By George Cloete, BPharm MSc
Prescribing for minor ailments in community pharmacy is long overdue for British Columbia and it is time pharmacists are recognized for the wealth of knowledge we already have.
However, implementing prescribing authority here in B.C. won’t be without challenge, and these challenges will remain until a level of comfort and confidence is built within patients and pharmacists ourselves. This will take time.
Experienced pharmacists in B.C. have been working within a realm where we have been taught to always ask “permission” from a physician, for example, when we adapt a prescription, we still have to inform the physician. New to practice pharmacists may be far more eager, but will lack the practical clinical experience that only comes with time.
Patients already do trust pharmacists, but the question in their minds might be whether a pharmacist can do just as much as their regular prescriber. Would a patient visit a pharmacist for an acne prescription instead of dermatologist? How long might it take for a patient who has been trained their whole lives to visit the doctor’s office, to realize a visit to the pharmacy for their minor ailment is possibly a better option?
For business owners, we have been told in early May by government that minor ailments will be compensated at $20 per assessment. If it was 100% up to me, I would risk investment and employ somebody who will be dedicated to do the service. I would look at it much like any other investment: borrow money from the bank, take the risk, make the investment and hopefully I will get a good return. I know that when we offer this service, we will definitely have to be mindful of how long each assessment would take. This will be a challenge. However, I would still strongly encourage providing the service of minor ailment assessments because it's something I feel passionate about.
George Cloete graduated in 1994 from Nelson Mandela University in South Africa and eventually owned four pharmacies, before moving to Alberta in 2009. There, he worked in both Slave Lake and Fort McMurray, and he became among the first pharmacists in the northern Alberta region to receive Additional Prescribing Authorization. In 2017, he moved to British Columbia, where he serves as Associate Owner of Shoppers Drug Mart #273 in Surrey.
At the moment, there is a shortage of health-care workers in British Columbia and beyond. For many community pharmacies, accommodating prescribing authority will likely mean employing additional labour. As a pharmacist who has practiced previously in a prescribing province (Alberta), some of the things I’m thinking about is whether I can grow my team, whether that’s an additional pharmacy assistant, a pharmacy technician or another pharmacist.
t’s also about preparation. Before June arrives, business owners will need to engage with their staff to ensure each team member understands exactly what is happening, and that when a patient arrives at the counter all staff is familiar with the 21 minor ailment conditions that a pharmacist may prescribe for. Does the patient need an appointment? Can they walk-in and see the pharmacist for their minor ailment within 10 minutes? Or do they have to come back tomorrow? What documentation is required? The last thing you want is for a patient to visit the pharmacy with an uncomplicated urinary tract infection and being told they need to visit their doctor due to a breakdown in communication.
In terms of identifying a pharmacist to do the work of assessing minor ailments, we all have the same book knowledge, the difference will be in your clinical presentation, how you physically present yourself and your confidence behind your minor ailment prescribing. Pharmacists need to understand that a sound clinical decision cannot be challenged. On the other hand pharmacists may be challenged if required paperwork is missing, if grossly negligent in their decision-making process, overlooking crucial factors when assessing a patient, those are things that becomes challenging.
At the end of the day, you want a pharmacist who has crossed their “T”s and dotted their “I”s and who can deliver their decisions in a clinically sound manner, with confidence. If you and your team can do that while managing the rest of your workflow, then you are on the right track.
Since the initial announcement for expanded pharmacy services in October 2022, patients have already been asking about pharmacist prescribing. In June, when this becomes official, it may be slow at first but in time and the support of other prescribers, word of mouth will spread and the demand for pharmacist prescribing will increase.
The little seed is planted already in their minds.