It’s not business, it’s personal!

by Nicola Gray, RPS Regional Liaison Pharmacist

I have no doubt that the success of forthcoming integration across systems and sectors is going to be determined by the strength of personal relationships between stakeholders. Human beings crave connection with others above all else and the strength and authenticity of these connections will influence partnership working.

Making connections

These connections cannot be formed ‘on demand’. Sometimes people meet and immediately recognise a ‘soul mate’, personal or professional, but this is rare. And even then, we have to hope that the first flush of exhilaration for a strong new connection settles into something enduring and mutually enriching.

Developing relationships

I was recently a guest of Greater Manchester LPC at the NPA Conference in Manchester, and a thread about relationships became apparent across a number of presentations. Ed Waller from NHSE highlighted the importance of developing relationships and collaborative networks to enable community pharmacy to play its optimum role in PCNs. Simon Dukes from PSNC reflected on why partnerships fail, including lack of trust, stalemate, and the perceived power of one party over the other.

Later, Rose Marie Parr, Chief Pharmacist in the Scottish Government, countered that good relationships are built upon a shared vision, effective leadership and trust. Russell Goodway from Community Pharmacy Wales spoke of delivering a shared ambition through a willing partnership, and our own Paul Bennett spoke of unprecedented co-operation among representative bodies through aligning on the major issues facing pharmacists

Focus on what’s real

I think it is time to reflect on the strongest connections and most enduring, authentic relationships that each pharmacist has made – without exploiting them but focusing on mutual benefit. An obvious source of many enduring connections for pharmacy is with patients. How can pharmacists really tune into those connections to find out what is most relevant and valuable to their local population? Is that not the foundation on which our ‘offer’ to the local health system must be based? How, can we then share this common vision and facilitate strategic change at local level?   NHSE is sending a strong message through PSNC that a ‘tsunami’ of separate pharmacy approaches to PCNs will not be welcomed. What is needed is a coordinated effort from contractors within each locality.

Make use of support

We should also reflect on wider support from the pharmacy system that we can draw upon. From connections with colleagues in local hospitals, and our ‘academic hubs’ in our Schools of Pharmacy. Reminding us who we are, where we have been, and where we are going – not least with what we have to offer to the health system of our understanding of new medicines and new science. For those who already have strong and enduring relationships with multidisciplinary partners in primary care and beyond, try to anticipate the turbulence that they must also be experiencing and consider how you can help them to achieve shared objectives for your community.

So let’s take stock now of our best and most enduring connections, and pool our knowledge to make maximum impact when the time is right.

Our new resource on system leadership helps point the way. It includes case studies from pharmacists working in different levels of the system and links to tools, standards and guides to develop the leadership qualities required to work collaboratively across boundaries within your local health and care systems.

Diabetes: the team approach

By Philip Newland-Jones and Anna Hodgkinson, Consultant Pharmacists in Diabetes

People with diabetes need the support of a full multidisciplinary team more than ever, and utilising pharmacists trained in diabetes care are an essential part of this vision.

Statistics from Diabetes UK show that one person is diagnosed with Type 2 diabetes every three minutes in England and Wales, and 500 people with diabetes die prematurely every week.  It is estimated that the NHS currently spends 10% or £10 billion of its annual budget on diabetes and its complications.

We know that over 65 year olds with Type 2 diabetes have on average six to seven other health concerns, often needing multiple medicines. Both the Long Term Plan and the NHS Interim People Plan recognise the value and impact pharmacists can have to improve outcomes for people living with long term conditions, including diabetes. This paper outlines a clear vision for pharmacy and the need for the NHS to utilise pharmacists alongside other healthcare professionals across all care settings to improve the care of people with Type 2 diabetes.

In the past, pharmacists have held a more traditional but key role in the management of diabetes, including being an integral part of improving medicines safety and supporting medicines optimisation. Over the past few years, recognising the skills and positive impact on care pharmacists can have both with individuals and at a population health level, we have seen a change in mindset. Increased numbers of pharmacists are now working in diabetes and Consultant Pharmacist posts have been developed. Although this is a start, as highly trained and skilled professionals, we know we can do more whether this is at a GP practice, care home, a community pharmacy, hospital, or Integrated Care System level.

The direction of travel for pharmacy in the management of Type 2 diabetes is clear. We have a huge role to play alongside our healthcare professional colleagues in improving outcomes for people with Type 2 diabetes, after all supporting people with diabetes needs the full multidisciplinary team more than ever.

We are excited for the opportunities that the RPS policy document, The Long Term Plan and NHS Interim People Plan will bring for pharmacy and we look forward to working with the profession over the coming days, months and years to promote and support the role of pharmacists within all care settings to improve outcomes for people living with Type 2 diabetes.

It is important to note that pharmacists cannot do this alone, we need the right environment for development, the support and mentoring from colleagues with experience in diabetes care such as practice nurses, diabetes specialist nurses, GP’s, specialist dietitians, podiatrists.  The only way we are going to be able to effectively tackle diabetes across all care sectors is to ensure this seamless teamworking and collaboration is encouraged and cultivated.

We’ve got two things to ask of you:

  • If you are a pharmacist, and you are interested in supporting people with diabetes then please ensure you have thought over what competencies you need to develop using the UKCPA Integrated Career and Competency Framework for pharmacists in Diabetes
  • If you are a healthcare professional working in diabetes in any sector of the NHS, think if your team would benefit from the support of a pharmacist, and if you work with a pharmacist embrace and support their development to ensure they are the best they can be for your team and your patients.

How my pharmacist helped with my diabetes medicine

by Mike Schofield

Although my type 2 diabetes was diagnosed more than 12 years ago, it is only in the last 15 months that I have been medicated.  Prior to that, I had controlled it through diet and exercise. 

On collecting my first prescription for metformin, the pharmacist went to great pains to explain that I should take one tablet each morning and a second tablet each evening on a regular basis and to contact them immediately if I suffered any ill-effects after taking them. We also discussed dietary factors and the need for regular exercise.

The pharmacist then phoned me the following day, on the third day and after one week, to again check that I was taking the medication as prescribed, not suffering any ill-effects and had no questions about the medication.  One month later, when I collected my next prescription, the pharmacist again checked that I was following the instructions and had not suffered any ill-effects as a result of taking metformin.

For the next 12 months I collected my prescription on a regular basis until at the annual renewal the pharmacist asked that I had a consultation with him.  He then asked if I was taking the metformin as prescribed, not suffering any side effects and was following dietary advice and taking regular exercise.  He also asked me to confirm that my feet were being checked by my diabetic nurse and that I received an annual check for diabetic retinopathy.  I as able to confirm that it was the case with both.

In my opinion I have received excellent service from my local pharmacy and am most impressed at the level of care that I have received.

Diabetes care – get involved!

by Professor Mahendra G. Patel, Diabetes Lead, English Pharmacy Board

Today we’ve published our new policy ‘Using pharmacists to help improve care for people with Type 2 Diabetes’. Aimed at policy makers and service commissioners within the NHS in England, it calls for pharmacists in various care settings to be fully integrated into services for those with Type 2 diabetes. This makes way for increased prevention, earlier detection, and better access to diabetes care tailored to individual needs.  

More than five million people in the UK are expected to have Type 2 diabetes by 2025. This is a national challenge in terms of poor health outcomes, economic burden to the NHS, and ever-widening health inequalities largely driven by factors such as ethnicity and deprivation. Each year within hospitals, there are thousands of patients with diabetes experiencing medication errors that could be avoided.

Significant numbers of people are failing to meet the nationally recommended treatment targets in reducing risk of complications associated with type 2 diabetes. Many are not understanding their condition nor adhering to prescribed treatment. In my opinion, this is a critical time to make more effective use of the extensive clinical skills of the pharmacist.

The NHS Long Term Plan recognises the vital role of pharmacists and their clinical skills in supporting patients to achieve better health outcomes, improving patient safety and reducing medication errors. The recent establishment of new Primary Care Networks and the growing maturity of local Integrated Care Systems, together provide unparalleled opportunities for people to receive better access to their pharmacists, more personalised support, and joined-up care at the right time in the optimal care setting.

In line with new and emerging roles for pharmacists and advancing practice, and at a time when technology is set to command a pivotal role in healthcare, our new policy on diabetes builds on our previous national campaigns.

It translates the latest evidence into practice, focusing on helping people to live longer and lead healthier lives whilst ensuring effective and safe use of medicines. It further highlights the need to support services within and across different care settings, where pharmacists can make significant and meaningful differences in improving health outcomes.

It also shows how pharmacists, who are integrated within a specialist diabetes multidisciplinary team, can provide added value and synergy across care pathways as routine daily practice.

Professor Sir David Haslam, Chair of NICE, one of the many organisations supporting our policy states, ‘Diabetes is a public health emergency’. We will continue to press these recommendations to progress this crucial national work.

Pride: professional is personal

by Gareth Kitson, RPS Professional Development and Engagement Lead

Like everyone, my professional identity is informed by my personal life. Achieving that identity has at times been a struggle and is always a work in progress. It’s something I have learned to take pride in.

As I have progressed through my career, I’ve realised that identifying as a gay man is a bigger part of my identity than I once thought. 

Speaking up

I have had countless conversations with colleagues about what it is like to be a gay man living in London. I’ve spoken about how I have faced prejudice and discrimination because of my sexual identity.  I have highlighted the changes in sexual health provision and how HIV is no longer associated with the falling tombstone of the 1980s. I’ve updated people on how PrEP is transforming the prevention agenda for men who have sex with men.

Being a pharmacist is a huge part of my identity and my sexual identity is too. It often intertwines with other aspects of my personality, including my professional life.  If I feel accepted and safe in my working environment, I’m more creative, better engaged and form stronger working relationships.

Pride

This is why I’m really proud that the RPS is walking in the Pride in London Parade in 2019. 

This is the first time we’ve done something like this.  I’m proud that my professional body recognises both my professional and personal identity. Members of staff and members of RPS will be walking in the Parade on July 6th – if you see us, give us a wave! #wearepharmacy.

Why Pride matters


By Gareth Kitson, RPS Professional Development and Engagement Lead

I had known for a long time that I was gay but had never had to acknowledge it. I never engaged with the LGBT+ community at Uni as I had a ready-made group of friends. I wasn’t confident enough to engage with members of the community as I felt I had to behave in a certain way.  After moving to London I was pushed into the one of the most vibrant and diverse communities in the world and wasn’t ready for the effect it would have on me.

Fitting in

Every aspect of the LGBT+ community had “tribes” or “communities” and I really struggled to find my place.  I also found it really hard to make friends outside of a dating environment.  Most gay men will tell you the same story – insecurity, isolation and the struggle to “fit in”. 

In July 2012 I was out shopping on Oxford Street and accidentally stumbled on the Pride in London Parade.  I felt overwhelmed, curious and confused as to what was happening.  I stopped and watched the entire Parade pass by and spent the rest of the day reflecting on what I had just seen.

Not alone

For the first time, I suddenly felt that I wasn’t alone.  I suddenly realised that there were other people living in the same city as me who identified as a member of the LGBT+ community.  There were opportunities to meet people who may have gone through the same experiences as you, be it coming to terms with your own identity or coming out to your family and friends. 

This one day showed me that people from all backgrounds can stand next to each other and be proud of who they are.  That families can gather and show their children that it is OK for a man to love a man and that some of their friends may have two mummies instead of a mummy and a daddy. 

It was heart-warming, confidence-boosting and empowering when I finally realised that I wasn’t alone.  That I could live my life as I wanted, being true to who I really was, in the city I now called home. That’s why Pride matters.

Members of staff and members of the RPS will be walking in the Parade on 6th July. If you see us, give us a wave #wearepharmacy.

The role of pharmacists in the PCN revolution

By Ravi Sharma (Director for England, RPS) and Graham Stretch (Clinical Director, Brentworth PCN and Vice President, Primary Care Pharmacy Association)

The NHS in England is set for transformation as the Long Term Plan is put into place over the next decade to ensure the NHS is fit for purpose in the future.

The Plan’s key aims are to:

• ensure everyone gets the best start in life,
• deliver world class care for major health problems
• and support people to age well

Read more The role of pharmacists in the PCN revolution

What’s it like to be a guest at a meeting of the Welsh Pharmacy Board?

At our recent Welsh Pharmacy Board meeting, RPS members Nia Sainsbury, Medicines Information Pharmacist from Bridgend, and Boots Pharmacist Simon Taylor, came along to observe the open business proceedings.
We caught up quickly with them to see what they’d made of the experience.

Nia Sainsbury and Simon Taylor
Nia Sainsbury and Simon Taylor

Can you tell us why you decided to come along to the Welsh Pharmacy Board meeting today?

NIA – What motivated me and engaged me to come today is having been involved with the palliative and end of life care policy. So that made me think about what other things are RPS Wales engaged with at the moment. Coming here today I’ve seen that it’s lots of different issues that are being looked at, and how RPS Wales can lead on those issues, like the really interesting presentation we had on advanced therapies.

What have been your main takeaway messages from attending today?

SIMON – I think the enormity of the scale they (the WPB) have to consider each issue with. It’s like they’re looking into the future, how far they have to consider the impact of the decisions they’re making will have. So you don’t appreciate that from the outside always, seeing how much they have to consider, how many different roles there are in there. The other things that people do there, not necessarily in terms of different agendas, but actually there is a lot of representation from different bodies in there.

What would you say are the benefits of pharmacists being able to attend board meetings?

NIA – I very strongly believe that all pharmacists should be members of the RPS, and open board meetings are one of the many things we can do to engage all pharmacists and show them the benefits of membership. When you see the policies, the Palliative Care Policy for instance, being brought out and actually the changes that creates, it’s really useful.

What’s been your overall impression of the Welsh Pharmacy Board?

SIMON – The impact of decisions that are made there have quite wide-reaching effects, so taking everything into consideration from the pharmacy point of view, the health point of view, the public point of view, everyone’s kind of representing that, giving a nice rounded opinion in that decision making process. In terms of the decision-making process, it’s clear they’re not going to miss things.

Would you recommend attending board meetings to other RPS members?

NIA – Yes absolutely!

SIMON – I wasn’t quite sure what to expect, there were only 3 guest observers there which was a little bit daunting at first, but perhaps there can be more (members attending) added to that in future. Coming in as an observer as well, we were given an opportunity to get our opinions across, which I think is really important, from whatever place we’re representing, whether hospital, community or education. That’s important I think, to put that opportunity out there so members can contribute.

The next meeting of the Welsh Pharmacy Board will take place in September. If you’d like to attend, just drop us an email at Wales@rpharms.com to reserve your place.

System leadership: how to get involved

By Amandeep Doll, RPS Regional Liaison Pharmacist

The NHS landscape is always changing and it can be difficult to know where to start for pharmacists who want to get involved in their local health and care systems.

You may have recently heard a lot about ‘systems’ in healthcare – but what are they really about? In short, they mean working collaboratively across health and social care boundaries to improve patient and public outcomes.

Current systems

The systems in England which plan, organise and deliver health and care services are called Integrated Care Systems (ICS), Sustainability and Transformation Partnerships (STPs) and Primary Care Networks (PCNs). The NHS Long Term Plan will be delivered through these systems, which will work in collaboration with existing commissioning, secondary care providers and local authorities.

Pharmacists must be part of these structures at leadership level to ensure the future success of the profession at every level of practice. Our impact in systems is maximised when we integrate with the wider health and social care team.

Our challenge

The challenge for pharmacists is to deliver system-wide medicines optimisation, creating a collective sense of responsibility across different areas of pharmacy, organisations and individuals. This has the potential to dramatically improve population health.

To do this, pharmacists must be formally recognised by these systems and a framework established to support pharmacy integration and build a collaborative approach.

But where on earth do you start? If you’re keen to get involved, we can help you explore leadership opportunities within healthcare.

We can help

Our brand new online tool A systems approach to medicines optimisation and pharmacy will help you navigate the opportunities for pharmacy service development and medicines optimisation within local health and care systems.

It identifies six ways you can support effective system leadership and is packed full of practical advice to encourage collaborative working. It also provides checklists of the resources, standards and guidance needed to build knowledge and skills, along with case studies of how pharmacists have improved medicines optimisation and patient care.

A systems approach to medicines optimisation and pharmacy is part of our support for members working to improve medicines optimisation. I really hope that other pharmacists will contribute their experiences and share good practice in this rapidly changing environment. We need to see what works and what doesn’t so we can all learn to lead better.

Why not submit your own leadership case study?

Download our case study template and email it to england@rpharms.com

Related resource: Medicines Optimisation

Salbutamol – landmark asthma treatment

by John Betts, Keeper of the RPS Museum

2019 marks the 50th anniversary of the landmark asthma treatment Salbutamol becoming commercially available in the UK. Salbutamol is still widely used today to relieve symptoms of asthma and COPD such as coughing, wheezing and feeling breathless. It works by relaxing the muscles of the airways into the lungs, making it easier to breathe.

Launched in 1969 with the brand name Ventolin, Salbutamol revolutionised the treatment of bronchial asthma.

It treated bronchospasm far more effectively compared with previous bronchodilators and had fewer side effects.

To understand how much of a breakthrough Salbutamol was in the treatment of asthma, it’s first worth comparing it to the drugs that were used to treat asthma before 1969.

One of the main drugs used for treating asthma in the mid-1960s was isoprenaline. This is a powerful bronchodilator and was used to relieve bronchospasm. However, the side effects include a sudden increased heart rate. Between 1963 and 1968 in the UK there was an increase in deaths among people using isoprenaline to treat asthma. This was attributed to overdose due to both excessive use of the aerosols and the high dosage they dispensed.

In the mid-1960s the mortality rate for asthma sufferers had risen to over 2,000 deaths a year. An effective bronchodilator was desperately needed that did not stimulate the heart or affect blood pressure.

Salbutamol was discovered in 1966 by a research team at Allen and Hanburys (a subsidiary of Glaxo). Salbutamol was the first drug that selectively targeted specific receptors in the lungs, inhibiting the production of proteins needed to produce muscle contractions. It works by relaxing the smooth muscle of the airways, opening them up and so lessening or preventing an asthma attack. Not only was Salbutamol a good bronchodilator, it lasted longer than isoprenaline, and inhalation caused fewer side effects.

In addition to the effectiveness of the drug, the method of administration itself was also revolutionary. The Ventolin inhaler was designed to ensure metered aerosol doses of Salbutamol were inhaled straight into the patient’s lungs.

The drug was an instant success.

The only real deficiency of Salbutamol was its short duration of action; at 4 hours it couldn’t prevent night-time asthma attacks. In response to this the pharmaceutical manufacturer Glaxo aimed to develop a longer acting drug. The result of their research was Salmeterol. Launched in 1990 with the brand name Serevent, it had a 12-hour duration of action.

50 years on Salbutamol is still on the World Health Organization’s List of Essential Medicines; a testament to the major role it continues to play in the treatment of asthma. 

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