It is estimated that approximately 1.6 million
people visit a community pharmacy in England every day. Like general
practitioners, nurses and the vast array of other health professionals that
make up the NHS; community pharmacists have a very important role to play in
the provision of health services. Most community pharmacies are situated in
easily accessible locations such as high streets, shopping centres and
supermarkets and are open long hours, making them a frequent stop; and for
many, the first port of call when in need of medical advice. Traditionally, the
role of the community pharmacist has been to oversee the safe supply of medication,
alongside numerous other things such as providing patients with support and
advice, treating minor ailments and educating patients about their health. However,
in recent years the role of the community pharmacist has evolved deeply and
many community pharmacists are now qualified to prescribe.


In 2006, legislation that permitted suitably
qualified pharmacists to prescribe independently was passed. These rights were
an addition to the original supplementary prescriber role that many pharmacists
were fulfilling. In order to qualify as an Independent Prescriber, pharmacists
must complete a six-month further education programme that fulfils the
requirements set by the General Pharmaceutical Council (GPhC). This enables
pharmacists to assess patients clinically, ascertain a diagnosis, determine how
the patient will be managed and prescribe the relevant medication when it is
needed. Independent prescriber pharmacists may prescribe at their discretion for
any condition within their area of clinical expertise.


The role of the pharmacist in the field of
healthcare is thought to be diversifying every day, with many prescribing
pharmacists also going on to pursue specialisation in various different areas;
one of which is antimicrobial pharmacy. In recent times and with today’s
rapidly multiplying population, antibiotic resistance is on the rise. It is
estimated that at least 12,000 deaths occur as a result of antibiotic resistant bugs in
the UK alone, each year.

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– would like to talk about what
antimicrobial resistance is

– how it occurs; why there is such an
issue with it

– how we have tried to overcome it

– why have these methods failed

– what prescribing antimicrobial
pharmacists can do to make a difference


Aims and objectives






The research conducted will be undertaken in
three phases and will take place over the span of three months. The first phase
of the project will entail the introduction of an infection walk-in clinic in
local community pharmacies within the Portsmouth and Southsea area. This phase
will also involve the recruitment of a prescribing antimicrobial pharmacist for
each of the participating pharmacies. The clinic will take place twice a week
for four weeks, and will take place during normal business hours. Saturdays and
Thursdays will be the allocated clinic days as this will allow the clinic to be
accessible for all individuals. For example, individuals that work Monday to
Friday can access the clinic on Saturday and vice versa. The clinic will also
provide patients with a very easy-going and relaxed environment in which they
can have their symptoms reviewed by the prescribing pharmacist and consider the
relevant treatment options that the pharmacist recommends. Additionally, the
clinic will be fully equipped with facilities such as a private consultation
room to ensure patient confidentiality and privacy are maintained, should the
patient need to be examined or discuss sensitive matters. Moreover, patients
will also benefit from shorter waiting times and will not require an
appointment to be seen.


The second phase of the project will commence subsequent
to patients having been tended to by the prescribing pharmacist. After having
attended the clinic, patients will then be sent a post service patient
experience questionnaire which will be used to organise an analysis. The
questionnaire will be used to determine if the prescribed treatment was
successful in eradicating the infection and/or symptoms and will enable patients
to provide feedback about the standard of care that they received. The questionnaire
will also enable the researcher to find out if the patients required subsequent
treatment in primary or secondary care, for example; via a GP appointment or
admission/readmission to hospital. The questionnaire will employ the use of
open and closed questions to allow the patients to get their views across in a
clear and efficient manner. Open ended questions permit an unlimited range of
answers and unanticipated outcomes may be discovered through this.

Additionally, closed ended questions are quick and easy to answer, answers are
easier to analyse statistically and the answers obtained from respondents are
easier to compare. The questionnaires will be sent out via a google form, which
patients will receive through email access.


Questionnaires are more suited to this project
as opposed to other methods such as interviews, as patients are able to answer
questions within their own time, at their leisure and in the comfort of their
own homes. Patients are given a greater length of time to consider their
answers, providing the researcher with reliable data to draw conclusions from. Questionnaires
may be more suitable than interviews due to the fact that interviewer bias can
be avoided through this method. The presence of an interviewer may influence or
distort the views and answers that patients may provide due to the body
language, appearance, tone and questioning technique of the interviewer. Questionnaires
tackle this problem by presenting patients with the same questions and
information in the same layout. Moreover, questionnaires are a more economical option
as the cost of this method is lower than that of conducting patient interviews.

Additionally, the use of focus groups will not be employed for this project. This
is because focus groups may distort the findings and conclusions drawn from the
project and may not be representative of the general population. Another one of
the problems encountered with the use of focus groups is that dominant
personalities may provide significantly more input than other personalities in
the group. This would mean the views of other personalities and people would
not be accounted for, distorting the results obtained once again.


The third phase of the project will aim to compare
and contrast prescribing patterns of antibiotics between GP surgeries and
prescribing antimicrobial pharmacists. To carry out this phase of the project,
a report will be compiled during the span of three months. The report will
consist of the names and number of antibiotics prescribed and whom they were
prescribed by. To ensure that the results obtained are fair, data from GP
surgeries will be collected twice a week. This is to match the infection
walk-in clinic days at the community pharmacies. Establishing prescribing
patterns may reveal findings about unnecessary prescribing, the problems
associated with this and what antimicrobial pharmacists can do to tackle these
problems and make a difference in the community. The acquired results will then
be statistically analysed for a final conclusion to be drawn.


Ethical considerations

It is important to take ethical considerations
into account, as without this approach research findings may be invalid and
could also have detrimental effects on the research community. Research
projects concerning patients as participants would need to seek approval by the
NHS Research Ethics Committee (REC), to uphold the ethical standards of
practice in research. For this research project, the identities of the patients
who have chosen to complete the questionnaire will be kept strictly anonymous. Patients
wishing to take part in completing the questionnaire will be asked for their
email addresses, so that they may be sent the questionnaire google form via
this medium. Although patients will be under no obligation to provide any of their
personal details should they not wish to, a medical history will be taken upon
attendance of the walk-in clinic. This is to ensure that patients are provided
with the best possible treatment for their symptoms and to minimise harm that
may occur due to concurrent illnesses or medication that the patients are
already on. Patients will be given information about the project and what the
questionnaire entails, and will be reminded that completion of the
questionnaire is not mandatory. Patients will also be reassured that attendance
to the walk-in clinic and any subsequent interventions will remain between the
prescribing pharmacist and the patient only, to ensure patient confidentiality.

Approval from the NHS Research Ethics Committee would also need to be sought
for the third phase of the project as this involves accessing patient
prescription records.


Anticipated outcomes


There are several potential outcomes of this
research project. One of the primary outcomes anticipated from undertaking this
project is the reduction in unnecessary prescribing, and the subsequent
decrease in antibiotic resistance. The third phase of the study will enable
researchers to identify the differences in prescribing patterns amongst general
practitioners and prescribing pharmacists. General practitioners and other
health professionals such as nurses are often under immense pressure to provide
patients with antibiotic treatment and thus may over-prescribe for infections
that are often self-limiting and cite patient satisfaction as a major reason
for this. The over-prescribing of antimicrobials could have extremely
unfavourable effects on modern medicine and it is anticipated that there is
much that antimicrobial pharmacists can do to tackle this problem.


Unnecessary prescribing also occurs due to
other prescribers having a limited knowledge of antimicrobial agents and their
purposes. Prescribing pharmacists are considered experts in medicines and their
usage and may use their expertise to limit this from happening. Prescribing
antimicrobial pharmacists can do this by limiting the use of broad-spectrum
antibiotics, limiting the wrong selection and unnecessary prescribing of
antibiotics and by educating the general public about the detrimental effects
that antibiotic resistance can have on the world. Additionally, antimicrobial
prescriber pharmacists may go on to become antimicrobial stewards and can
educate the general public about how critical it is to follow dosage


One of the other outcomes anticipated from
undertaking this project is that prescribing antimicrobial pharmacists will be
able to lessen the burden of GP surgeries in the treatment of infections and
other minor ailments. The first and second phases of the project will enable
researchers to identify whether prescribing antimicrobial pharmacists have been
successful in the eradication of infection or if the patients needed subsequent
treatment in a primary or secondary care setting. If the prescribing pharmacist
is successful in doing so, the researcher may decide to broaden this project by
trialling the introduction of antimicrobial prescriber pharmacists in different
cities outside Portsmouth and Southsea.


To conclude, there are several benefits that
come with the introduction of prescribing antimicrobial pharmacists into the local
community. Patients benefit from shorter waiting times, are freed from the
hassle of booking appointments and can access expert medical advice and
treatment easily. Pressure is taken off of GP surgeries and as a result are
able to provide a better standard of care for existing patients. Additionally,
prescribing antimicrobial pharmacists can prevent wastage and misuse of
antibiotics and medication, and as a result tackle antimicrobial resistance
nationally and globally. 

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