Consultation skills and social prescribing principles

This is probably the most important part of the consultation if exploring the wider social determinants of health have not featured prominently in previous consultations. It provides an ideal opportunity to think about the patient.

Time with a patient is limited, so any opportunity to prepare before talking to them is vital. How well is the person known? This will affect the way a pharmacist interacts with them. For example, if the person is unknown to the pharmacist, it will take time to gain their confidence and trust.

Many health conditions are associated with personal, social and environmental risk factors, and these always need to be part of decision-making. What has brought the person in at this point in time? This will shape the questions to ask.

If possible, the patient should be asked to prepare questions and practise explaining their concerns before the consultation, and to think about what they hope will happen as a result of the discussion.

For many patients, talking about their non-medical needs is challenging. It is important that pharmacists build rapport and trust in order to provide a safe atmosphere where patients feel they can share their thoughts and feelings.

Setting the agenda

It is here that a pharmacist can set the agenda for the consultation, be upfront with the patient and explain that they want to listen to their story. This will involve wanting to know about current health problems, and exploring their social circumstances and wellbeing.

It is important to give patients time to tell their story. They may want to concentrate on their medical problems but pharmacists should explore what is important to them and what they would like to improve. In medical consultation models, this is partly addressed through the LICEF (Lifestyle, Ideas, Concerns, Expectations, Feelings) acronym. What other strategies can be implemented to ensure this is done effectively?

From a social prescribing perspective, this means changing the conversation from ‘What’s the matter with you?’ to ‘What matters to you?’ The best approach is to allow the patient to identify the focus of the problem and determine its relative importance. However, this approach is time consuming. Therefore, the information on the next screen should form part of any questioning strategy.