Pharmacists across the world have been impacted by the demands of managing the COVID-19 pandemic, including the 2,318 overseas members of the Royal Pharmaceutical Society (RPS). Here, The Pharmaceutical Journal asked RPS members from around the globe, as well as Great Britain, to tell us how the pandemic has changed the way they work to support patients.
Contributors pictured above, clockwise from bottom left:
- Rob Wood, superintendent pharmacist at Cara Pharmacy, based in Dublin;
- Kevin Hayward, consultant pharmacist and director of Medicines Management Services Pty Ltd, based in Queensland, Australia;
- Jodie Gwenter, pharmacy education and training lead at Swansea Bay Health Board and member of the Royal Pharmaceutical Society Welsh Pharmacy Board;
- Ash Soni, community pharmacist, member of the Royal Pharmaceutical Society English Pharmacy Board, and vice president of the International Pharmaceutical Federation, based in London;
- Dilmini Udugampola, deputy general manager of Cargills Food City Pharmacy, based in Sri Lanka;
- Jonathan Burton, community pharmacist and independent prescriber, and chair of the Royal Pharmaceutical Society Scottish Pharmacy Board, based in Stirling, Scotland; and
- Piotr Merks, adjunct professor in the Faculty of Medicine, Cardinal Stefan WyszyÅ„ski University, Warsaw, and assistant professor at the Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Poland
How has your working life c
hanged since the start of the COVID-19 pandemic?
Dilmini Udugampola, deputy general manager of Cargills Food City Pharmacy, a large community pharmacy chain in Sri Lanka: It’s been very challenging, especially in an environment where online pharmacy is at a minor level. But we were well prepared as a company when it came to essential drug procurement; we managed to keep sufficient stock and prevent shortages. I’d like to thank the RPS and the General Pharmaceutical Council for providing guidelines and advice, which has helped me so much to support and educate my team of more than 300 pharmacists.
Kevin Hayward, consultant pharmacist and director of Medicines Management Services Pty Ltd, based in Queensland, Australia: I work with general medical practices providing private in-surgery medicines reviews, federal government-funded home medicines reviews, and care home medication reviews. We have adapted our practice: instead of our usual cosy chat on the veranda, we now talk at a distance of two metres, usually with me outside the screen door and the patient indoors. Patients now leave their medicines and supplements out for me in a clear polythene bag, so I can see them, and return the bag unopened and disinfected.
Jonathan Burton, community pharmacist and independent prescriber, and chair of the Royal Pharmaceutical Society Scottish Pharmacy Board, based in Stirling, Scotland: The main thing has been the introduction of social distancing and the use of personal protective equipment (PPE), which was such a culture change, but patients and pharmacy team members are getting used to it now. Much of my work as a community pharmacist was done face to face with patients in my consultation room, and now a lot of this needs to be done over the phone, or — in some limited circumstances — face to face but with the use of PPE.
In the first eight days of the pandemic in Poland, the number of pharmacist-issued prescriptions rose by 33.1%
Piotr Merks, adjunct professor in the Faculty of Medicine, Cardinal Stefan WyszyÅ„ski University, Warsaw, and assistant professor at the Faculty of Pharmacy, Collegium Medicum in Bydgoszcz: We did a survey that showed that patient rotation through pharmacies had increased by 76.5%. In the first eight days of the pandemic in Poland, the number of pharmacist-issued prescriptions rose by 33.1%: these were emergency supplies, where we provide packs of medicines for patients with chronic illness.
At the beginning, there were no standards to follow, and all the health authorities were late to respond. Finally, I tried to help pharmacists myself, and, with the support of private sponsors, we issued the first guidelines for pharmacists, employees, employers and patients. Guidelines were prepared based on International Pharmaceutical Federation recommendations and RPS guidelines as references.
Ash Soni, community pharmacist, member of Royal Pharmaceutical Society English Pharmacy Board, and vice president of the International Pharmaceutical Federation, based in London: We had to completely rethink working and home practice. I pulled my son out of school the week before schools were shut, as he was using public transport and I felt the risk of him bringing the virus home was too high. This was a particular concern because I was working at the pharmacy every day, which carried a risk of him potentially becoming infected and then infecting me, with a knock-on effect on the pharmacy.
Rob Wood, superintendent pharmacist at Cara Pharmacy, based in Dublin: Remote working has definitely been the biggest change. I think everyone now has experience of a video call in a support or field function at this stage. In our group, my intention is that we continue to operate our pharmacy services as normally as possible. We’ve seen a decline in usual retail buying patterns, and an uplift in over-the-counter (OTC) medicines and prescription items as a result of the restricted movement guidelines. We’re seeing more new patients who are worried about supply of their medicines as some pharmacies have had to close through a confirmed outbreak, or have reduced hours.
The advent of electronic prescribing, although in a more diluted version than we anticipated, has made a massive difference to supporting patients to access medicines. The removal of the requirement to hold a legally valid signed-in-ink prescription by a patient to dispense for them has revolutionised the speed of the care we can provide. Most of us in the pharmacy sector hope we can retain this after the pandemic has passed.
It is almost incomprehensible looking back at the extent and pace of change; having to manage uncertainty and the relentless focus
Jodie Gwenter, pharmacy education and training lead at Swansea Bay Health Board and member of the Royal Pharmaceutical Society Welsh Pharmacy Board: My activities over the past two months have sky-rocketed; protecting our students, re-learning critical care, challenging the regulator, inducting staff at field hospitals, redesigning pathways and providing pastoral care remotely. It is almost incomprehensible looking back at the extent and pace of change; having to manage uncertainty and the relentless focus. It’s been quite a journey and while it is far from complete, today offers an opportunity to reflect, learn and plan for what’s next.
What is the most challenging thing about doing your job during the pandemic?
DU: Delivering insulin and other chilled items, and how to avoid misuse of prescription drugs, were key challenges. Ensuring staff safety created a lot of mental strain for me.
KH: Sitting in the midday Queensland sun in a hazmat suit and mask, trying to read a laptop screen wrapped in polythene, and operate a touch screen with latex gloves, is pretty challenging. But the biggest problem has been that people are focused on the COVID-19 pandemic, and are reluctant to have a home visit or go out. We must remember the ongoing importance of chronic disease management, safe use of medicines and the implications of unnecessary secondary care admissions.
It can be more difficult to show empathy from behind a face mask
JB: Trying to get the same quality of messages and advice across to patients while factoring in social distancing measures. In some ways, I feel I’ve been stripped of some of the usual tools I use when consulting with patients. It can be more difficult to show empathy from behind a face mask, for example. I’m well aware of the issues many pharmacy teams have had with angry and abusive members of the public, and, although these are a minority, I think it needs to be recognised as a major challenge for pharmacies and continue to be taken very seriously. The police have been very supportive in this regard.
RW: The responsibility to get our response to COVID-19 correct for all of our colleagues and patients has weighed heavily on me. Our group has two pharmacies that provide pharmacy services for residential care settings and hospitals. Responding to the challenges of our own pharmacies along with our care partners has been difficult. Supply issues were identified early on as a potential problem, and it was great to see advice from all stakeholders to only dispense one month’s worth of medication at a time.
PPE availability is still an issue and we’re working hard to maintain a supply to our teams.
The mental health of all of our teams, and myself, really has taken a bashing during the pandemic. Not being able to see family and friends, face to face, along with the continual work/home/work routine, has definitely taken its toll on all of us.
The main challenge was extended working hours — we were literally unable to close on time
PM: The main challenge was extended working hours — we were literally unable to close on time. Patients were stocking up on medicines: not only prescriptions, but also OTCs and food supplements.
In my opinion, the 2009/2010 swine flu pandemic should have been a lesson and homework should have been done. Unfortunately it was not, and we had the same story again: there were no gloves, no antiseptic, and no masks. Thanks to a call by the Trade Unions of Pharmacy Workers and Pharmacy Chamber, we pushed the Ministry of Health in Poland to think about pharmacies, we eventually got hand sanitisers, which are now regularly delivered. And the Ministry of Health now has a website through which we receive everything we need.
On day 3 of the pandemic in Poland, I decided to open a coronavirus helpline with 12 pharmacist colleagues. We gave advice to patients, and later we hired a psychologist who helped pharmacists on the front line. One pharmacist told us they had slept in their pharmacy for three nights in a row; another said they had slept in their pharmacy for a week. They were exhausted, and at that point I realised we were doing something more than just a helpline: we were giving hope and real support.
We also started a campaign — https://pharmacyheroes.com — to raise awareness of what the sector was doing by sharing photos from the frontline.
AS: The initial surge and customer demand was something I’ve never experienced in the very long time I’ve been a pharmacist. Then, being told that pharmacies were expected to open on Good Friday and Easter Monday was a challenge, as the staff were exhausted and looking forward to the break. To manage that, we reduced staffing to a minimum and I just accepted that I would work extra hours and days over the weekend to stay on top.
My staff have been magnificent in the way they have responded, and that has been a sign of their extraordinary dedication to their community
Prime minister Boris Johnson announcing that pharmacies would provide a delivery service was a real challenge as it created patient expectation — which we had to meet — without any resource to enable it. I suddenly had to find extra driver capacity, and fund it without any commitment to meet the additional burden this would place on the pharmacy.
My staff have been magnificent in the way they have responded, and that has been a sign of their extraordinary dedication to their community.
JG: The main challenges have undoubtedly involved an appreciation for balance: risk versus benefit, expectation versus compromise, pace versus safety. As a pharmacist these aren’t alien concepts — we make decisions like these many times across the course of our careers — but to manage the high-stakes nature of decisions related to COVID-19 at such high volume and pace has been quite something.
What do you think will be the lasting changes for pharmacy after the pandemic?
DU: I have concerns for the future around the survival of pharmacy as a business. Will people have money to spend; will the supply chain break down, or will companies cut jobs or salaries? These lingering questions give me some sleepless nights. But so far, even as a developing country, we have done well. I hope for a positive ending soon.
KH: I am hoping that telehealth consultations will remain in place, particularly for those patients in the bush, who are sometimes so remote that they would not get a home visit.
JB: In Scotland, we are well supported by the government and our representative bodies. I’m confident that the rollout of services such as Scotland’s minor ailments service, Pharmacy First, and increased numbers of independent pharmacist prescribing clinics, will happen, albeit with slightly different timescales. I can see telemedicine as part of our future, for symptom-based consultations and for medication review-type services. I am already talking to my local NHS health board about using the ‘NHS Near Me’ system, which I can see great potential for in community pharmacy in Scotland. Despite this, I do really hope that in time we can return to some sort of normality in terms of routinely seeing patients face to face.
I hope that healthcare stakeholders around the world sit up and take notice of what would have happened had the pharmacy network not been there for patients
RW: I hope that the pharmacy profession around the globe is remembered for how we rose to the challenge of COVID-19. There has been a Herculean effort by every pharmacist and support colleague I know to deliver consistent, quality pharmaceutical care for all of the patients. I hope that healthcare stakeholders around the world sit up and take notice of what would have happened to populations had the pharmacy network not been there for patients, especially in primary care.
PM: I think this is a good lesson for stakeholders, and the Ministry of Health in Poland, to recognise the profession. I couldn’t believe how resistant the Ministry of Health was to say thank you to frontline pharmacists.
AS: I think we have seen a change in patient behaviour. We still have the occasional patient that is rude or demanding, but generally they have become much more sympathetic and understanding towards pharmacy staff.
I think we will see more patients using their local pharmacy for their care, and I think there will be more utilisation of pharmacies as the first point of care rather than defaulting to wanting to see the doctor.
JG: Social distancing has transformed the way we manage medicines and, arguably, pharmacy has received the digital jump start it always needed. The trick now is to stay the course with virtual consultations, paperless prescribing and remote team-working, and make these the ‘new normal’.