Pharmacist prescribing – past present and future

Kirsty Chambers 2Ravi-Sharma1-300x225By Kirsty Chambers (Clinical & Operational Lead Pharmacist GP Connect) & Ravi Sharma (Head of General Practice Pharmacy at Green Light and Senior Clinical Practice Pharmacist at Honeypot Medical Centre)

Over the last two decades non-medical prescribing has undergone something of a revolution. 1986 was the breakthrough year when district and community nurses were granted limited prescribing rights; through the 1990’s the Nurse Prescribing Formulary was developed and when the new millennium dawned pharmacists started to get involved. Presently, the list of allied healthcare professionals (AHPs) that have some level of prescribing privileges is almost unrecognisable from when the concept of non-medical prescribing was born.

As the new Prescribing Competency Framework is published, more and more people are undertaking their prescribing qualifications in response to the huge increase in demand for prescribers. As NHS burdens intensify on a daily basis we must utilise each profession’s skill to their maximum level. Whilst trying to fulfil the almost impossible task of providing more by spending less, there needs to be an acceptance and push for more integrated working and an awareness of how to extract the most out of the available skill mix.

New ways of working and developing models of care via the standardisation of prescribing amongst healthcare professionals should lead to an increase in quality, safety, efficiency and ultimately better patient outcomes. The Prescribing Competency Framework incorporates ‘shared decision making’ and ‘prescribing as part of a team’ as key components. This is about building a relationship with both the patient and other colleagues that are involved in their prescribing journey. Continuity of care and mutual understanding of each other’s purpose can only enhance the services and quality of care we are offering.

In our workplaces there are multiple prescribers – nurses, GPs and pharmacists. We have established an excellent relationship that allows each of us to contribute effectively to the patients without duplication or omission. A number of examples where as a collaborative team of prescribers we have been able to provide better support and management to those with complex long term conditions as well as some of our most vulnerable patients (elderly, housebound, mental health). This framework will allow us to develop our understanding further and learn to work in partnership even more effectively. It can also be straightforwardly used to support yearly appraisals and eventually revalidation.

The NHS values of person-centred care and ‘no decision about me without me’ are prominent throughout the framework. It ensures prescribers work safely and effectively while allowing development of scope and the ability to work at maximum skill level by having competencies underpinning your professional responsibility as a prescriber.

Medicines have the potential to significantly improve the quality of lives and patient outcomes if prescribed appropriately. We have been given a chance to get this right with the framework as a fundamental tool to encourage higher standards for prescribing and united working between professions. The future of prescribing looks bright.

 

The coming revolution in personalised medicines

Mike Hannay - Small

Mike Hannay MRPharmS

The decoding of the human genome has paved the way towards a silent revolution currently ongoing within the pharmaceutical industry; its name is personalised medicines and the effect this is set to have on the wider healthcare system within the next ten years is profound.

As a direct result of the human genome project the understanding of the genetic basis of disease has grown to a level which was unforeseen even 5-10 years ago. The implications for this on patient care are staggering, soon medicines will no longer be selected for patients according to empirical guidelines, but will be matched as a result of their individual genetic makeup. We will be able to select the best drug for that patient from within its class based on the accelerating body of evidence currently being acquired. Further tests carried out on specific metabolic processes coupled with precise in situ-drug formulation technologies such as 3D printing will allow for highly accurate dosing resulting in more optimal plasma levels, with a reduction in adverse drug reactions.

This may sound like science fiction, but the technology is already here, the first 3D printed medicine has recently been approved by the FDA, furthermore genomic sequencing costs have reduced steadily from $10 million in 2006 to around $1000 in 2016 and continue to decline, meaning it will soon be economically feasible for widespread application. The impact that these changes will have on the development, selection, optimisation and supply of medicines is difficult to understate.

Community pharmacies are in the best position to put personalised medicine into practice by facilitating the selection, optimisation and supply of personalised medicines; no other group of scientists or clinicians is better able to accomplish this, however this can only happen if the profession acts now to take on the knowledge and expertise needed to fit into this emerging care pathway.

What is required is for pharmacy educators to integrate the teaching of personalised medicines into their course material. The science behind medicines is at the heart of pharmacy education, and this is the reason the profession is respected as the authoritative source of information when it comes to the science of medicines. If this is to remain the case then pharmacy educators must keep abreast of these new changes and ensure that both new and current members of the profession are thoroughly informed on what they need to know, and how they can apply it.

I’ll be speaking at the RPS conference this year to outline these changes, the impact they’re set to have on the profession as a whole, and how best we can plan to be ready for them as they are unveiled in the coming years.

The RPS conference will be held in Birmingham, Sunday 4 September – Monday 5 September 2016. Find out more about key issues affecting pharmacy and how we can solve them.

To secure your place at the RPS 2016 Annual Conference visit: www.rpharms.com/RPSconf16

Supporting The Changing Role of Pharmacists within Primary Care

By Paul Gimson MRPharmS

Improving medicines safety and ensuring quality improvement are vital components required for the maintenance and growth of any modern healthcare system. There are a multitude of healthcare professionals which make valuable contributions to this field, but as pharmacists increasingly find themselves working in new sectors, including primary care, the opportunity for the profession to increase its impact on quality improvement is expanding. 1000 lives Wales started as a two year healthcare improvement initiative, seeking to save 1000 lives and prevent 50,000 episodes of harm within NHS Wales. The campaign initially ran from 2008 until 2010, however after reaching its initial goals the methodology used by the campaign was expanded into new areas, forming 1000 lives improvement which continues to this day.

In 2015-16 we worked with over 40 partners to deliver 182 events, and through our ‘improving quality together’ programmes we’ve provided training to over 8,000 people. Together with NHS Wales working with the aim to reduce harm and improve patient safety we’ve been involved in quality improvement programmes, designing services related to maternity care to mental health.

I work with 1000 lives Wales as the lead for primary care, seeking to integrate our philosophy of quality improvement within this sector. The emerging roles for pharmacists within the primary care sector in GP practices and care homes, which we’ve seen becoming increasingly widespread across Wales as part of the new primary care plan for Wales, form an integral part of this strategy.

I’ll be speaking at the RPS conference this year to highlight the importance of quality improvement.. I will discuss the new primary care model that is emerging in Wales, and the changing and growing role that pharmacists are playing in it.

The RPS conference will be held in Birmingham, Sunday 4 September – Monday 5 September 2016. Find out more about key issues affecting pharmacy and how we can solve them.

To secure your place at the RPS 2016 Annual Conference visit: www.rpharms.com/RPSconf16

Identifying Education, Training and Development as part of your Faculty portfolio

Professor Bryony Dean Franklin FFRPS MRPharmS

When it comes to the Faculty, the general advice I’d heard was toBryony dean portrait April 2013 start with the cluster you’re most comfortable with, that’s why I’d left Education, Training and Development until nearer the end. However when it came to starting this cluster I was more certain of the process, therefore I found it much easier than I had first anticipated. I started by downloading the Faculty Core Professional Practice Curriculum for Education, Training and Development from the RPS website. This includes six individual competencies:

  • Role model
  • Mentorship
  • Conducting education and training
  • Professional development
  • Links practice and education
  • Educational policy.

I then read the general descriptions for each of these competencies, together with the specific descriptions for each of the three levels (advanced stage I, advanced stage II, Mastery) I did some brainstorming to come up with examples of my practice that worked with each competency including what evidence I could provide for each.  I scribbled these thoughts on the curriculum document as I worked through it.

As with all of the clusters, I found some of the competencies harder to address than others and for some of them I initially couldn’t think of anything at all. To avoid getting ‘stuck’ I initially tackled those I felt were easier, and came back to some of the others later. I found that for those I was struggling with, if I left it for a week or so I often came up with examples of what I do on a daily basis that fitted the competency – sometimes things that were so obvious that they hadn’t occurred to me initially.  For example, I initially drew a blank for ‘role model’ and ‘mentorship’, but then it occurred to me that a key part of supervising PhD students is to act as a role model and mentor to the student as well as supervising the research.  I think we sometimes take for granted what we do every day.  I was then able to come back and fill in the gaps. There are also some useful tables at that back of the curriculum guide that suggest the knowledge, skills, experience and behaviours for each competency at each of the three levels.

Once I had identified some key pieces of evidence that would address one or more of the competencies, I entered these into the online system.  Since each piece of evidence can have multiple mappings, I tried to pick evidence that would address several competencies to save having to enter too many.  I tried to ensure that the ‘description’ field would be clear to another reader without knowing anything about my particular role, and that I was fairly explicit about how it addressed the competencies concerned. I then mapped the entries to the relevant competencies.  This meant that clusters I did later would already have some evidence mapped onto them, and there were fewer new entries that I needed to make.

I completed the whole Faculty process on my own as there weren’t many other pharmacists I knew doing it at that time – I was in the first wave of Faculty members. However, I’d recommend brainstorming the competencies and suitable sources of evidence with a colleague if possible as I am sure this would be more effective and more motivating.

I found the whole process very useful in identifying any gaps in professional expertise to allow a more focused approach to professional development.  Getting started and entering the first piece of evidence is the hardest – once you have done one, the rest are much easier!

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Congratulations to Nadia Bukhari on her achievements as the youngest Female Asian Fellow

Nadia SmallNadia Bukhari has been interviewed by National and International media, as she makes history being the youngest Asian and youngest female to be awarded the status of Fellow of the Royal Pharmaceutical Society. Being a Fellow is the highest recognition that is awarded to RPS members and is an honour which recognises excellence in an individual’s pharmacy career. Read more Congratulations to Nadia Bukhari on her achievements as the youngest Female Asian Fellow

What else can you do with your pharmacy degree?

Whilst at UniversityDaniel Sutcliffe - 150, I, like many, viewed my career options upon graduation as falling broadly into one of two camps: Hospital or Community. I was vaguely aware of other career paths for pharmacists in different sectors but with industrial pre-registration placements so scarce and with no idea about the other roles for pharmacists I decided to apply for hospital pharmacy. I had no idea that a year later I’d be a qualified pharmacist working primarily in the field of marketing, an area I hadn’t even considered at the time.

Read more What else can you do with your pharmacy degree?

Identifying Management to help build your Faculty portfolio

by Nahim Khan MFRPSI MRPharmS

Management is not just about managing people, it includes your day to day work, meeting objectives in your appraisals or managing processes and projects. To some degree, everyone has some experience in these areas.

The organisation that you work for will have its’ own standard of practice. For example, key performance indicators, such as the target time that medicines reconciliation must be completed. I found that understanding the development descriptors was key to mapping competencies correctly.

If you’re going through the Faculty process with colleagues, I recommend you discussing your entries with them to gather their feedback. If there is no one in your workplace undergoing the Faculty process, then get feedback in other ways! Talk to the Faculty Team at the Royal Pharmaceutical Society and find out if there are any workshop events or Faculty Champions in your area. There are also articles in the Pharmaceutical Journal articles and a portfolio building support discussion group and webinars on the Royal Pharmaceutical Society website.

I lead on an audit which was based on Alert 18 from National Patient Safety Agency: Actions That Can Make Anticoagulant Therapy Safer. One of the actions stated that there should be an annual audit on anticoagulant use, therefore this was implementing a national priority. Recognising standards of practice for the safe use of anticoagulants was necessary to benchmark the compliance of prescribing, monitoring, counselling as well as for documentation. ‘Managing performance’ was met here, as I completed an audit as part of my personal development plan, gathering the knowledge needed to understand anticoagulants.

I delivered the results of the audit to the doctors within my organisation in order to meet the ‘managing risk’ competency. I also used this as an opportunity to present the principles as supporting good anticoagulant prescribing. There were key deadlines of the phases to the audit;  data collection, analysis, report writing and presentation of the results, they also met  the ‘project management’ competency. My report included recommendations to improve data collection rates for future audits. The recommendations required liaising with other members of the team to prepare for the change, thus meeting the ‘strategic planning’ competency.

Take a look at all of your pieces of evidence and decide whether they can be mapped to any of the other management competencies. My audit, which by its’ nature would be mapped to competencies in Cluster 6: Research and Evaluation. While it’s important to describe the piece of evidence and how you meet the competency, you also need to reflect on your experience. The portfolio is yours – so always remember talk about you and what you did!

I feel that reflecting on the achievements in my career to demonstrate how I met the competencies made me feel more confident when dealing with large projects. Receiving the personal development plan and reading through objective feedback from the assessors on my achievements was also a great feeling. The assessors also gave feedback on how to progress to meet the management cluster competencies for Advance Stage II.

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Find out more about the Faculty programme.

 

Integration across Primary Care – Pharmacists in Care homes and GP Practices

With Graham Stretch MRPharmS

Pharmacists are pioneering new models of integrated working across the primary care sector, including work in GP Practices and nursing homes. Increasingly the success of these models is being recognised; it was for this reason that Graham Stretch and team were awarded the 2015 British Medical Journal Primary Care Team of the Year.

Graham Stretch

Graham is responsible for a service providing pharmaceutical care to 19 nursing homes, with a total of 900 beds, as commissioned by Ealing CCG over the past three years. Graham’s approach is to integrate care across GP practices, community pharmacies and nursing homes, removing the barriers to effective pharmaceutical care. Unlike some clinical pharmacy models, the pharmacists involved do 95% of all prescribing, and after earning the trust of their GP colleagues they manage the clinical reviews and undertake the bulk of prescribing within nursing homes using a technician led service.

The results of this method speak for themselves: with 11% fewer prescribed items, 20% fewer hospital admissions, a 63% reduction in anti-psychotic prescribing in Dementia, and a 45% reduction in end of life admissions. Graham argues that when pharmacists are involved in prescribing and medicines management then fewer errors occur, resulting in better outcomes for all patients. He describes this model as nothing radical, stating that any pharmacist has the ability to have a positive impact on medicines management if given the opportunity.

After having the contract extended a for further 2 years by Ealing CCG, Graham is now hoping to translate this model into other areas, publishing research and aspiring to replicate this success elsewhere. Describing the process as personally and professionally rewarding he argues that more pharmacists should have the opportunity to embark upon this journey.

Graham will be speaking at RPS Annual Conference about his project, describing how pharmacists can successfully integrate themselves into primary care, and the benefits this can bring for both patients and the pharmacy profession.

The RPS conference will be in Birmingham, Sunday 4 September – Monday 5 September 2016. Book your place to find out more about key issues affecting pharmacy and how we can solve them.

 

Stop the over medication of people with learning disabilities

david-banford(1)By David Branford, Chief Pharmacist, Derby Hospital


The nation was shocked by the Panorama expose of cruel behaviour to people with a learning disability living at Winterbourne View in Bristol. The subsequent enquiry not only raised many concerns about the care of people with a learning disability but also about the use of antipsychotics and antidepressants.

Subsequent investigations and actions took two paths. The first, a series of studies demonstrated widespread use of many categories of psychotropic drugs often in combinations. In addition there was widespread use of PRN psychotropic drugs. The second was NICE guidelines relating to aspects of treatment of people with a learning disability.
Stopping Over-medication of People with Learning Disabilities (STOMPLD) 2016 is a campaign launched by Alistair Burt today. It aims to improve the quality of life of people with a learning disability, by reducing the harm of inappropriate psychotropic drugs which are used as a “chemical restraint” in place of other more appropriate care and treatments. Read more Stop the over medication of people with learning disabilities