Q&A: Rahul Morjaria
Pharmacist at Madesil Pharmacie on keeping abreast of medical developments, working with GPs, and the mysterious allure of Norwich
Interview: Ellie Costigan
Portrait: Christopher L Proctor
Tell us about your background: how did you come to be a pharmacist?
I’ve always had a passion for healthcare and I love helping people—the front end, primary care approach to patients. I was born and raised in Kenya, then moved to Norwich to do my master’s degree. A lot of people ask me, why Norwich? I have no idea, but I don’t regret it. Their school of pharmacy was very different to other established schools. We have family in London and the previous owner of this shop is a really good friend of my cousin’s. I needed some experience, so we were introduced and he offered me a Christmas temp job. Marylebone is lovely at Christmas, I absolutely love it. The experience was great, so the following year when I had to start my pre-registration, I always had in the back of my mind I’d like to do it here—and I did. I’ve been at Madesil Pharmacie for 10 years now.
What services do you offer here?
We have general medicines—simple paracetamols, ibuprofens, things like that—then comes the pharmacy lines, which are specific to pharmacies only. We have the general NHS dispenser, as well as a large base of private prescriptions. We also have a consulting room in which we run a travel vaccine clinic, including yellow fever and winter flu jabs. We do blood pressure checks, cholesterol checks. If patients have manual dexterity issues or trouble taking their medicines, we dispense them in a little plastic wallet labelled Monday to Friday, morning, lunch, evening and night. Some pharmacies don’t do it, but I think it’s part of the service we should provide for the community, especially for the elderly.
In the 10 years you’ve worked in pharmaceuticals, have there been any notable developments in the sorts of medicines you’re able to prescribe?
There are heaps of examples I could give you. New prescription medicines come out often, especially because we’re private-orientated. For example, warfarin is a commonly prescribed anti-coagulant used by patients to help thin their blood. The newer generation of anti-coagulants being prescribed over the past five, six years are far better with regards to patient tolerance—it’s now a simple daily or twice-daily dosing and requires less monitoring. That improves patient compliance and the overall effect of the treatment. At the end of the day, that’s what we’re looking for—patient satisfaction, patient safety and effective treatment.
Every year or two there are also medicines that are switched from prescription-only, to pharmacy lines, which means where initially the doctor would have to prescribe it, we can now potentially sell it to you. One recent example is esomeprazole—the common brand name is Nexium—which is for patients who suffer from gastrointestinal ulcers. That esomeprazole can now be bought over the counter saves the patient going into the surgery and potentially saves the NHS money. If the patient is satisfied the product works for them, they can get on with it.
How do you keep on top of medical developments?
That’s really important. It’s part of our yearly training and the re-validation procedure of the council. We encourage all members of staff to engage in continuous learning. Because we deal with private care as well, we sometimes get prescriptions for things that we’ve never dispensed before, which intrigues us—that might involve looking into a treatment that isn’t allowed on the NHS yet because it’s still at clinical trial stage. It gives us an upper hand because when it eventually gets released into the market, we are ahead of the curve.
Because we’re on the high street we also have a lot of footfall, so there’s a lot of counter sales—people coming in to buy regular painkillers, remedies, cold and flu, so we’ve also got to be up to scratch with that, which again is part of the procedure. But again, we like to be a step ahead. We always go out of our way to find out as much information as we can about a new medicine. We have knowledge about a lot of different products and that’s what makes us special.
What is the relationship between pharmacists and GPs?
We’re in a very crucial position and our responsibilities are increasing. If you come into the pharmacy with a list of medicines prescribed by the GP, we can counsel you—reassure you if you have any concerns and discuss any potential side effects. Where our role is really important is, if the combination of medicines prescribed have a potentially unwanted interaction, we will flag that up to the doctor. They may have decided the benefits outweigh the risks, but we will bring it to their attention to make sure they are aware, and let the patient know that we are raising a concern.
Pressures on doctors are far more than we could ever realise at the moment, which is why they’re trying to encourage pharmacists to work in doctor’s surgeries and care homes, as well as improve our prescribing lists. Our role in community pharmacy in particular can significantly improve if the medicines we can prescribe are broadened. We love the NHS—it is the forefront of the country and it’s increasing our life expectancy significantly—but it’s overwhelmed, over-pressured and under-staffed. There have been lots of cuts and we are feeling the ramifications of that.
Is there anything pharmacists offer that the public perhaps isn’t aware of?
NHS England has invested a lot of money in becoming digital. Recently we’ve been given access to something called SCR, summary care records. Pharmacists now have the ability—with consent from the patient—to look at their medical records. If you’ve come down to London from Manchester and you’ve forgotten your daily pills, we can potentially log on to your summary care record and see what you’re taking. If it’s something we can supply to you over the counter we will do that, if it’s prescription only, we will recommend you go to an A&E or a walk-in doctor to get a prescription, or if it’s something general we can help you otherwise.
There’s also the 111 service, which is run by the NHS. You can call 111, and a person there will go through a set of questions with you, before generating a digital prescription. This can be pinged across to us, we download it, and we can give you an emergency supply.
Madesil Pharmacie is embedded in the Marylebone community. How have you achieved that?
The pharmacy has been here, under three different owners, for more than 30 years. I personally know the previous owner, and the owner before him. I actually deliver his medicines to him. I think that continuity makes it feel like a family business, even though it’s not. Patients in the local neighbourhood know us for who we are and I feel we are very approachable. Having those people skills is really important—it’s as important as clinical knowledge. There are loads of regular faces and it’s so pleasant seeing them. I go out of my way to help: they’ve picked us, so we have to provide the best service.
A lot of the time people walk in with a bit of concern and we will make sure they walk out with a smile. The regular walk in trade, the locals, it’s all there. It’s just like any other community pharmacy, but we’re based in central London. Marylebone is like a village within the city, which makes it very different. It’s really special. It makes you want to come to work—it really does.