Introduction and How to Use This Book

Community pharmacies are becoming increasingly important in the United Kingdom (UK) National Health Service (NHS) in providing assessment and advice about minor ailments and symptoms. Pharmacy teams are used to encouraging self‐care and have become ever more widely used as a first port of call for minor illness, as well as for referrals by other health professionals. Pharmacists are responsible for ensuring that their staff provide appropriate advice and recommendations.

UK government policy has enabled pharmacists to have a greater role in the direct supply and supervision of medicines and some of this is achieved through license reclassification. There are three main categories for medicines which hold a licence authorised by the Medicines and Healthcare products Regulatory Agency (MHRA). Those that can be prescribed by a doctor, or by non‐medical prescribers, are ‘prescription only medicines’ (POMs). After some years of use, if there is enough evidence to support their safe use without a prescriber’s supervision a medicine may be reclassified by the MHRA to make it available for sale from pharmacies under the supervision of a pharmacist. These ‘pharmacy medicines’ (P) are not usually ‘on display’ on open pharmacy shelves. P medicines which have been safely used for several years may be further reclassified to ‘general sales list’ (GSL) medicines where they can be bought from pharmacies and other retail outlets, such as supermarkets and convenience stores and can be selected by patients from open shelves. Where the distinction between POM, P and GSL is particularly important this is indicated in this book.

Since the last edition of this book there have been several important changes in health policy, and events, which have strengthened the part played by community pharmacies in the assessment and management of common conditions. One change is that the coronavirus disease (COVID‐19) pandemic has accelerated the adoption of remote consultations with pharmacists by telephone and video, which has enhanced the role of and increased access to community pharmacies. There has also been greater digital integration of community pharmacy with the wider NHS which has enabled electronic referrals from general practitioners (GPs) in primary care and from NHS telephone triage services.

In this book, we recognise that members of the public present to pharmacists and their staff in a number of different ways and pharmacists require a mix of knowledge and skills in diseases and their treatment, as well as excellent consultation skills.

This introduction to the book has six sections:

1. Working in partnership with patients
2. Working in partnership with other health professionals
3. The consultation and developing consultation skills
4. Effectiveness of treatments and how we have used reference sources in this book
5. Layout of the chapters in this book.
6. The future

These set out the current context for community pharmacists’ response to symptoms, a concise guide to pharmacy consultation skills, a summary of how we compiled evidence about treatment effectiveness and some comments on likely future developments. Throughout, we suggest how the reader might use this book and we then explain the layout of the chapters that follow.

WORKING IN PARTNERSHIP WITH PATIENTS

We refer to people seeking advice about symptoms as patients, although recognising that many will in fact be healthy people. We do this because we feel that the terms ‘customer’ and ‘client’ do not capture the nature of pharmacy consultations about health. In the past, pharmacists were seen as experts and patients as beneficiaries of pharmacists’ information and advice. However, patients are not blank sheets or empty vessels; they have choices to make and are experts by experience in their own and their children’s health. The following diagram illustrates some of the thoughts a patient may be having about their symptoms.

The pharmacist needs to take these factors into account during the consultation and enable patient participation by actively eliciting the patient’s views and preferences. Many, but not all, patients will want to engage in decision‐making about how to manage their symptoms. Some will want the pharmacist to decide on their behalf. The pharmacist needs to find out what the patient knows and wants. Finding out the information source(s) used by the patient is important, and if the reliability of the information is poor, this may need to be pointed out.

Healthcare professionals can only truly learn how to work in partnership by listening to what patients have to say. The list provided in the following section comes from a study of laypeople’s ‘tips’ on how consultations could be more successful. Although the study was concerned with medical consultations, many of the tips are equally relevant to pharmacists’ response to patients’ symptoms.

How to make a consultation more successful from the patient’s perspective: tips from laypeople

• Introduce yourself with unknown patients.
• Keep eye contact.
• Take your time; do not show your hurry.
• Avoid prejudice – keep an open mind.
• Treat patients as human beings and not as a bundle of symptoms.
• Pay attention to psychosocial issues.
• Take the patient seriously.
• Listen – do not interrupt the patient.
• Show compassion; be empathic.
• Be honest without being rude.
• Avoid jargon; check if the patient understands.
• Avoid interruptions.
• Offer sources of trusted further information (leaflets, weblinks, etc.).

Source: Reproduced from Bensing et al. (2011).

Reading and listening to patients’ accounts of their experience can provide valuable insights. Websites and blogs can give a window into common problems and questions, can help to see the patient perspective, and can also show how powerful social media can be in sharing experience and information; examples are Patient Community Forums at https://patient.info/forums and netmums at www.netmums.com. These lay networks can be very valuable, and pharmacists can contribute with their own expertise.

Some information from online sources or social media can be inaccurate or of poor quality, and some can create unrealistic beliefs and expectations. Others may be overtly or covertly promotional. Sometimes, information relates to medicines in different countries. A different issue is deliberate misinformation about health and treatments, and this has come to the fore during the COVID‐19 pandemic. If you are concerned about the quality or relevance of health information that has been accessed by a patient, you can tactfully point them towards accredited sources of information, such as that provided on the NHS Health and NHS Medicines joint website (www.nhs.uk).

Pharmacists observe from their own experience that some patients are content to discuss even potentially sensitive subjects at the pharmacy counter. Sometimes, this ‘public disclosure’ may seem inappropriate and potentially embarrassing for other customers. While this is true for some people, others are put off asking for advice if they perceive insufficient privacy. The vast majority of UK community pharmacies have a consultation room or area. Research shows that most pharmacy customers feel that the level of privacy available for a pharmacy consultation is now acceptable. There is some evidence of a gap between patients’ and pharmacists’ perceptions of privacy.

Pharmacists should always bear privacy in mind and seek to create an atmosphere of confidentiality if sensitive problems are to be discussed, even if the patient does not seem concerned. Using professional judgement and personal experience, the pharmacist can look for signs of hesitancy or embarrassment on the patient’s part, or identify inappropriate openness, and can suggest moving to a quieter part of the pharmacy or to the consultation area to continue the conversation. Proactively inviting a patient to the consultation area in response to a request about a sensitive topic, such as contraception, is appreciated by many.

Patients often assume that their community pharmacist and GP are both aware of the advice and treatments that each has prescribed or supplied and research shows that patients are keen for the health professionals providing their care to work together.

WORKING IN PARTNERSHIP WITH OTHER HEALTH PROFESSIONAL...