t always get checked. We also socialise together – we all went out for a meal last month, and we meet quite regularly.
Community pharmacy is changing, pharmacy on the whole is changing a lot, and last year I felt there was a lot of duplication of work, because we’ve got that community pharmacy background and those skills, but then the patient is going to the pharmacy and getting the same treatment. I feel that we need to do some work on trying to make sure we’re doing things differently from community pharmacy and using, for example, their New Medicine Service. Obviously, GP services are so overloaded, waiting times are going up, it’s trying to work a bit smarter and see how we can rely on each other a bit more.
What is the biggest patient need in your area and how does that influence your work?
Mental health, I think it’s the whole political situation, the energy bills crisis, all of that has just meant that mental health services can’t cope at all. And there’s a backlog from Covid on the wait for secondary care, so we’re having to deal with a lot of patients who have been waiting and waiting for a referral. Mental health is taking over most of our day.
Are you currently undertaking any training? How is it going?
I’m doing two leadership courses – one which is specifically for pharmacists called LEAD and it’s really helping me with my leadership skills. I’m also doing a leadership course for BAME NHS leaders called Reaching New Heights, which has been more of a struggle to get through.
Do you have any areas of special interest or any particular projects that you’re working on?
I started as a sexual health pharmacist, that’s what I did my prescribing in, so contraception and sexual health are my forte, but within three or four months I just realised that I wanted to learn everything. When you’re a community pharmacist, you know a little bit of everything because you have to be able to answer every question in every area. So, when we come into GP practice with that background, we get told to specialise in one area and we come in thinking that’s what we’re going to do, but we always want to look at the whole person. I think we’re programmed in that way.
I’ve put each pharmacist who has joined us into a specific role and they’ve ended up becoming generalists, so we’ve changed the way we do things in our surgery. When they come in, they spend about three months specialising in an area and then they become a GP pharmacist. So, we all work through this pool of general queries and medication reviews.
I specialised in hypertension for a number of years, I ran a hypertension clinic, but since then I’ve been doing a lot of mental health, all the cardiology prescribing, and I run a pain clinic alongside a physiotherapist. I’ve also been running a detox clinic for the last six years, helping people to come off diazepam and other benzodiazepines. That’s been a really successful clinic, I’ve had a lot of interest in that and we get a lot of people join our practice just for that clinic. That’s something that I’m really proud of.
What do you think will be the biggest opportunities/challenges in the sector as a whole, over the next five years? What changes would you like to see?
Right now, there’s a bit of a buzz around GP pharmacy. If I put out an advert, I get so many applications, I’m spoiled for choice, everyone wants to work as a GP pharmacist. I’m also paying them way less than community pharmacy, whose pay has gone up in the last year or two. I’ve not even tried to match it and I’m still getting people interested. They all seem to want to be doing this and what I’m a bit worried about is that over the next few years, that bubble is going to burst.
My pharmacists have all taken a pay cut to come into this sector and it’s one of my priorities to ensure all my pharmacists are happy and confident and feeling fulfilled. They say to me they’ve never been so happy and content, they’re all finding what they’d been looking for, that’s something that I focus on every day – what does this person need next? There’s so much to learn, I’m still learning after seven years. My role is to take workload off GPs, and that’s never-ending, there’s always work you can take off the GPs. We’re still just scratching the surface of what we could be doing for them.
It would be great for all pharmacists to realise that there is a role where they could be really happy. Over the last 20 years I’ve met a lot of pharmacists who really aren’t happy in their roles, and this seems to be a role in which people can feel good about what they’re doing and make a change in people’s lives. I’m hoping in the next five years, more and more people find this path.
Pharmacy schools are now teaching prescribing and I’m thinking about all the people who haven’t done it. In a way it’s good that everyone’s being encouraged to do it, but it’s quite hard and I feel for the slightly older pharmacists who are going to feel like they’re not able to do as much as the others. In five years’ time there will be very few who haven’t got that prescribing qualification. That’s a concern for that group of pharmacists who have been through really hard times in the last 10 years.
Suddenly pharmacists are being recognised: there’s GP pharmacists, PCT or ICB pharmacists, PCN pharmacists, there are so many different roles. I see a much, much brighter future for pharmacists. We’re being recognised and valued for the first time, and it’s about time.
I recently read an article about pharmacists being used as ‘cheap GP labour’ or something like that and I commented, ‘why not?’ Ok, we’re cheaper than doctors, but you can still earn more. Obviously, as a partner and with everything I’m doing, I’m earning way more than I would in community pharmacy. But even if you’re not, just the fact that you’re feeling more fulfilled, and ok you’ve got to be at the right time in your life to be able to take this step, but I felt like it was a really bad way to look at it, that we’re ‘cheap GPs’. That’s the route we took, we’re never going to be paid as much as a GP, but I don’t think it matters. It’s just good that we’re being recognised now.
And what do you like to do in your time off?
I’ve got a lovely family and I do spend a lot of time with them. I’ve got two lovely kids and my mum lives with me and we spend a lot of time together. In Brighton there’s always something happening, we go to a lot of festivals, which I love. And I walk loads, on my day off I’ll just walk from morning to evening. I just love walking, and I’ve got a dog as well.
I’m very spiritual, so I did a 10-day meditation retreat last year, where we meditated literally round the clock for 10 days. I wasn’t as spiritual years ago, but I have become more so over the last few years. I also love being in nature, I’ve got a campervan, so we go camping a lot!