Ade Williams is an independent prescriber — but a frustrated one. Since he returned to full-time work at a community pharmacy during the COVID-19 pandemic, he has been unable to use his prescribing skills to their full advantage.
He can prescribe privately and much of his current prescribing work involves travel health. But he is unable to prescribe more widely under NHS regulations in England, although he could do just a few miles away in Wales.
“NHS England has not really started to utilise the pool of independent prescribers who are not in general practice,” he says. “We have to be more intelligent in our use of skills.”
But he points out that even if he cannot prescribe more broadly for NHS patients, clinical expertise is still available for all patients. However, he finds he often has to tell patients to make an appointment with their GP to get a prescription that he could have written himself.
One of the reasons this frustrates him is that he works in a relatively deprived area. “I am acutely aware that I have not been able to help some people as much as I could,” he says. “I live in an area with stark health and socioeconomic inequalities, which are impossible to ignore. We need to keep asking the system to do better for everyone.” His award-winning pharmacy has a healthy living ethos and has run cardiovascular checks in local pubs and supports patient education.
Williams, who qualified as an independent prescriber in 2018, used to work part-time as a clinical pharmacist in a GP surgery while also retaining a role in community pharmacy. He had been attracted by the flexibility the practice role offered him, including the opportunity to work from home some of the time.
“My first prescription was written in general practice. I took a picture of it, took out the patient’s details, and sent it to my independent prescriber tutor to say I had finally got there!” he says.
As the COVID-19 pandemic hit, he decided to relinquish his role in general practice to focus on supporting his colleagues in community pharmacy. He set up a medicines delivery service, using a local running group, which meant fewer people needed to visit the pharmacy, and did media work to highlight the pressure community pharmacies were under. And later in the pandemic, he was involved in the delivery of COVID vaccinations.
Williams was also one of the 12 NHS workers selected to be photographed by British photographer Rankin to show the extent and diversity of NHS work during the pandemic: this led to his image being projected onto a giant billboard at London’s Piccadilly Circus.
But the loss of his ability to prescribe for the NHS still grates. “Our patients are losing out and, if we are not careful, we as a profession will lose out.”
He enjoyed his independent prescribing course and the focus it offered on person-centred care, especially in his chosen specialist area of pain management. “It was a good experience, it was the first time I had gone into structured academia since I was an undergraduate, and that can be daunting,” he says.
He welcomes the news that undergraduate courses will now have independent prescribing embedded in them but warns of the danger of ending up with pharmacists who are trained to prescribe but not able to do so.
Quick fire questions
- How many prescriptions do you write? “20 to 30 a week, mainly malaria prophylaxis.”
- Do you do more prescribing or deprescribing? “Prescribing – although I was involved in Royal Pharmaceutical Society work on deprescribing.”
- Any regrets about qualifying as an independent prescriber? “My only regret is that it is not being used to support NHS care as much as I could.”
- Favourite time of the working day? “I do tend to like early afternoons. I love my patient interactions. You are really aware of the opportunities and the privilege you have … you can really make a difference.”
- How do you destress? “I paint. That’s a great distraction. I’m part of an artist’s collective — it helps me turn off completely.”
- What makes your heart sink? “It is inequality that people accept as their God-given lot. They are unaware of the injustice they are living with. Sometimes they are not angry about where they are because they have accepted it for so long as their rightful allocation.”
- What makes your heart sing? “It’s always the patients — the humour from my patients.”