“I have always been looking for something new” - How does someone become a pharmacist prescriber?
Tuesday, 22 March, 2022
There are many career paths for a freshly graduated pharmacist: they can work as a pharmacist, a researcher, an employee of a large pharmaceutical company, or even in the perfume industry. Viktória Vajda, who graduated as a pharmacist in Pécs, has an exciting career path unknown in Hungary: she is working as a prescription pharmacist in Portsmouth, southern England, and has also worked as a pharmacist in the London Olympic Village. We discussed the requirements a pharmacist needs to meet to prescribe medicine, adjust the dosage autonomously, and what the differences are between the Hungarian and English pharmacy systems with the alumni of the UP pharmacy program in our interview below.
Written by Viktor Harta
"I have always been looking for something new"
“Pharmacy training began in 2000 at the University of Pécs Medical School, I enrolled in 2001, we were the second class. The atmosphere was familial, there were only a few of us, and everyone knew each other,” says Viktória Vajda, who founded her university studies in the class of biology and physics at the Mihály Babits high school.
- Mostly, I was interested in the career path of a physician or dentist, which is why I chose the mentioned orientation during my high school studies. When it was time to apply to higher education institutions, a friend of mine who chose the newly launched pharmacy training in Pécs at the time, persuaded me to go with her - and I did. There was no pharmacist in the family, so I did not have a role model from home. I wanted to stay in Pécs, my original aim was to apply for medical training, but in the end, I chose pharmacy. As every pharmacy student in general, I was also seriously shocked by all types of chemistry - organic chemistry, inorganic chemistry, pharmaceutical chemistry - but I got used to it to an extent that I wrote my thesis on pharmaceutical chemistry.
Viktória graduated in 2006 as a pharmacist at the University of Pécs of Medical School. Then she started working at a community pharmacy as a pharmacy manager until 2010. Around this time, she came across an opportunity offered by the Boots UK pharmacy chain: European pharmacists were recruited to work in England.
- My original plan was that if I got accepted to the job, I would spend a few years in England, gain work experience abroad and learn English in a foreign language environment - she said.
- From 2010 to 2018, I worked in community pharmacies, at several big chains, I consciously looked for new opportunities and new experiences. The year 2012 was especially exciting. The London Olympics was held then and the chain where I currently worked, called LloydsPharmacy, operated a remote pharmacy in the Olympic Village, and I got a job there during the Olympics - said the pharmacist whose career took another turn a few years ago.
- I have always been looking for something new, for opportunities. In 2018, a new type of state-funded postgraduate course was launched in England. In the frame of this, pharmacists with the right to prescribe drugs have been trained to effectively support the work of GPs with their expertise and tasks that can be allocated to them in the possession of new knowledge. GPs received support for hiring pharmacists, but only those who completed the required two years of training. I submitted my application, I liked that I was able to use my previously acquired clinical knowledge again. I completed the training successfully, so I am currently working in a Portsmouth office as a pharmacist with prescription rights.
As it turned out from the interview, the operation of the English and Hungarian health care systems is markedly different. In England, drugs taken by patients on a regular, long-term basis (such as antihypertensive, and thyroid drugs) can be simply prescribed for half a year or a year without seeing a doctor, the physician receives the prescription, and only needs to sign it. Previously, when someone was discharged from the hospital, their medical findings were processed by a GP. GPs also dealt with medication, and this task was sometimes outsourced to a staff member working outside the clinic.
At the same time, the physician's time is finite, their primary task is to diagnose the diseases and determine the treatment, and patients often have only a 10-minute appointment, which must be used effectively. The pharmacist prescriber makes this tense process more dynamic: their expertise allows them, within certain limits, to prescribe the necessary drugs (after receiving the recommended active substance and its amount) and even to adjust these doses. Physicians tend to treat acute cases, while pharmacists are tasked with long-term patient follow-up in terms of drugs.
- The training required specialization, focusing on an area of medical care, mine was blood pressure treatment. During my studies, I had to prepare drug plans that met professional criteria, examine patients, and write case studies. During the two-year training, everyone who wanted to work as a pharmacist in a GP's office received the same training, as everyone had a different professional background (pharmacy, research). A six-month extra training was built on this, and with its successful completion, we obtained the right to become pharmacist prescribers - said the pharmacist who graduated in Pécs.
And what does all this mean in practice? While in Hungary drugs have so-called brand names (for example, we come across product names in any painkiller advertisement), in England prescription is based on the active substance. I.e., they only tell the patient what kind of active ingredient to take and the dose, they do not give the name of an exact product, it is the task of the pharmacist.
If something is out of stock, an alternative must be sought, or if a hospital asks for a prescription that is not possible under current regulations, they must also suggest another solution. In the case of long-term medication, the doses should be reviewed every six months or annually, and if necessary, a laboratory test should be performed. Depending on the new results, either the current practice should not be changed, or a new dose or another drug should be recommended - this is also the responsibility of the pharmacist prescriber.
The new system, in which Viktória Vajda also works, was developed in response to emerging needs with the support of the English government. It has also been expanded since then: 2-3 GP’s offices are cooperating with each other to ensure more efficient patient care.
- Every GP's office has its characteristics. We seek to highlight good practices and implement them in as many places as possible. As a pharmacist, I sit in the office, but not in the same room as the physician. Pharmacists, in some respects, have a deeper knowledge of the administration of medication than physicians, and we also know the types of blood tests and blood works required by certain drugs - says Viktória adding that a system like the one in England would also have a raison d'être in Hungary.
- When I come home and look at my parents’ medication, several questions arise, for example, when they last had blood tests, when their cholesterol or kidney function were checked. There are drugs that should be reduced, for example, if the kidney function decreases. The point of the English system is that it is easier to prescribe permanent drugs, it does not require a physician’s authority, but after a while, the dose is reviewed to see whether it is still optimal. The prescription cannot be renewed without it. If someone is diabetic, they should be examined annually, if they are taking blood thinners, a blood test is required. We prepare the necessary tests for them and recommend booking a drug review appointment in light of the recent results. Here the physician reviews the results. If everything is in place, the previous practice will continue unchanged. However, if a result may suggest a change, the physician will tell us, pharmacist prescribers, who will then discuss it with the patient.
- Let's take a specific example: if someone has good blood test results but their blood pressure is higher than it should be, I can check what the reason may be. If the patient is taking drugs for high blood pressure, I can change the dose, if not, I can prescribe it. We will then renew the prescription request, which the patient can automatically request again for a certain period. I am also competent in the possible side effects of drugs for certain diseases, if any, I can suggest an alternative without the involvement of a physician.
Relearning after relearning
Viktória Vajda has spent years in community pharmacies in both Hungary and England, and, according to her, there are great differences between the two systems.
- As a recent graduate of the Faculty of Pharmacy in Pécs, I had a great deal of diverse lexical knowledge, I knew which active substance was prescribed for what. However, as soon as I started working in a community pharmacy, I came across product names instead of active substances, as this is how drugs are sold in Hungary. I had to learn these names. In England, then, I had to relearn everything, in other words, I had to readjust my brain, because as I mentioned, the active substance is prescribed there, and the pharmacist has to associate the right drug with it. However, the English system has a great advantage. When a prescription check is performed, the box of drug the patient is taking also contains the active substance, not a product name, making the process simpler.
According to Viktória, the peculiarity of the English system is that people with minor problems visit the pharmacist there. In addition, community pharmacies are given a lot of work to do, such as administering flu and other vaccines, for example, coronavirus vaccines. As a pharmacist, this requires training, and, if successfully completed, the specialist will have the right to administer intramuscular injections.
- You can constantly learn - says Viktória. - I have just completed an Advanced Clinical Assessment Course. I saw the need for this so that, for example, if someone reports labored breathing when reviewing their medication or measuring blood pressure, I have the right competence to examine the complaints in my own area. I can see what may cause them, for example, if it can be traced back to heart failure, or whether there is another source.
One degree, many career opportunities
You simply cannot get bored with a degree in pharmacy, there are a lot of opportunities for people, either in Hungary or abroad - says Viktória Vajda. As she said, the knowledge gained at the Faculty of Pharmacy in Pécs provided a solid foundation for the later stages of her career.
- This qualification has a lot of opportunities, a lot can be built on it, and many career paths open up. It is a marketable degree; pharmacists are needed everywhere. I recommend everyone who is interested in this career path to do it. There are also a lot of foreigners working in healthcare in England, so you do not have to worry about not having a job even outside Hungary.