Chris’s Peer Discussion Blog

As I get older I think I’m becoming more last minute.com. I recently zapped my CPD records to the General Pharmaceutical Council – just in time for 31 October deadline.  Perhaps I should be more compare the supermarket.com?  Now I have revalidated for 2018 my mygphc.org account has re-set to what I need to do in the next 12 months. There are new things to think about.

I work at the Royal Pharmaceutical Society (RPS) as Head of Workforce Development looking at the standards, guidance, and policies that will develop our profession. Having been involved in the RPS approach to supporting its members with revalidation I thought I should write a blog about my own journey with staying on the register.  Each month I will cover different aspects of a new additional way us pharmacists have to keep our knowledge and skills up-to-date – the peer discussion.  The what, who, where and how. Read more Chris’s Peer Discussion Blog

My day with the English Pharmacy Board

by Sarah Browbank, Hospital Pharmacist and an RPS Ambassador

I’ve been fortunate enough to become an RPS Ambassador recently.  To do my best in my new role, I asked to attend the English Pharmacy Board meeting last week as an observer.  I feel it is important to understand how the RPS works.  Prior to taking on the Ambassador role, I felt I had some idea of what went on but really wanted to get under the skin and truly understand the activity and influence of the RPS.  I can only tell you how inspired, motivated and impressed I am by the work of the RPS and the committed staff that support our profession!   Read more My day with the English Pharmacy Board

Pharmacy breakthroughs in mental health treatment

By Julie Wakefield, RPS Museum volunteer

From the 1950s onwards there have been significant breakthroughs in the medicines used to treat mental health problems.

In the early 1900s the drugs used in psychiatry were the ‘chemical straightjackets’ such as opiates, bromides, and barbiturates that simply sedated patients.

This all changed in the 1950s with the introduction of chlorpromazine for psychosis, lithium for bipolar disorder, and imipramine for depression.

It began a pharmacological revolution because it demonstrated that drugs, not just psychotherapy, could restore mental health.

Antidepressants

Imipramine was the first of a class of drugs called ‘tricyclic’ antidepressants. In 1955, researchers gave it to 40 depressed patients. The results were dramatically successful. The pharmaceutical firm Geigy had produced the first drug in the history of psychiatry that acted specifically against depression.

Since then many more of these drugs have been developed, with varying side effects. However, imipramine is still considered by many psychiatrists to be the gold standard of antidepressant therapy.

Antipsychotics for Schizophrenia

Many pharmacy historians have regarded chlorpromazine as the single most important drug in the history of psychiatry. Chlorpromazine treated the symptoms of schizophrenic psychosis with less sedation than previous drugs.

A trial on 38 psychotic patients in the early 1950s showed that it could not only calm the patient but also treat a whole range of their symptoms. These included hallucination, delusions, confusion, anxiety states and insomnia.

Chlorpromazine was the first of a class of drugs called ‘typical’ antipsychotics for schizophrenia. A dopamine antagonist, it works by blocking the uptake in the brain of excessive levels of the neurotransmitter (a chemical that helps transmit signals in the brain) dopamine, believed to partly cause the symptoms of schizophrenic psychosis.

Bipolar Disorder

Just as chlorpromazine brought relief to sufferers of schizophrenia, lithium carbonate, launched in 1954, became the ‘gold standard’ treatment for bipolar disorder. Lithium is a mood stabiliser used in the prevention and treatment of mania associated with bipolar disorder (manic depression).It is still the most common treatment today as it both treats and prevents mood disorders.

The pharmaceutical treatment of mental health in 2018

However despite the significant developments in psychiatric medication over the last 70 years, many patients with mental health problems are still not receiving a high enough standard of care.

As part of its mental health campaign, the Royal Pharmaceutical Society is exploring how pharmacy teams can help improve the physical health of people with mental health problems.  People with mental health problems often have more difficulty accessing healthcare than others and the life expectancy of those with a serious mental illness is 15-20 years less than average.

A key part of improving this is ensuring patients get the best outcomes from their medicines, so reducing adverse events, minimising avoidable harm and unplanned admissions to hospital, while using resources more efficiently to deliver the standard of care that people with mental health problems deserve.

Heads down or heads up?

by Nicola Gray, RPS Regional Liaison Pharmacist

One of the privileges of being a Regional Liaison Pharmacist for RPS is having the opportunity to go and speak to pharmacists working across different sectors of care about their current work and their aspirations.

One common theme across all sectors for me has been the difficulty so many of us have in imagining a different practice scenario to the one we currently work in. The very real and constant pressure of daily work means that pharmacists often have to concentrate on traditional tasks to meet the needs of an increasing – and more complex – patient caseload. It might be the community pharmacist chasing yet another medicine in short supply; the chief pharmacist considering how to cover their on-call responsibilities; the academic pharmacist running the same lab 5 times to accommodate student numbers; or the GP practice pharmacist team leader covering several practices themselves because of the churn in their team. The common feature is ceaseless demand, which restricts our capacity to think and act strategically and to connect with the wider system.

Tied to the wheel

I’ve come to call it the ‘heads down’ phenomenon, but another pharmacist recently described it to me as being like ‘hamsters on wheels’. Those of us who are not caught in this cycle might become frustrated by a disappointing pharmacist response to funded offers of training, or worry that opportunities for strategic development will be missed because system leaders do not see demands from the profession for their ‘place at the table’. I believe that the ‘heads down’ phenomenon gives us a very reasonable explanation for why this might be – and a way to consider what we really have to do to facilitate change.

Looking up

Each of the four Regional Liaison Pharmacists has many stories of the innovators and local and national pharmacy leaders who are determined to look beyond the daily grind. For example, I attended the Greater Manchester Pharmacy LPN conference in the summer and awards were given there to pharmacists, pharmacy teams and multidisciplinary initiatives to celebrate solid innovation rooted in the needs of local populations. These awards showcased pharmacy-led improvements in patient safety and equitable access to services, which need acknowledging in a national healthcare system where both seem to be an increasing daily challenge.

Becoming part of a movement

The future of pharmacy has to be a system-wide movement united by a common cause and guided by shared values. Where I live in Greater Manchester, a recent meeting about workforce strategy – involving representatives from all patient-facing sectors – showed strong consensus around moves to affirm our shared identity there and use it as a basis to market pharmacy to patients, the public and other professions. This isn’t window dressing – it is fundamental to creating an effective movement.

As a representative of pharmacists in different roles in my past, and in the role that I perform for RPS now, my greatest nightmare is that promises will be made to local system leaders about pharmacy without the certainty that everyone else is committed to that cause. Conversely, the critical mass of pharmacists needed to give that support can only be created if they too feel part of a movement that is not just about another plan, or pilot, but that has the capacity to actually get us from where we are to where we really want to be.

In order to encourage more pharmacists to raise their heads, they will have to start to see small but meaningful positive changes in their daily work. Nothing less will do. This may be facilitated by shifts in commissioning to align incentives for pharmacists with value for patients. It may also be linked to better retention of pharmacists in localities and roles so that the work becomes more proactive than reactive. This will promote trusting personal relationships between pharmacists working in different sectors and with the wider healthcare team. The right approach will be decided at an increasingly local level, but support for these ‘local pharmacy movements’ from RPS and other national bodies and employers will help to sustain pharmacy leaders, and raise more heads up.

Palliative and End of Life Care – getting it right first time

Sudhir Sehrawat, Community Pharmacist and RPS Welsh Pharmacy Board member
Sudhir Sehrawat, Community Pharmacist and RPS Welsh Pharmacy Board member

by Sudhir Sehrawat, Community Pharmacist and RPS Welsh Pharmacy Board member.

 

Getting it right – first time.

 

In every day working life we strive to get things right so we achieve the results that people need. It saves time, avoids duplication of effort and you get the result you want. Yet, as a community pharmacist, I see palliative care as an area where we sometimes don’t get things right first time due to the complexity of the systems and processes involved.

 

What happens when we get it wrong

 

In a real life scenario I was presented with a prescription by a patient’s relative for end of life medication on a Saturday morning. The medication prescribed was not on the Health Board Palliative Care Formulary and the family had spent most of the previous day travelling to various community pharmacies to get the prescription dispensed. I contacted the out-of-hours GP explaining the situation and the relative was asked to attend the out-of-hours service for a new prescription. They returned after lunch with a new prescription, however, the hand written prescription did not meet the controlled drugs regulations. I contacted the out-of-hours service again and the family member was asked to pick up a new prescription and return to the pharmacy. The controlled drug was supplied in part due to limited stock held but was enough to last until Monday evening. I explained we could order the remaining stock and deliver it when it arrived. After work on Monday evening I visited the patient’s address with the remaining medication only to discover the patient had sadly, already passed away on Saturday evening.

When a patient is at end of life members of the family and friends need to be with their loved ones, not chasing supplies of medication.

There’s lots to consider within this one real life scenario.

  • Why was a non-formulary palliative care medication prescribed?
  • Why was the alternative controlled drug prescription not written correctly?
  • Where were the communication channels to let the community pharmacy know the patient had passed away?

This single case is typical and highlights multiple opportunities to improve care at the end of life.

 

Getting it right in future

 

I welcome the upcoming policy on palliative and end of life care by the Royal Pharmaceutical Society in Wales. This leading policy will address the issues we healthcare professionals face and importantly, allows patients high quality coordinated care. Patients and carers have the right to be treated with dignity and respect. The policy outlines key areas to ensure patient empowerment through timely access to medication, providing the right support through shared health care plans and offering education and training to the workforce.

If we work on an All Wales approach and implement the key recommendations of the policy, we have the opportunity to drive quality improvements as well as reduce demands on our health and social care services. I’m fully behind the policy as I hope many of you reading this blog will be. Lets get it right – first time.

 

RPS new Palliative and End of Life Care policy for Wales will be published at the end of November, and launched at the RPS Medicines Safety Conference in Cardiff on November 22. 

Medical exemption fines: could they be better spent?

by RPS England Board Chair Sandra Gidley

The Government have announced plans to strengthen checks at pharmacies for entitlement to free prescriptions in England.  Whilst we all want to see fraud stopped, I have to ask – is really the right approach?

Only patients in England can be judged to have committed prescription fraud because prescriptions are free in Scotland, Wales and Northern Ireland.

Many patients who fall foul of the medical exemption fine have simply forgotten to renew it. They only need to do this every five years, so it’s a diary date that is easy to miss. We shouldn’t label people with a serious long term condition who have forgotten to renew their medical exemption certificate as fraudsters because they have made a genuine mistake. Read more Medical exemption fines: could they be better spent?

Volunteering at FIP 2018

Elisa Lee, Fourth Year MPharm student at Robert Gordon University 

What I did

I was one of the few fortunate students who was elected as a volunteer for the 78th FIP world congress in Glasgow 2018.

I started my volunteering a few days before the event, along with other student volunteers from all over UK, where we were split into different working areas. These included FIP booth, press and speaker room, accreditation and registration, and poster session. On the first two days we helped set up the exhibition hall, work stations, equipment and helped pack badges.

I was part of the accreditation and registration group for the duration of the congress. My role consisted of handing out evaluation forms, recording any filled-out forms on excel and answering any questions regarding accreditation. I also helped at the registration desk, helping participants collect their membership badges, handing out programmes and helping with any other general enquiries. Read more Volunteering at FIP 2018

Palliative Care & The Pharmacy Team – what do we have to offer?

by Elizabeth Lewis, Palliative Care Pharmacist

What do we pharmacists have to offer?

I have just retired, having had a very rewarding career as a palliative care pharmacist. I firmly believe pharmacy has a key role to play in supporting patients and their families, as well as other professions, in the delivery of palliative care services in both community and secondary care. Currently we are an under used resource but have the potential to offer much more to existing services.

Community Pharmacists are ideally placed to advise on the safe and effective use of medicines. The local pharmacist is a readily accessible source of information and advice for both the patient and those supporting them. With improved communication with fellow professionals in both the community and secondary care services they would be better placed to ensure the supply of essential medication and support. This in turn would help community services in supporting patients who wish to die at home.

In secondary care the inclusion of an advanced specialist pharmacist in the palliative care multidisciplinary team is beneficial in providing advice on all aspects of medicines management from the suitability and availability of drugs and the prescribing options to the use of drugs in renal and hepatic failure. Non specialist pharmacists also have a role in ensuring symptom control is optimised, appropriate and effective.

For pharmacists to reach their full potential in the field of palliative care they need access to education and, where appropriate, the opportunity to gain experience in working with palliative care patients.

The scope of palliative care includes many non-cancer diagnoses and, with an ageing population, there are more patients requiring palliative care input than ever before. Pharmacy needs to rise to the challenge. We have made a start in Wales and have formed the All Wales Palliative Care Pharmacist Group, for pharmacists with a particular interest in palliative care.

*The group undertakes projects on a national basis such as the Just in Case Box scheme and the development of the syringe driver chart and also acts as a support group for its members.

We need to build on these foundations to ensure pharmacy provides great care for palliative care patients and continues to develop expertise in palliative care medicines use across the whole range of pharmacist roles

Elizabeth Lewis is a major contributor of expertise to our new Palliative and End of Life Care policy for Wales, which will be published at the end of November and launched at the RPS Medicines Safety Conference  in Cardiff on November 22.

FIP – like hosting the pharmacy Olympics

I spent the first week of September in a surprisingly sunny Glasgow, at the 2018 FIP World Congress of Pharmacy and Pharmaceutical Sciences. This was the 78th FIP event and the first time it had been held in the UK for nearly 40 years. We had the privilege and huge challenge of hosting it – and let no one underestimate the size of this challenge! A global gathering of pharmacists and we were responsible for the venue, the catering, much of the programme, the formal opening ceremony and the big events. It’s like hosting the Olympics except for pharmacy! It took considerable effort from our great events team and many other colleagues to plan and deliver this.

The ‘myth’ concerns the view sometimes expressed that such events are irrelevant to the majority of the profession and are only for a select few – the ‘pharmacy elite’ from academia, science, research and pharmacy politics. If you’d asked me previously what FIP was all about, I may have told you rather dismissively and from an uninformed position, that it was not really relevant to us in the UK, out of reach to the ‘typical’ pharmacist and out of touch with the younger generation. What a huge misconception that proved to be!

Glasgow 2018 really did dispel that myth for me. Many community pharmacists and their representative organisations were in attendance actively participating in the event, as well as people from hospital practice and chief pharmacists from all across the globe, including our own from here in the UK. Read more FIP – like hosting the pharmacy Olympics