‘I think it’s really cool to have a stethoscope and to be able to use it’

So it's been streamlined, much more rigorous and a lot more clinical component at the moment, but it has been an incredible journey and I think it's really changed the way that I practise regardless of whether I'm providing consultations directly or just in my general day-to-day role as a pharmacist. I think it's really changed the way I approach my patients.

So for people coming through JCU where cohorts three and four and soon to be five have been going through and it's two subjects. The first one primarily on the prescribing process, so a lot more of the governance history, taking consultation and writing the prescription. And then the second part of the course is all of the clinical content. Now as part of that clinical content, you attend face-to-face workshops to develop those clinical skills.

For my group that went through, we had four days of clinical content, now you get two five day workshops. So it's improved in terms of the delivery and I think that will be a really valuable experience for those that are coming through now to get much more hands-on in the training. With the training, there's exams throughout, some of those are face-to-face OSCEs and then some written online components as well.

So I structured my practical component where I did a combination of doing or I guess stepping into the consult room more often in the pharmacy and just kind of working with my general patients and doing a little bit more and then having discussions with my supervisors and then also going in and working half a day a week at the general practise, which was really outside of my comfort zone.

I think I developed a respect for how many patients we actually manage in a day compared to general practise, but helped me really cement my skills. So for me what that looked like, I developed the training plan with my supervisor. Initially I just sat in, watched them deliver consultation, kind of get a feel for how to really connect with patients and then fast forward, kind through a few steps and by the end I was going through the wait list where I live, we have a six week wait to see a GP.

So I was going through the wait list trying to pick out patients that looked like they fell hopefully within my scope and I would ring those patients, see them at the general practice, and then my supervisor would come in at the end, review all of my work and then decide, yes, I've made the right decision about what I would like to treat and prescribe, and then they would just finalise off the consultant and write the prescription when I was not able to do so.

But what I've been finding is that the patients that I'm seeing a lot of the time is really opportunistic identifying patients on the floor who maybe otherwise wouldn't be getting treated. And I think realistically, a lot of the patients that I'm seeing either don't have a regular GP would've ended up in emergency or just wouldn't have been treated at all. So there's a whole range of

presentations that we're having. I had a mom, I was walking out the door the other day, a mom with a child with fevers and she said, oh, my other kids get ear infections. I'm a bit worried that my daughter has an ear infection as well. I said, I'll come and I'll look after you come in. And she had four kids. I'm looking at one doing the consultant, checking in the ears and noticing at the same time another one has impetigo.

So I actually ended up seeing two of her children just off her walking in to ask for some help with the fevers that her child was having. So it's really, I think in this initial stage, not going to be patients that are booking in advance to come in at a structured time in terms of how we're capturing those patients. It's the ones that are coming in and whether we can see them then or whether we say, can you come back in an hour or two and I can see you,

you there. So it's been very, very interesting to see all the different presentations and the relief from patients when they realise actually there's a solution that I can do for them straight away.

providing service. Our time is valuable. So absolutely under the pilot there are set fees that we need to charge for our consultations and they are controlled while it is still under pilot. So minimal advertising at this stage. I do allocate time every Wednesday when I have another pharmacist with me for consultations. That being said, I have worked on a weekend where patients have been in need and I have been the only pharmacist and have coordinated it into my workflow with the help of my

very well-trained support team to be able to see those patients. So one Saturday that I worked, there was a five hour wait at our emergency department. Patients were happy to sit in the pharmacy and wait for me for an hour, hour and a half until I could kind of juggle things around to fit them in because that meant a saving of quite a lot of time for them than sitting up at the hospital.

So I think it's about us rethinking our workflow, rethinking the way that we train our team and utilise our team, making sure that we are delivering really good quality safe services that we're not trying to check scripts in the middle of a consultation, but we felt like this when we started vaccination, we felt like how could we possibly step away from the dispensary to vaccinate someone and now that is part of our workflows.

So it is obviously not really realistic that I'm going to sit in a consult for half an hour, an hour to do travel health while I'm the only pharmacist on duty. But acute situations where you've got a child with impetigo or an ear infection, those consultations are 10 to 20 minutes. The vast majority of them are falling into that standard consult territory that we are more than able to work that into our workflow if we need to support these

patients. And like I said, people are really happy if you say, look, I can't see you now, but I know it's a bit quieter in the afternoon if you want to pop back in the afternoon.

I have in my team intern pharmacists and pharmacy assistants that do the initial, get all of the patient data just like a receptionist or a practise nurse with. They take all the observations. So when I walk into the consult, I am straight into that, connect with the patient, do the clinical. I'm not there asking what their date of birth is and getting their phone number in. And that helps to kind of streamline things and mean that I'm just really focusing on clinical work.

I think then the rest from people that I have spoken to are doing a real mix of things and we all want to help and we are so used to not being able to help. So we've got all these great new skills that I think many of us are going, right, okay, yes, I've got this patient here, they've got potentially an ear infection and so I'm going to try and fit that in

now. But ideally, we're all trying to have time where we are allocated as consultation and I think that is the best case scenario we can have. While maybe not the easiest to implement in smaller, more remote locations where this will be game changing for those communities to have someone that can deliver care in a town that has no other primary healthcare provider.

If we can get those pharmacists skilled to be able to deliver this, that will change the way their community's health is looked at after and how their health outcomes are. So I think it's really about us creating nuances to our own practises to make sure that we are putting patients first, supporting our practitioners to deliver it and then making the practise adapt to how we can do that.

There's very few bulk filling doctors these days, so people don't seem to be worried about paying for that. One of the barriers at the moment is that we don't have access to PBS prescribing, so that becomes a cost implication. And I think as pharmacists we are very conscious of the hip pocket of our patients, and so we sometimes are rationalising, is this the right, yes,

I can do this. Yes, I can write a prescription, but is this going to be fair and cost effective for the patient or should I be looking for ways that I can manipulate the health system to support them better? I think if we can get access to PBS prescribing, which thanks to the announcement of the women's health package where from 1st of July we'll be able to do that. That is the stepping stone to having full PBS prescribing rights and that will change everything dramatically. But in short,

no, patients do not care about paying. In my experience, they are so thankful. If you think about a busy mom, their child is not allowed to go to daycare because they've got impetigo, they have to be treated for 24 hours before they can return. They're losing sometimes two or three days before of work before they can see the GP.

So if they can come into me back to work quicker, their child is getting better, quicker, it's really a no brainer and people are so thankful and relieved to be able to access the service.

So I think that's been really cool. And I love when my kids, I have two young children, my little one likes to say, I'm very sick mom and I can't go to school. And so now mom can pull out this stethoscope and say, oh no, your chest is all clear, you're fine. So I think that's probably what I've enjoyed the most, but just being able to examine my patients to be able to identify where there might be problems.

I did a abdominal examination on a patient coming in for hormonal contraception the other day and she had a massive increase in her endometriosis symptoms, which was very evident from the abdominal exam. So that sort of, as soon as I did that was very clear, nope, I need to refer on and I got her back in contact with her gynaecologist and GP and to have the skills to be able to do that is really comforting, I think, to know where we can look after people.

I don't think it really matters in what direction we head as long as we're following what our patients need. And so we're delivering patient-centered, really safe quality healthcare. We are capable to do this and what we can do to contribute to improving the delivery of primary health services is where we need to be.

in them. So things like reflux and hay fever or allergic rhinitis. We can treat nausea and vomiting, minor skin conditions, so things like eczema, acne, impetigo and shingles, and then we can do wound management. We talk to glue wounds and remove sutures and things like that, and a bit of musculoskeletal. And then there is a whole section on chronic disease management, so cardiovascular risk reduction, asthma management,

COPD management. So all of that is done as part of a collaborative healthcare model so that we are working with patients and their gps to manage their symptoms better. And then there is a lot of wellbeing services, so helping people to quit smoking, to manage their weight and things like travel health and what is beyond just the fullscope pilot now is the hormonal contraception. And we're seeing really excellent uptake of that and very passionate about women's health.

And it is so nice to be able to see and support women and them not feel like I have to plan my life weeks or months in advance to make sure that I have access to contraception. So we're seeing really good uptake and feedback from those services.

I think as long as you're approaching it that you are prepared to put in that effort to really make sure you've got good quality clinical skills, then we will be fine. We have seen one and two, we've had quite a number now graduate cohort three has just finalised and a large number of pharmacists have come through there. And then post APP, there seems to be this explosion of interest that I absolutely was not expecting.

I think those very strong announcements from Minister Nichols and also from a federal level in terms of expanding women's health services is seeing a real interest. And I know within our pharmacy group drug chemist outlet, I sort of put a bit of a, Hey everyone, if you've got questions, here's our little chat group. And it's really exploded with people just wanting to find out more. So I really see this as the way of the future.

There is intention that within the next decade there is an intention that we have 80% of the workforce that is able to deliver these services and we will start to see graduates coming out of the doctor of pharmacy programme with these skills. So I think it's only going to be an exponential growth from here. What's been a slow burn is just going to, it would be great.

Even just since the announcements in the few news articles and things that have been out in the last couple of weeks post a PP have certainly had more people asking. I had the local ed nurse actually come to me for an appointment the other day because she said, this is so great and I can't wait when we are busy in the ed department to know that you are there and we can just send any low acute stuff straight over to you so that we can alleviate time in the ED. And that's what this is all about.

Half a day to a day a week is probably realistic to commit to doing the training. And then don't be afraid to trust in the skills and the quality of your service already and to recognise that your time is so valuable. There's nothing to stop us now charging people for our time.

Just what we are delivering is going to change, but we can start seeing patients and charging for consultations and delivering services now and build your confidence when you have someone coming in for a contraceptive pill, start pulling them in and asking them questions. Practise your skills and then start jump in if you want to dip your toe in the water, start with hormonal contraceptive. If you don't want to go to the full scope, that's a nice little taster to see whether it's for you or not.