Shetland is just the right prescription for ambitious pharmacists

Far from limiting career opportunities, working within a small-scale healthcare system like Shetland’s can enhance professional development and job prospects – with the local health board’s director of pharmacy Anthony McDavitt a prime example.

In addition to becoming one of Scotland’s first advanced clinical pharmacists in primary care, since relocating to Shetland from the central belt Tony has led nationwide training programmes and reforms for the profession – and overseen the installation of a dispensing robot in one of the island’s pharmacies.

He credits the opportunities presented by working in a remote and rural area with allowing him to both advance his own career and pioneer improvements to Shetland’s pharmacy service.

“It’s been down to the development opportunities working in a small, remote and rural health board has given me – through the welcoming feeling, welcoming attitudes and approaches of GPs, nurses and most importantly the pharmacy colleagues that I have,” he says.

Having led the development of the primary care service for several years, earlier in 2022 Tony was appointed as director of pharmacy for both NHS Shetland and NHS Orkney.

That exemplifies how, far from holding medical professionals back, in the field of pharmacy working within smaller health boards can offer greater chances to develop your career.

“The skills and knowledge and behaviours you need to be successful in remote and rural are exactly the same skills you need to be successful anywhere in pharmacy,” Tony says.

“Your personal contribution is felt and acknowledged. You’re personally responsible and while that can be intimidating it’s also exciting. It helps you develop a level of professionalism that isn’t available to you in bigger systems.”

The pharmacy workforce has grown significantly in the islands over the past 20 years – part of a wider, gradual revolution in how healthcare is delivered since the turn of the century.

NHS Shetland’s service began with a single pharmacist. Now the team has swelled to nine pharmacists, alongside seven pharmacy technicians, and the health board is continuing to grow and diversify its team to absorb more and more healthcare functions traditionally performed by doctors and nurses.

In the decade since he moved – via Aberdeen, Thurso and Orkney – to Shetland, Tony has witnessed, driven and now oversees major improvements in the pharmacy service: “It’s pretty incredible, the change even during my own career,” he says.

NHS Shetland’s team now includes three pharmacists and a technician based at the island’s only hospital, the Gilbert Bain in Lerwick, along with a full time pharmacist at Lerwick Health Centre and a pharmacist for several days a week at the Brae, Levenwick and Bixter practices.

Many aspects of delivery have been transformed, with pharmacists and technicians now tasked with ensuring the correct medicines and supplies are available and dispensed to patients at hospitals, health centres and beyond.

“Making sure you have the right medicines when you’re a hospital inpatient can absolutely be done by our pharmacy technicians on the ward,” Tony explains. “It means you’re freeing up other professionals including GPs, consultants, junior doctors’ time, whilst providing the right professional for the patient.”

Pharmacists are involved in a range of outpatient specialisms including diabetes and dermatology, which may soon be expanded to include rheumatology.

They are delivering “complex care” and “supporting significant changes in how we prescribe medicines” to ensure the service is “as safe and effective as possible”.

Technicians can also help support people in their own homes – with the intention of supporting people to manage their own medicines where possible, empowering and maximising their independence where possible.

Tony says: “We’ve got an increasingly frail and elderly population, who we want to be able to live independently in their own home, and medications often become more complex as you age.”

A Shetland-wide network of pharmacy professionals regularly brings NHS employees and community pharmacists face-to-face and provides a “really strong voice” for what Tony describes as the “sister professions” of technicians and pharmacists.

“The pharmacists rely on technicians as much as the technicians rely on pharmacists,” he says. “They work together really, really well – it’s one of the best places I’ve seen it work.”

The presence of five pharmacists working at advanced clinical levels in Shetland constitutes more per head of population than any other Scottish health board. The service also achieves excellent performance across “a whole range of national therapeutic indicators”.

“We’re cost-effective, we’re well-integrated with other clinical services and we’ve won awards recognising the innovation and benefits of having pharmacists embedded across health services,” Tony continues.

He describes Shetland more generally as an exciting place with a “very normal way of living” and abundant opportunities for leisure activities.

“People come here and they integrate well, and find lots of people from elsewhere with similar stories working and living in Shetland. It’s really easy to make friends, to join communities, to have interests with other people as part of clubs.”

Tony adds: “Being a pharmacy professional in Shetland is an opportunity for people who want to come and be part of a community – a community inside of work and a community outside of work.”