These commentaries by John Macgill represent his opinions only and not those of any Ettrickburn client.

Cost of medicines falling

Three Nations Three Practices

Community Pharmacy Eliminating Hepatitis C

Homeless People make Glasgow

Heart Failure – we can get treatment right for everyone

Bundles of Safety

Community Pharmacy’s Leader in Scotland

CPO: On the Road to Achieving Excellence

Pharmacy technicians may become prescribers

Profile: Dr Norman Lannigan OBE

Profile: Jonathan Burton MBE

Profile: Clare Morrison MBE

Deep Dive Pharmacy

Mind the Gap - Diagnostic Skills for Pharamacists

Bundles of Safety

Supporting Excellence - Alison Strath Interview

2018 Pharmacy Forum Agenda Launched

Which Referendum to Choose

Three Perspectives on Pharmacy and Mental Health

Pharmacy and the New GP Contract

Bordering on Problematic

Recognised by the Queen and her community

VACANCY Reporter/Researcher: Health and Care Policy in Scotland

Prescribing in Mental Illness – A Practice Pharmacist’s Perspective

What Matters to You? Communication in Pharmacy

Prescribing in Mental Illness – A Patient’s Perspective

Focusing the Vision: Dr Rose Marie Parr on the new strategy for Scottish pharmacy

All the things that could go wrong - looking ahead to the SNP conference

Ask Once, Get Help Fast? Pharmacy and Mental Health

Automation and Delegation in Pharmacy: Understanding the Moving Parts

Initiatives Highlight Potential of Community Pharmacy

Pharmacy First in Forth Valley One Year On

Trying to concentrate on the day job

Health and the Local Elections – a strange silence

The Pharmacist Will See You Now – The Growth of GP Pharmacy

Montgomery’s Review – Dr Brian Montgomery answers questions on access to new medicines in Scotland

An afternoon with SMC

Pharmacists at SMC

SMC – are drug firms voting with their feet?

Radical Surgery on the Horizon for Scotland’s NHS

The Future’s Bright – in General Practice

Community Pharmacy in a Changing Environment

Disclosing payments to doctors – has Sir Malcolm done the pharma industry a favour?

Health and Care in the First Minister’s Programme for Government

CMO: Scotland’s pharmacists “absolutely ideally placed” to practice Realistic Medicine

Profile: Maree Todd – MSP and Pharmacist

Scottish Parliament Health Committee Work Programme

Scotland’s new NHS – a Summer of Speculation

Scotland’s New Health Committee

Two million voices in Scotland – is integration the big opportunity to listen?

Medicines – levelling the playing field

Key appointment raises the bar for health & social care partnerships

What did our new MSPs do before?

SMC says no then NICE says yes – three times

SNP promises single formulary and a review of Scotland’s NHS

More Generous than the CDF – but less transparent

Comparison of Funds: New Medicines v Cancer Drugs

Bonfire of the Boards? SNP signals NHS Review

A tribute to five retiring MSPs

New Medicines Review - Health Committee sends findings to Government

Medicines New & Old in the Scottish Cancer Strategy

Great Ambitions, Slow Progress – New Models of Care in Scotland

Scottish Minsters Demand Up-Front Medicine Price Negotiation

Opportunity and Disappointment: MSPs Investigate New Medicines Access

Scottish NHS Strategy calls for 'Realistic Medicine'

The Scottish Model of Value for Medicines: Taking Everything into Consideration

When SMC Says No: An Access to Medicines Lottery

Reviewing the Review: Access to New Medicines in Scotland

A day of psephology and kidology

Insulting the Lifesavers

Worthy of Mention – Health and Science in the Honours List

News Silence from North of the Border

A Christmas PPRS Present from Pharma

Tuesday, July 3, 2018: Mind the Gap - Diagnostic Skills for Pharamacists

The Scottish Government’s ambitions for pharmacy don’t stop at pharmacists qualifying as independent prescribers. It’s clear they expect prescribers to also employ broad clinical and diagnostic skills. Researcher, lecturer and GP pharmacist, Gordon Rushton works with colleagues to identify and fill the gaps. 

“If you read the Chief Pharmacists’ Prescription for Excellence and then Achieving Excellence, you see that we are encouraged to have advanced clinical skills but it’s not that clear what kind of things were talking about,” says Gordon Rushton. “It is important that people get a better idea of what is expected of us, that appetites can be whetted, and people shown a route from feeling that they have limited clinical and diagnostic skills to becoming competent and confident in using them safely.” 

Gordon has a portfolio post which encompasses a clinical role within a GP practice where he works with patients face-to-face on two and a half days each week> a further half day is spent teaching pharmacists how to run clinics and to improve their clinical and prescribing skills; and two days a week are spent doing university practice research and teaching undergraduate medical and pharmacy students. 

“If you take General Practice where I am mainly working,” says Gordon, “I think we've got quite a clear steer from government about exactly what they would like us to do as prescribers in that setting. As autonomous practitioners there is an onus now on us to have a different skill set from before, which must now include consultation skills and softer skills: being good at clinical history-taking and decision-making with the patient. And we are also expected to have diagnostic skills. 

“Of course, it is a fallacy to think that pharmacists haven't been diagnosing. For years community pharmacists have been having millions of contacts every year where people present to a community pharmacist with a set of symptoms. They don't present with a condition. And the pharmacist at the counter discusses those symptoms with them and explores these with the patient to the point where they can make a diagnosis. In the most likely cases, where this being a minor ailment, they then offer treatment and propose a plan for follow-up and safety. If it’s more serious, they refer them on.

“I am interested in the next step. A lot of the general practice roles are new and different. I am employed by my practice now to operate as what you might call an advanced pharmacist practitioner, with undifferentiated illnesses and patients who require to be seen on the day for some sort of acute problem, perhaps pain, an infection or a skin complaint. Maybe a baby. Maybe someone over a hundred years old. As we explore where our place is and where we fit into that type of team, we need to layer new skills on top of our expert medicines knowledge. I believe we can no longer rely on a diagnosis that somebody else has given. If we are being asked to take on responsibility for prescribing, we need to have an appreciation of the underlying condition.” 

In the new GMS contract for Scotland, GPs are styled as ‘expert medical generalists’. Gordon says he like this description.

“It conveys the level of complexity that they can deal with across the health and social care communities, acting as the linchpin. As a result, I think, as pharmacists we have an increasingly important role to play. Each of us now needs to explore how we equip ourselves with the clinical and diagnostic skills that must go with our prescribing and medicines management knowledge.” 

Gordon Rushworth FFRPS is Programme Director at the Highland Pharmacy Education & Research Centre (HPERC) and lectures at Robert Gordon University and the Universities of Aberdeen and the Highlands and Islands. He is presenting on ‘Progressing Clinical and Diagnostic Skills’ at the Pharmacy Management National Forum for Scotland in Dunblane on 30 August. Registration is free for pharmacists at