This article is published in the current issue of Scottish Pharmacist Magazine.

The central tenet of Scottish Government health policy is that those delivering health and care should do so in a way that is person centred, safe and effective. The simple question ‘What Matters to You?’ is not just a handy reminder about how to listen to patients, it has become a global catchphrase for an approach to communication that is based on listening to patients: to try to understand them, not just to be able to reply to what they say.

At the recent Pharmacy Management National Forum for Scotland, veteran pharmacy leader, David Thomson, led seminars on communication, examining how pharmacists in different settings can equip themselves to get the best out of conversations.

And, as John Macgill reports, some delegates suggested that the challenge may be less how to communicate better with patients, and more how to be understood by other professionals.

Scotland’s Chief Medical Officer, in her introduction to her second annual report ‘Realising Realistic Medicine’, says practicing realistic medicine means putting the person receiving care at the centre of decision-making. Her counterpart, Chief Pharmaceutical Officer, Rose Marie Parr, told Scottish Pharmacist that she is committed to continuing to intertwine ‘What Matters to You’ with the other threads of pharmaceutical care. 

‘What Matters to You’ is a fantastic movement. It complements work already done around ‘ask your pharmacist’. Pharmacists are already having difficult conversations, for instance around palliative care or whether we should be using preventative medicines with people in their 80s. We have to ask people what they really want of their medicines. For some people treatment is a burden for them and that's not what we want for older people. Equally, I am mindful that in the early stages of caring for someone with a long-term condition we need to find out what matters to them so we get it absolutely from the start. 

Thomas Ross, a Lead Pharmacist with NHS Highland, says many patients themselves know that they are in the driving seat. 

‘Patients tend to be very much better informed now. Clinically they are much more aware of the treatments options available to them. And, if they don't get what they want, the complaints procedure is much more straightforward for them. Indeed, they are encouraged to complain and that’s actually a good thing as it is a real route to improving services. Many people are keen to be participants and partners in their care where before they would have just accepted what was offered as being the best available and that wouldn't have been questioned.’ 

Thomas accepts that, for some pharmacists, this change in emphasis is not easy: 

‘I think it is a bit of a challenge for some individuals to change themselves. There are some roles across the wider profession where people aren't patient facing but the profession is clearly moving towards being much more patient facing and we have to adapt to that.’

“We know from history that a lot of people did pharmacy because they did not want a patient-facing role,’ says Dr Parr. ‘I think it's changed and young people coming into the profession probably do want the clinical role and sometimes you actually have to remind them they have to master the basics first.’ 

RPS Fellow and NHS Greater Glasgow and Clyde’s Lead for Community Pharmacy Development and Governance, David Thomson, agrees that a new generation of pharmacists is better equipped to take these changes in their stride:

‘I think for younger people, there is less formality, which is a good thing. They are not disrespectful, but they are not handicapped by that same level of reverence or awe that we had in my generation to our detriment. I was brought up in a rural farming community. The doctor was revered. It didn't matter how ill the person was, the house was dusted and cleaned before he arrived. That's not necessarily the case anymore. There is a degree of familiarity now that wasn't there previously. So, I think the younger people are more adaptable. I think the need for us all as a profession is to learn skills for communication in different scenarios because a particular style isn't going to work in every scenario. 

‘The profession enjoys a high status and a high level of esteem with the public and patients. In community pharmacies, before registration came in, pharmacists relied purely on goodwill to maintain their customer base. If you didn't treat the patients well that was the end of your business because people voted with their feet. So, in a way, our community colleagues are ahead of the game in their communication with patients.’ 

David Thomson is adamant that pharmacists, whatever stage in their careers, can change their communication style, to match the changing needs, demands and expectations placed on them. He says he has adapted his style and suggests that honest conversations with friends and colleagues – and watching some of the examples of good and bad practice available on YouTube – can give valuable pointers. But multi-disciplinary working can throw up a different set of communication challenges: 

‘I can empathise with some who I have met who have been managing a team within a pharmacy,’ says David. ‘They enjoy an elevated position. They have status but may find that it doesn't readily transfer to another environment. They walk into a GP practice as the prescribing support pharmacist and they are ignored. They are side-lined. They think ‘hang on a minute, I've got many years of experience, I've got this senior role’, but it doesn't carry any weight in that new environment. They haven't got the ability to engage readily, quickly enough to change their communication style from day one. 

‘So, we need to equip them with the expertise to engage in a different way and at a different level. To do that they need to be clear of their own strengths and identify their own weaknesses and what they need to change so they can, if they need to, be a forceful, effective, assertive player right from the outset.’ 

‘It is about gaining confidence and going into practices and speaking to GPs, particularly how you challenge GPs around their clinical practice,’ says Thomas Ross. ‘I think you can train people how they should do that but a lot of the trust comes through experience and a bit of trial and error as well.

‘It can be challenging and quite daunting when trying to get GPs to change their prescribing or clinical practice. This can be difficult enough with one GP but much more so when faced with a group of GPs. Often you feel that your advice and judgement is being questioned so it is about how you deal with that sort of situation and my advice is to be well prepared. 

‘I also think GPs are taught how to stand their ground. They have such a pivotal role in patient care and are seen as the key advocate for each patient. To be fair to them they are trying to coordinate a patient’s care, often with numerous different professionals trying to have a say.’ 

When it comes to redesigning the relationship between pharmacists and fellow healthcare professionals, Inverclyde is perhaps under the fiercest spotlight having been chosen to pilot New Ways of Working to develop better multidisciplinary team working in primary care. This has included providing additional pharmacy support for the area’s GP practices and extending the scope of the minor ailments work by community pharmacies. 

Margaret Maskrey leads the team of pharmacists and technicians working with GP practices (it works out as an average of three quarters of a pharmacist per practice) as well as care home and social care staff across the Inverclyde Health and Social Care Partnership. 

‘While there were some challenges,’ says Margaret, ‘what was really helpful was that we were not beginning the process of placing pharmacy teams in GP practices from a standing start. Health boards across Scotland already have experience of pharmacy teams working with and within GP practices. 

‘While there was a positive mind set to testing change, it was important to establish a trust and mutual understanding through a collaborative working approach. This was crucial to working closely with GP practices to understand their needs and to target pharmacy team resources to achieve the best outcomes. As you can imagine, this was very much an iterative process balancing skill mix to need as well as establishing meaningful multidisciplinary working with understood roles and responsibilities. Importantly, the one size fits all approach was not the way to go.’ 

Any thoughts that GPs might not recognise the true value of pharmacy were dispelled when practices came up with a long wish-list for how they might use additional pharmacy time. 

‘Yes, you could say that expectations were high,’ says Margaret, ‘but through close partnership working with general practice colleagues we were able to establish the appropriate skill mix needed, the range of tasks appropriate to clinical skills and development of the pharmacists and technicians, strengthening patient facing and prescribing skills, as well as growing capacity as a multidisciplinary team within practices across the HSCP area.’ 

Given that What Matters to You is about patients, the last word should go to them. When NHS Borders undertook a patient satisfaction questionnaire following the introduction of a new patient-centred medicine review service within its community pharmacies, the response was overwhelmingly positive. 

When asked ‘overall, how would you rate your consultation with the pharmacist today?’ 88 per cent rated it ‘excellent’, 12 per cent ‘good, while none chose ‘fair’ or ‘poor’. 

Individual comments included: ‘It is the first time someone has spoken to me about my medicines – this service is needed’; ‘She is a marvel’; ‘A brilliant place and a brilliant service’; ‘Very helpful, explained things clearly, no complaints whatsoever’; and ‘Cannae fault it’.