Our take on the NHS Long Term Plan

By Gareth Kitson, Professional Development and Engagement Lead  

The way the NHS delivers care to patients is constantly evolving and aiming to meet the changing needs of an aging population and people living with multiple conditions. As a busy pharmacist providing the best possible care to our patients, it can often be difficult to get to the bottom of the changes and truly understand how the changes might affect you in your day to day roles.

A few weeks back, NHS England launched a discussion paper looking at how the NHS should be developed over the next 10 years, the Long Term Plan (LTP).  The plan is split into three sections, each examining specific areas which will need to improve, if we are to continue to provide the best possible care to our patients. These areas include:

  1. Life stages
  2. Clinical priorities
  3. Enablers of improvement

Each section will resonate with healthcare professions differently and I’ve highlighted areas in each that might be relevant to our members. However, one of the biggest changes that will affect most pharmacists will be how care is provided to our patients.  The traditional method of providing care to patients (the patient moving around different parts of the health system) is a relatively inefficient way of delivering care and one that does not put the patient at the centre of everything we do.  A new, proposed method of providing care is through the use of Primary Care Networks.

Primary Care Networks

We’ve already seen improvements in the way that care is provided to our patients and I would expect the NHS LTP to build on this and develop it even further – I’ll talk through some of these proposals and the LTP later on. However, as I previously mentioned the way we are providing care to patients is changing.  You may have already seen the development of the Primary Care Home (PCH) model which sees care services being redesigned and delivered around a defined population, with the patient being placed at the centre of care provision and the MDT working around them.  You may also have heard about Primary Care Networks.  More information about them can be found here.  However, how might this new model of care affect pharmacists working with patients on a daily basis?

It’s important to remember that this new way of providing care to patients is a positive step for pharmacists as it will allow us to support patients using the full breadth of our skills and showcase the value we can add to patient care. There have already been some great examples of where pharmacy have become integrated into a primary care home model and have had a lasting impact upon patient care.  We’ve seen pharmacists managing long term conditions for their patients, COPD and hypertension, for example.  We’ve also seen them change how patients on multiple medications are managed and highlight the importance of polypharmacy to both patients and prescribers.  Integration of pharmacy into this new model of care also promotes better collaborative working, improved working relationships and more effective use of resources, which in turn, leads to better care for our patients.

The RPS realises the importance of promoting pharmacists and ensuring they are included in any new model of care. Consequently, we have produced 5 key considerations that we think should be included in the formation of any new primary care network that is designed to support our patients.  The key considerations and further information about our work with Primary Care Networks can be found on our website. I’d encourage you to read it and discuss with your colleagues and local leaders to ensure that pharmacy is at the forefront of any changes that are made to how care is provided to your patients.

NHS Long Term Plan

When reading the NHS discussion paper, it can be difficult to picture how you might be affected by these changes.  It can also seem quite intimidating to submit your views and give your opinion on how the plan that will be developed over the next few years.  As your professional body, the Royal Pharmaceutical Society is developing a response to the discussion paper which aims to represent the views of our members.  The finalised plan will be developed and published in good time but what might the future NHS look like and how might this affect you?

Life Stages

The LTP has dedicated the first section of the consultation to different life stages; Early Life, Staying Healthy and Aging Well. Pharmacists are well positioned to support all areas of this section.

Pharmacists from all sectors come into contact with thousands of people every day. Through these contacts, we can promote public health campaigns and work collaboratively with our primary care colleagues to support our patients throughout all life stages.  Pharmacists already do a great job in this area; the flu vaccination service being a prime example.

Mental Health is a huge priority for our health service over the next few years and I would expect all pharmacists to soon be playing an even greater part in supporting the public in this area. Mental Health is a topic that crosses all life stages and the RPS have recommended that this should be the one of the top priorities for addressing health inequalities over the next five to ten years.

Furthermore, as the experts in the safe and effective use of medicines, pharmacists will continue to have a key role to play in ensuring patients with long term health issues get the most from their medication and are empowered to make informed decisions about their health and treatments. This role is sure to develop and pharmacists and their teams will be key in ensuring this is a success.

Clinical Priorities

The LTP highlights three main clinical priorities that will be focused upon, over the next five to ten years. These are Cancer, Cardiovascular and Respiratory Health, Mental Health and Learning Disability and Autism.  Once again, pharmacists are already doing wonderful work in these areas and our recent Mental Health campaign in England, showcased some of these.  One area where pharmacists could play a bigger role in these specific areas could be through supporting disease prevention services (for example, supporting stop smoking services via community pharmacists) or working alongside other healthcare professionals, such as GPs and other doctors, to help reduce the incidence of cardiovascular and respiratory diseases.  Many pharmacists already work to help detect atrial fibrillation but this is an area that could be expanded over the next few years, with more pharmacists being used to recognise early signs and symptoms of LTCs.  This could also see pharmacists doing more to support the physical health of patients with mental health conditions.  This is something that the RPS have recently highlighted as part of our mental health campaign  

Workforce

We all know the exceptional work that members of the NHS workforce do. As the system develops, we need to make sure that the workforce is also developed and supported to be the best they can be.  Without a highly trained, compassionate and effective workforce, the NHS will not be able to deliver the best care to patients.

At the recent FIP conference, the report on the global trends in the pharmacy workforce was launched with some interesting findings.  I’m sure that everyone has been involved in workforce discussion at some point in their carer and have seen how the workforce greatly impacts upon patient care.

Therefore, as part of this consultation, the RPS have highlighted that the pharmacy workforce needs to be included in any changes made to the NHS. As a workforce, we are expertly placed to use our skills to help deliver services to patients using new and innovative methods.  Some pharmacists within our workforce are independent prescribers and are skilled to support patients to manage their long term conditions and to support them with problems they may encounter when taking multiple medicines.  The advancement of technology is undeniable and therefore, we also need to pay particular attention to ensuring our workforce is digitally literate and can translate this in to ensuring we support our patients, to the best of our ability.

 

How pharmacists can support older people with mental health issues: a personal view

By Dr Amanda Thompsell, Chair of the Faculty of Old Age Psychiatry of the Royal College of Psychiatrists

Having met with members of the Royal Pharmaceutical Society to talk about their mental health campaign it made me reflect on the many ways that pharmacists support older people with mental health issues.

Not only do pharmacists give helpful advice around reducing unnecessary medications, on side effects and potential drug interactions and ways to improve adherence, but pharmacists help in so many other ways that can go unnoticed. Read more How pharmacists can support older people with mental health issues: a personal view

A Welsh perspective on FIP World Congress 2018 

Jodie Williamson MRPharmS, Pharmacist at the Royal Pharmaceutical Society
Jodie Williamson MRPharmS, Pharmacist at the Royal Pharmaceutical Society

by Jodie Williamson, Professional Development and Engagement Lead at the Royal Pharmaceutical Society in Wales.

 

Last week 3000 pharmacists from 108 different countries came together in Glasgow for the International Pharmaceutical Federation (FIP) World Congress. This is a conference where pharmacists from around the world can share advances and developments from their country with an international audience in order to improve the benefits patients get from their medicines on a global level. With RPS hosting this year’s conference, I was lucky enough to attend and represent our team in Wales. FIP World Congress last came to the UK nearly 40 years ago, so getting to attend the conference so close to home was a once-in-a-lifetime opportunity for me.

 

We know that healthcare systems around the World are facing increasing pressures and demands on their services and this resulted in a real sense of the need for pharmacy services to change amongst all delegates. It was an eye-opening week for me!  

 

I learnt about how community pharmacists in Portugal are now working with general practices to offer early screening for a variety of conditions and are able to refer patients directly to the most appropriate services if a condition is identified, relieving the pressure on their GPs. They also run clinics with nurses and nutritionists to offer advice about diet and nutrition on the high street and now their patients are calling for them to be able to request blood tests and interpret their results. Community pharmacies are the first port of call for most healthcare needs in Portugal. 

 

I also attended an emotive and thought-provoking session on death and dying. We heard from countries where euthanasia has been legalised about the role of pharmacists in the process and how they are trained and supported to deliver excellent end-of-life care. The session challenged my thinking around the guiding principle for healthcare professionals to do no harm. An excellent quote that resonated with me during the session was “sometimes death ends suffering, not life”. 

 

Welsh RPS representatives at FIP 2018
Welsh RPS representatives at FIP 2018 (L-R) Avril Tucker, Andrew Evans, Dai John, Jodie Williamson, Suzanne Scott-Thomas, Rob Davies, Cheryl Way, Sophie Harding, Sarah Hiom

 On the other hand, the conference also made me realise how lucky I am to be trained and practicing in the UK. Our healthcare system, the quality of our training and development, and the standards that we work to are the envy of so many pharmacists from around the World. Whilst I learnt a lot from other countries a number of our Welsh pharmacists were also presenting their innovative work. From our community pharmacy Discharge Medicines Review (DMR) service to developments in cancer care at Velindre Cancer Centre, our pharmacists are doing an excellent job of putting Wales on the map as leaders of the profession on a global scale! 

Pride in Practice : Being brave

by Dr. Claire Thompson, RPS Deputy Chief Scientist

She…

I’ve written lots of blogs on science or leadership but never about being gay, so this is my first professional outing.

I’m fortunate in that I have never experienced overt homophobia in the workplace. This is in stark contrast to my personal life, where experiences have ranged from:

– Being abandoned by groups of friends at school;
– Family members not coming to my wedding because they didn’t “agree with it”; and
– Strangers in the street shouting “You deserve to die” for simply holding hands with my girlfriend. (No, this wasn’t the 1950s, it was 2003)

Even though they haven’t been painful professional experiences, it doesn’t mean there haven’t been uncomfortable ones. Like every time someone asks “What does your husband do?”. I’ve lost count of the number of times I’ve responded “They….” or “My partner….” Because I didn’t want people to feel uncomfortable or embarrassed. But the longer you leave it, the more uncomfortable the discussion gets.

When is the right time?

So, when is the right time to say “She” or “My girlfriend” or “My wife”? Over the last few years, I’ve made a conscious decision to get “She” in early. The birth of my daughter really helped with this. As a proud parent, I would show people photographs and they would say “You look great for having a young baby” to which I could respond “Oh my wife gave birth to her, and she looks better than I do!” (See the photo below as proof). I find that openness, humour and a baby photo go a long way to diffusing any discomfort. Of course, there have been occasions where I have just taken the compliment (please don’t tell my wife)!

Dr. Claire Thompson (right) with her family

Brave

Coming out to colleagues still doesn’t come naturally, it always takes an element of bravery and I do admit that there are some people that I still don’t tell because I know they will judge me unfairly. Ultimately, we need to be comfortable with what we share about ourselves.
But if you do want people in the workplace to know that you are gay, take a deep breath and go for it.
Be brave. Be you.

Pride in Practice

by Sarah Steel MRPharmS, RPS Wales Policy and Practice Co-ordinator

Sarah Steel MRPharmS, Policy and Practice Coordinator

With August being the month we in Wales choose to celebrate Pride, what better time for the RPS Wales team to join the ongoing campaign for unity, equality, acceptance and embracement. To show our solidarity, some of our RPS staff members will be sharing their experiences in pharmacy as members of the LBGT community, and on the 24th of August, the eve of Pride Cymru, in the office we will be donning our brightest colours, eating rainbow cakes and flying the flag in support of Pride.

Why we still need to worry about equality

I’ve found myself thinking recently – if last year marked the 50th anniversary of the 1967 Sexual Offences Act and the “de-criminalisation of homosexuality”, why are members of the LGBT community still being tormented, isolated and discriminated against? It turns out, my ignorance was distorting my understanding. In 1967 homosexuality was in fact only partially de-criminalised; many anti-gay laws remained, and criminalisation did not in fact toally end in the United Kingdom until 2013. That’s only five years ago!

Five years ago, I was in my second year of University. Through my time at University and my career to date, I have been a proud member of the LGBT community. For the majority of the time, I have felt accepted and embraced, but I can’t say I have always felt that I am, or would always be, treated the same. My sexuality is something I am conscious of in interviews, when starting new jobs or working in new teams. I am still, in 2018, worried how people will react when, for example, I correct he to she when talking about my personal life. And I am sad to hear from colleagues and friends that they have had much worse experiences, including homophobic slurs and discrimination.

Join us and show your Pride in Practice

What stands out to me clearly is that LGBT rights and support is not a moot point, and there’s still a long way to go. The celebration of the campaign and the achievements so far is as important as ever, and we hope that through our blogs and  photos, we can be a part of the campaign for unity, equality, acceptance and embracement for all of our members. We’d love it for members to join us by sharing photos of your involvement this weekend, either at home or in the work place. Be sure to tag your social posts with #RPSPrideInPractice so we can share!

Improving mental and physical health – parkrun

By Chrissie Wellington, Global Head of Health and Wellbeing, parkrun

We all know that exercise is one way to improve physical and mental health, but it can be very hard to get started and motivate yourself to continue exercising.

I work for a brilliant organisation called parkrun which provides a fantastic way for anyone to improve their physical and mental health in a fun and supportive environment.

As a non-profit organisation, parkrun organises free 5k runs which take place every Saturday at 9am (9:30am in Scotland and Northern Ireland). There are currently over 770 parkrun events across the UK with approximately 140,000 weekly participants supported by around 14,000 volunteers.  Read more Improving mental and physical health – parkrun

How our Foundation program can help you

By Morenike Adeleke MRPharmS

Being a Foundation pharmacist has enabled me to continuously develop my practice, take into account what I’m doing well and what I can do differently or better. Finishing off the RITA1 stage of the Programme was a time of great reflection on my practice for the last year. I have always thought about my practice, but this brought back memories of some very difficult situations I have found
myself in.

The Peer Assessment tools were very helpful in terms of boosting my confidence in my daily practice; it is sometimes difficult to ask for feedback, as some colleagues may feel uncomfortable giving criticism to pharmacists directly. It was helpful in making me see the areas in which I need to grow; but it was also nice to read some very complimentary comments from my colleagues who may not otherwise have the opportunity to say those things to me.

The workplace- based assessments were initially a bit daunting, but my trainer was lovely and made me see for myself the areas in which I’m performing well. Sometimes with reflection, we focus on the things we need to improve on and forget to congratulate ourselves on the areas in which we are exceeding. Having another pharmacist there to see how I was working was actually quite refreshing and I felt comfortable enough to ask her some questions.The study days have opened my eyes to a number of areas of pharmacy that are important to my daily practice, that are not always obvious. For example, mental health was discussed at our last study day and we talked about how we can support our patients who may have mental health conditions, in a way that does not discriminate against thembut treats them just like any other patient. It’s also nice to meet some new pharmacists and catch up with some colleagues who I haven’t seen for a while! The reflective accounts and uploading all of my certificates so far made me realise how far I have come as a pharmacist. For me, that’s the great thing about the Foundation Programme.

Being able to look back on how far I have come and how I’ve grown as a pharmacist through the programme is fantastic and I’m excited because I have so much further to go.

Pharmacists working to Eliminate Hep C

Andrew RadleyArticle by Andrew Radley, Consultant in Public Health Pharmacy, NHS Tayside

In 2016, the World Health Organisation advocated that Hepatitis C (HCV) could be eliminated as a public health problem by 2030.  The current WHO factsheet for HCV tells us that:

HCV is a liver disease caused by the hepatitis C virus: the virus can cause both a mild illness lasting a few weeks or a serious, lifelong illness that can be fatal.

The most common route to infection is through exposure to small quantities of blood e.g. through injecting drug use. Across the world, an estimated 71 million people have chronic HCV infection. Approximately 399 000 people die each year from HCV, mostly from cirrhosis and hepatocellular carcinoma.  Read more Pharmacists working to Eliminate Hep C

Mental Health – awareness counts, action matters.

by Sarah Steel MRPharmS, RPS Wales Policy and Practice Co-ordinator

Sarah Steel MRPharmS, Policy and Practice Coordinator

Over recent years, mental health has become something of a global conversation, a buzzword, a hashtag. Remove the stigma. Break the silence. Be open, talk, share.

Awareness is fantastic, conversation is progressive but how we act is what matters. An episode of mental illness is frightening, frustrating and isolating. As a pharmacist and a patient I have seen mental ill health from both sides and both are scary. People involved on both sides are often scared about the same things. What is ok to say? How do I act? How do I not make this worse? Awkwardness can be destructive.

Admitted to hospital, as a patient in crisis it was exhausting being asked again and again by different people what medication I was taking. No, I didn’t bring with me the third lot of meds that my doctor has prescribed that right now aren’t helping me feel better. I desperately wanted to get better, but I especially wanted and needed to be treated as a person, recognised as a person at a time when I felt so much less than that.

Read more Mental Health – awareness counts, action matters.

The Hanbury Botanical Garden: a pharmacist’s holiday destination in 1906

By Karen Horn, RPS Librarian

The Hanbury Botanical Garden is situated on the La Mortola promontory overlooking the Mediterranean. A glance at TripAdvisor  tells us that it is ‘spectacular,’ ‘a real gem,’ and ‘a beautiful, calm place with stunning views.’

What we are not told, though, is the garden’s connection to the Hanbury family and pharmacy.

Thomas, Daniel and the making of a garden

Daniel Hanbury was an enthusiastic traveller, taking every opportunity to further his research on materia medica. It was he who brought La Mortola to the attention of his brother, Thomas.  In March 1867, Thomas, a merchant in Shanghai, visited the area and found the ruined Palazzo Orengo with its neglected grounds and olive groves. Read more The Hanbury Botanical Garden: a pharmacist’s holiday destination in 1906