The prescribing pharmacist

Queensland prescribing pilot
Image credit: Stephen Nutt

James Buckley MPS, fitness fanatic and partner at LiveLife Pharmacy Port Douglas, is full speed into the expanded Queensland prescribing pilot.

My high school chemistry teacher told me, ‘James, choose something you like, and something you’re good at’. I was good at chemistry at school and loved helping people, so why not do both? Pharmacy to me is about helping people understand their health through teaching them about their medicines. It’s rewarding to now formally prescribe S4 medicines, alongside existing scope of Schedule 2 and 3 medicines and lifestyle advice that will improve their health.

Tell us about prescribing under the Queensland Community Pharmacy Scope of Practice Pilot?

The pilot program gives pharmacists the ability to prescribe appropriate medicines for the patient’s condition as per the therapeutic guidelines, in many cases to suit the individual.

The structured protocols allow pharmacists to identify red flag and referral triggers for the patient and for us to practice safely and effectively.

Consult times allow for discussions between patient and pharmacist with the opportunity for all stages of the prescribing cycle. This includes information gathering, examination, therapeutic discussions, management and patient communication.

How does the service work?

When a patient presents to the pharmacy with symptoms, I take a brief history and offer a consultation.

During the consult, I take a detailed history including back-ground information, medical conditions, medicines and social history. Red flags for the patient’s condition are ruled out as part of the diagnostic framework, and appropriate physical examinations are conducted.

This can include taking vitals such as blood pressure, temperature and blood glucose levels and conducting an ear, nose, throat examination.

All the information is assessed and an appropriate treatment plan is agreed upon by both parties. This can include pharmacological or non-pharmacological treatment, lifestyle advice and preventative treatment, or a referral if warranted.

The patient is then reviewed for an appropriate follow-up date. After seeing patients for holistic care consults, there has been no apprehension to pay for the services.

For patients who are ineligible to participate or are price conscious, this feedback is also transmitted through the software as missed opportunities to provide health care to patients in need.

Introducing patients to the service?

Our pharmacists and staff are on the frontline explaining our services to patients at every opportunity. Our assistants are trained to refer any patient who presents with ear pain (among other conditions) to the pharmacist, resulting in an instant consultation. We also have a great relationship with the local GP clinic and hospital, so they refer patients to our trained pharmacists. Patients are often ecstatic, thrilled and relieved that we offer the service. They trust our knowledge and medicine expertise, and have no problems discussing their health with the prescribing pharmacist. We see people every day who are unable to see the doctor for weeks, and are desperate for our assistance.

What have you prescribed so far?

Within the first week I successfully reviewed patients and prescribed a course of antibiotic ear drops for an international patient who came to Australia to see the Great Barrier Reef and subsequently contracted an outer ear infection while diving. I also saw a concerned mother who presented with her child who had contracted a case of impetigo on the knee from school and could not see a doctor for 3 weeks. I was able to prescribe antibiotic ointment and oral antibiotics to treat the infection.

Advice for other ECPs?

Pharmacy is a constantly expanding and rewarding career. Find what you enjoy most and work hard to make your mark on the profession. I’ve always wanted to be a pharmacy owner, be the cornerstone of a community and provide exceptional services to people in need.

Find like-minded people and mentors who believe in you. I want to thank my mentors from LiveLife Pharmacy and PSA. I would not be here without them.

A day in the life of James Buckley MPS, Pharmacy Partner, LiveLife Pharmacy, Port Douglas, QLD

5.00 am

Get up and moving
Start the day with a HIIT class. Let’s do this!

8.00 am 

First things first
Open the pharmacy, review bookings – online orders, pharmacist consult bookings for COVID-19 and other vaccines. Our ear clinic for diving, flying and swimming infections from reef-based activities is constantly busy. All staff are trained to triage. We conduct multiple ear checks a day (10 is my daily record), especially on weekends when doctors are closed.

9.00 am

Vaccination clinic starts
Administer shingles vaccine to a local couple. Other vaccines are booked online. All flu shots are free for Queensland residents and anyone aged 65+ is NIP-funded.

11.00 am 

Oral contraceptive pill
Miss Y needs to renew her contraceptive pill repeats that were misplaced. She was assessed and I was able to prescribe her regular medication.

2.00 pm 

Prescribing time
Miss P, aged 6, presents to the pharmacy with ear pain. She has been swimming a lot on her holiday and an examination is required. No red flags are present and she can safely be prescribed antibiotic ear drops.

3.00 pm 

Touch base with staff
Catch up with the team, which can be anything from helping with orders, professional development, staff training and upskilling on pharmacist consults or inducting new staff. On-the-floor quiz and teaching sessions with interns can include reviews of work in non-prescription areas, which for us is commonly bites and stings from mozzies and jellyfish and sunscreen uses for sunburn and (constant) heat rash.

5.00 pm

Winding down
Instruct staff to finish, tidy dispensary, scan scripts, and get ready for the next day.

6.00-9.00 pm Home time
Catch up with the ECP Community of Specialty Interest (CSI). Watch Netflix. Bed.

Catch James Buckley at PSA24 on the vaping policy panel on Friday 2 August at 11.50 am, and leading The first defence: consulting on skin conditions session on Saturday 3 August  at 4.00 pm. Register here to attend.