Andrew Carruthers: ‘Pausing recruitment of GP pharmacists is not the answer’

The chair of the Royal Pharmaceutical Society's Scottish Pharmacy Board speaks about pharmacy's role in preventing drug deaths, tackling health inequalities and providing vaccinations.

Andrew Carruthers first joined the Royal Pharmaceutical Society’s (RPS’s) Scottish Pharmacy Board in 2018, having been co-opted to fill an unoccupied position. Just a few years later, he has now been elected as that board’s chair: the youngest person to have ever held the position in Scotland.

The Pharmaceutical Journal caught up with him to find out his views on a range of important issues for pharmacy in Scotland and beyond.

What’s your background — what do you do when you’re not chairing the Scottish Pharmacy Board?

I am a hospital pharmacist and work in medicines governance, so I get involved in any incidents that happen within my sector and any significant adverse event reviews that we have. I still keep a clinical commitment and care of older people work as well; I do that one day a week. So it’s a nice mix. 

I was co-opted onto the RPS board originally, because we didn’t get enough nominations that year. So the board took a decision to get two ‘early years’ people on instead, because I think they felt that they were all well experienced in the role. I was RPS local coordinator for Glasgow at the time and the board called me up. It was a brilliant thing to be considered for it. So now I feel like I’m validated!

We know that naloxone saves lives if people are able to get their hands on it

The number of drug deaths in Scotland has continued to increase. What role does pharmacy have in addressing this issue?

I think it’s absolutely right that every pharmacy can provide naloxone to patients. And we need to advertise that it’s accessible. We need to make sure that this information isn’t just out to pharmacists and our members: we need to engage with communities so that they know that that’s where they can collect naloxone and get trained, importantly, on how to use it. We know that naloxone saves lives if people are able to get their hands on it.

RPS Scotland recently met with Angela Constance, Scottish minister for drugs policy. What can you tell me about that meeting?

It was a really good opportunity for us to share our views on how to address drug misuse and strengthen our call for access to naloxone in community pharmacies. We raised the current variation in access to naloxone that we have across Scotland and we talked about how we could address that through a national naloxone service, with pharmacies paid accordingly for that service. We also spoke about access to the longer-acting buprenorphine, but most of it was about equity of access to naloxone and really trying to drum up whether we can we get a national service in place for that, which would be fantastic.

It’s been a year since the launch of online pharmacy service ‘Pharmacy First’. Are you happy with what’s happened so far?

Yes. I think it’s changed the perspective about how much pharmacies can do. We now get people coming in asking for antibiotics; we can do urinary tract infections and, very recently, soft skin and soft tissue infections, and people also now come in with chest infections. That’s good because it means that the community pharmacist is the first port of call and if we feel they need any further treatment, or an assessment, then we can refer them to their GP or wherever they need to go.

I don’t think everyone’s aware of exactly what’s available and what goes on. But the more you do it, the more people are going to speak about how great it is. It’s just a better patient journey. And, obviously, we’re reducing the impact on out-of-hours services and GPs.

Would you like to see vaccinations embedded in future community pharmacy?

Yes; in terms of patient accessibility, it’s great. We are ideally placed to be able to store vaccines and we can obviously administer them safely. We know that the key to vaccination is accessibility. We can pump out as much information as we want but if people can’t get vaccines easily because they work Monday to Friday, 09:00 until 17:00, and they can’t get into a GP surgery, having these pharmacies open on their high streets means they can pop in and get them and we increase uptake. It’s definitely the way forward if pharmacies are appropriately funded.

The RPS and the British Medical Association produced a joint statement on the pharmacotherapy service in Scotland. Why?

From our perspective, we think that some of the roles that pharmacists are currently doing in GP practice aren’t making full use of their potential. We went as far to say that it’s undermining their professional role within that sector. And, from GPs’ point of view, what they’re saying is, actually, you’re not reducing the workforce for us at the moment: what the contract had promised hasn’t quite happened yet. 

What we’ve called for is that the issues are addressed urgently, first of all. And that we look at the roles that are there, and the skill mix that’s there too, because it doesn’t always need to be pharmacists. Quite a lot of the roles can be technical, and hopefully pharmacy technicians and support workers can then free up pharmacists to do the more clinical work.

We can see the benefits of the pharmacotherapy service; we know it’s going to be great. It’s just not there yet.

In August 2021, Community Pharmacy Scotland published a statement recommending a pause in the recruitment of pharmacy staff to primary care roles. Do you agree?

We agree with much of what Community Pharmacy Scotland said in the statement, such as the need for meaningful workforce planning, but we don’t believe that a pause in recruitment to GP practice pharmacy posts is the answer. We think that wherever there are medicines, patients should have access to pharmacists, and that includes GP areas. We think that pharmacists should be able to move between sectors, depending on what they want to do, in terms of their aspirations.

Training our technical staff and using them to the best of their abilities will free up pharmacists to do the more clinical roles

The RPS completely recognises that there is workforce pressure across pharmacy. It’s not just in community pharmacy, it’s everywhere. We need to work together across the sectors to address that, but we also need to invest more, and encourage more people to come and do pharmacy. We need to be invested in digital solutions, so we’re calling for single shared patient records; a lot of pharmacist time would be freed up if we had that.

We need a better skill mix — training our technical staff and using them to the best of their abilities. That will free up pharmacists to do the more clinical roles, which are coming quite quickly to us, but we can’t keep saying yes to things because we’re going to get to a point where we can’t do it all; it is going to be impossible.

Is Scotland ready for the new pharmacy foundation training year?

We are a little bit ahead because we’re used to having NHS Education for Scotland (NES). What we need to be really conscious of is, for pharmacists who are qualifying now, we want them to get their foundation training and independent prescriber training done, so that they are not at disadvantage compared to the pharmacists that are going to come out in 2026 as fully qualified prescribers.

We want them all to be prescribers; we don’t want a two-tier profession. We want everyone to be able to work to the same level. So I think that may be a bit of a challenge, but I know that NES are well equipped to handle that. They’ve got this whole plan about how many numbers they would need taught through each year. So it’s all under control, it just needs to happen.

Do you think there’s enough said about socio-economic background when discussing inclusion and diversity and health?

It’s not written in law that that it is one of the protected characteristics, but within NHS Scotland it is included as a kind of protected characteristic for discrimination. There’s an obvious link, we know that, particularly between black, Asian and minority ethnic groups and socio-economic status: that is a huge issue. And I think socio-economic deprivation is an issue in itself.

It’s something that, in Scotland, we’re fairly aware of because we have some of the best and worst life expectancies across society in Europe. In Glasgow, the differences are enormous compared to other areas. And so I think it absolutely has to be a focus, to make sure that people are getting the same healthcare opportunities. We know there is a disparity between where healthcare is available and we know that it’s more available in affluent areas, but the difference is that, with pharmacies, we are the opposite. We are more available in the socio-economically deprived areas. We have a really unique opportunity, I think, to help these communities and get them accessible healthcare. 

One of your colleagues at NHS Greater Glasgow and Clyde recently wrote about marking Pride month. How did that come about?

It started off with a Twitter discussion between Andrew Sommerville and I about what we could do; it was Andrew who was really pushing for that. He shared his story, which was really interesting. It was about the importance of being your authentic self, and he reflected on how, when you change jobs, you’ve got to kind of come out again. It never really ends, and he described his nervousness about that.

The RPS is focusing more on environmental sustainability; what are your thoughts on that?

The RPS is committed to ensuring that it’s a sustainable organisation, and also that pharmacy works towards that. I don’t think pharmacy as a profession is ever going to be net zero in terms of how medicines are made, packaged and distributed across the world; that’s idealistic. But it’s important that we are aware of it.

There is, rightfully, lots of pressure on us as individuals to do things — and I think in turn that puts pressure on organisations to do things: “If I need to recycle my stuff, then why aren’t you doing it?”. We know that organisations and industry are where the vast majority of emissions come from, so we’ve got to hold them accountable for it.

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Citation
The Pharmaceutical Journal, PJ, September 2021, Vol 307, No 7953;307(7953)::DOI:10.1211/PJ.2021.1.100327