This interview is published in the current edition of Scottish Pharmacist magazine

https://content.yudu.com/libraryHtml/A435n6/ScottishPharmacistVo/reader.html?

An Edinburgh community pharmacist was the only practicing pharmacist recognised in the 2018 New Year’s Honours. Sally Arnison, co-Director of the Barnton Pharmacy and Travel Clinic, receives an MBE ‘for services to Healthcare and the community in Edinburgh’. She told John Macgill that she remains unsure who put her name forward and exactly why. 

SA: I don't really know why my name was put forward because, as far as I'm concerned, there are many pharmacists doing good work all over Scotland every day. The citation is for services to healthcare and the community, so perhaps it recognises the work we've been doing here for the last eight years since we bought this business, how we have shown our community that pharmacy is about a lot more than just prescriptions – that it's about knowing the people that you live beside and serve. You know them when they are well, and you know them when they are not so well. And it's also about all the relationships that we have with all the other healthcare providers, be it the chiropodists, the dementia team, the GPs and all the team in the GP practices. 

JM: What would you say is the ethos of the Barnton Pharmacy? 

SA: It is really important to say this is not all about me. I have to give a big nod to my business partner, Leanne Carey. We bought the business together in 2010 and we still have lots of ideas. Our ethos has always been to deliver really great care in the heart of our community and, while doing that, Leanne and I are both working, as the term goes, at the limits of our professional licence. We are both independent prescribers and we have Advanced Clinical Certificates, so we can be hands-on in terms of examining patients: sounding chests, looking in eyes, looking into ears and so on, and then we might write prescriptions on that back of that. 

We offer an examination and treatment clinic in collaboration with our local GP practice and have been able to take on a lot of their workload. The majority of people who come to our drop-in clinic have been looking for an appointment that day to see a GP. When they phone the practice, they are signposted directly to us by the practice staff if it’s appropriate. There is a list of conditions that we can see people for, such as chest infections, earache, viral infections and skin conditions. It’s about increasing capacity in primary care: the access point has changed for them, but this way they are seen the same day.

I also work a day a week as a practice pharmacist, the bulk of the work being around supporting people with chronic conditions, long-term illnesses, and also addressing polypharmacy. It's driven pretty much by whatever the practice needs at the time, and one of our particular focuses is on respiratory and COPD. 

All this has not happened overnight. I know practice pharmacists are very trendy at the moment but both Leanne and I were what you might call early adopters: we started working in practices about 10 or 12 years ago. It has been about building a relationship over a long period of time. We refer to it as ‘sharing the kettle’: we get to know people during the tea breaks and then, when we need to rely on them professionally, and them on us, it's all much easier after that. 

JM: What difference has being an independent prescriber made to taking your vision forward? 

SA: The prescribing came a long time before we had our own business. I guess it has been a culmination of drivers and levers – nationally as well as locally. We have a very forward-thinking Chief Pharmacist whose vision is of pharmacists seeing people for common clinical conditions in the community. We also have NHS Education for Scotland who are providing the training to up-skill us so that, once you are comfortable prescribing, you then can be supported to become more clinically adept and to be more hands-on. It takes time. You have to sound a lot of normal chests before you hear a chest infection and you have to look in a lot of ears before you see your first burst eardrum. The prescribing is only one endpoint. If, after your clinical examination, you decide that a person, for example, needs an antibiotic then you have the ability to prescribe one. But for every antibiotic prescription you write, many more people will be given recommendations around self-care or over-the-counter medication. 

In the end, it's about having the right premises, the right procedures and protocols, the right agreement with your GPs, and the right funding mechanisms in place that, together, allow you to deliver the service that’s needed.

JM: Being in the heart of your community, what sort of work are you able to do to support people’s health not just support them when they are ill? 

SA: We do do a lot of flu vaccination which, of course, is not current through the NHS. We have given around 350 private flu vaccinations this season. So, people come through the door for those and we also talk to them then about how they are feeling. We do cholesterol checks and healthy heart checks. We run a travel clinic, as independent prescribers, as well. Ours is not a deprived area. We do have people who travel a lot and who have disposable income. From a business point of view, it is the private services that are growing, allowing us to grow our income at a time when NHS margins are harder and harder to maintain.

JM: How important was it for you to be dementia friendly? 

SA: We know the needs of our customers and we tailor our services accordingly to meet these. We have a large proportion of older folk. Our council ward has, I believe, the largest number of people over 85 in Edinburgh. So, we have a lot of diseases of old age, including isolation and dementia. Dementia is a disease where there are very few drugs, very little in the way of medical treatment, and it’s largely about managing people’s social care. We wanted to take the opportunity to help people navigate the systems as we integrate health and social care, making it a bit easier for older people with dementia and their families and carers. 

We started off about five years ago by inviting a dementia adviser to use our consultation room. That has blossomed into a dementia cafe in a church hall the road once a month down with us maintaining our strong links with everyone there. We’ve even run a marathon as part of dementia fundraising. What’s important is that it is all delivered in our community and by our community. It’s our whole team, not just the pharmacists. My colleagues on the front counter are the ones who see the changes in people's behaviour. You might have somebody who is well-known in the pharmacy but their habits change, they come in several times a day and they appear confused. We look for the signs and flag up early warnings to the GPs. We also work hard to try to keep our people with a known diagnosis of dementia living in the community through trying to understand them better and know what their needs might be. It's not rocket science. It is all just good customer service. 

JM: You operate from a single site. Are you not tempted to repeat your approach to running a pharmacy elsewhere by expanding into a new community or communities? 

SA: Both Leanne and I are in our first decade of business so both have bank loans to pay. We also both have young families. I'm not saying that, if the right pharmacy came up in the right sort of community, we wouldn't consider it. But it has never been our model to build an empire. It has all been about doing what we do really, really well. 

JM: Now that you've been recognised in the Honours List, what do you hope that that will allow you to do – how do you hope to use this?

SA: That's a tricky question. I think for me it is about taking the spotlight off me and putting it on other pharmacists. I feel that it's about doing the day job really well and there are many pharmacists doing really great work across Scotland who inspire me every day, and who I learn from every day as well. 

I guess, perhaps if there are young pharmacists coming into the profession and looking at community pharmacy, I would try to say to them that ‘it's up to you to make it what you wanted to be’. It can be very rewarding and, indeed, can be cutting-edge if you make use of all the skills and opportunities that are available. I still get a buzz out of my profession and from the work that others in this profession are doing. It would be nice to inspire others.