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 www.pharman.co.uk/events