Day 22: 50 shades of grey

Unfortunately not has as hot and sexy as it sounds. It's Monday. It's a clinic day. I work as a ACP (Advanced Clinical Practitioner) Pharmacist at Slieve. Just being in General Practice there is a sense of the unknown and unpredictability. Straight forward tasks can rapidly spiral out of hand. Simple presentations can often lead to a pandora's box of complex clinical decision making. We are a teaching practice, for Slieve that means we have a variety of students that join us throughout the year. We have had the privilege to host Physicians Associate students, medical students, trainee GPs and aspiring school students. I've had a few pharmacists come and shadow what I do, to get some experience of working in General Practice. Today I was quickly reminded how it feels to be starting out in General Practice.

In General Practice, symptoms can be vague, history taking can be sketchy at best, vital signs can be on the tittering on 'normal' and blood tests can be borderline of 'normal' too. So what do you do? Could it be a just a cough? Or is it something more sinister? Do you have a good poker face? Or does your face scream "Oh my god, this is not good!"? Sometimes it's a simple medication request and you ask the patient "how are you feeling?" and patients starts to breakdown in front of your very eyes. Often there's no perfect answer, sometimes your priorities are not the same as the patients, or their families. General Practice has policies and guidance but practice is not all black and white. So much uncertainty. So many options. So many shades of grey.

4 pillars of ACP: Clinical - Education- Research - Education - Leadership

One of our Physician Associates is upset, anxious and stressed today. It's OK to have these moments, it's really important that we acknowledge times when things don't go so well and support each other. That fear of not being good enough can be so destructive and consuming of all the good that you hope to achieve as a good competent clinician. You can't help it but you compare yourself to fellow peers whether they're in the same discipline or not. The MSc ACP course is not for the faint hearted and nor would I expect all pharmacists to go through this pathway. It's worth remembering that being ACP isn't just clinical assessment skills. There are 4 core pillars that as ACPs we need to demonstrate in our everyday practice. If you feel as a clinician your practice would be enhanced and you could demonstrate the core skills of ACP, then go for this career pathway. Many Independent Prescribing courses now have a clinically enhanced module(s) to compliment and encourages use of health assessment skills to ensure safe welfare of patients. Development of clinical skills is personal choice. There's being out of your comfort zone because you are a innovator and you have that 2% mindset and there's being out of your comfort zone and that allows fear will consume you and break you down. It's not right to impose judgement and opinions on others. There's really is enough work for everyone who joins General Practice regardless of experience and skill.

Developing as a clinician in General Practice is lifelong. I'm always learning new things and I have a supportive clinical multidisciplinary team around me, near and far. It's important we don't forget this when recruiting new members of primary care clinical workforce over the next 5 years. General Practice is a whole new beast, but can it be tamed with time and experience. We must learn to be patient with ourselves and each other. I strongly believe if we invest our time and effort in people and this leads to self-believe in the potential that we see in them. This culture organically creates a thriving working environment for the better.

Back to CD duties, I've met Jonathan Boyd, Head of Medicines Quality at Sandwell & West Birmingham CCG today. After to and fro-ing with dates to meet up, we eventually did. Genuinely I have a lot of respect for our local CCG team, they provide tools and give us autonomy to deliver quality outcomes. Whilst again the world is not perfect, the ask is doable and tangible. We both share similar ambitions for the pharmacy workforce and share concerns for the unknown. I have made my pledge to support where I can and keep the dialogue open and transparent. This is our first meeting and I hope a positive working relationship develops here. It's always reassuring to find others from your tribe.