My aspirations for the NHS Community Pharmacist Consultation Service

As the new Community Pharmacist Consultation Service goes live, English Pharmacy Board member Andre Yeung, a key developer of the earlier Digital Minor Illness Referral Service, offers his thoughts on how to make it a success.

How did the Community Pharmacist Consultation Service develop?

My good friend and colleague Mike Maguire and I actually started talking about this right back in the summer of 2014. Back then NHS 111 wasn’t really referring to community pharmacy – they mainly sent patients to GP services, walk-in centres or A&E departments. It got us thinking that community pharmacy could do so much more in this space if we only just connected the network up with NHS 111.

After our NHS Pharmacy Integration-funded pilot in December 2017 we’re now presented with a national roll-out this October. It’s taken some time to get to this point, and it took a little bit of convincing about pharmacists’ role, but I believe the future delivery of this service is really important for community pharmacy and the NHS. We’ve had over 28,000 patients referred into community pharmacies as part of our pilot and community pharmacists have done an absolutely astounding job of clinically assessing, advising, treating, managing and escalating patients within an integrated primary care system. 100% – we’re now the first port of call for minor illnesses here in the North East.

Why do you think the CPCS is so important?

My belief is that Community pharmacy developing a role in acute out of hospital care is more important than the sum of all other commission services that have been commissioned through community pharmacy.

Why? Firstly, because acute care is needed and appreciated by patients! Secondly, it doesn’t just disappear if pharmacy doesn’t do it so it’s needed by the NHS too. Thirdly, the size and scale of this is massive.  It seems to me a ‘no brainer’ that if pharmacy helps out our GP and nurse colleagues they too would start to argue that the right place for managing patients with minor illnesses is within community pharmacy. Pharmacy can provide patients with excellent access to services and because of our scale can take pressure off NHS colleagues as we head into the busy winter season.

What are the considerations that are needed to enable around a national roll-out?

It’s a big task to get the best out of this service. In some respects, this is business as usual for pharmacists, in others it’s completely different. I don’t think there’s been a more challenging service launch in the history of community pharmacy.  As of October 29th we’ll be connected to the NHS in a way that we haven’t been in the past. People will be monitoring and counting on our clinical interventions so we need to ensure the quality of what we deliver is of a really high standard across the board. If we can do that, and I believe we can, then this could be a seminal moment for our profession – a really positive turning point that leads to further developmental opportunities in the clinical arena. How great would it be to achieve amazing results with the spotlight on us like never before?

What message would you give to front-line pharmacists?

These are a few of my top things to remember about CPCS:

  • CPCS about YOUR clinical assessment in the pharmacy. Get the info you need and make your own professional clinical judgement as NHS 111 have only done a triage based on what the patient has reported on the phone. A great clinical assessment keeps the patient safe, is rewarding for the pharmacist and importantly helps patients get well as they have the right plan in place.
  • Three most likely outcomes of your assessment will be a) you can help the patient, b) you need to escalate the patient or c) you can’t help the patient but you don’t need to escalate.
  • Safety net every patient: advice on when to act and how to act if things don’t improve or get worse.
  • Keep decent clinical notes in the IT system, for patient benefit and yours.
  • When you escalate in hours, most times you’ll need to speak to the GP not the receptionist. You’ll be escalating because you have a clinical concern so it’s only natural you’ll want to communicate this to the receiving GP – it’s both helpful and courteous to do so! Out of hours you’ll be going back to NHS 111 via the healthcare professional line so be prepared to request a referral or support from the clinical assessment service.
  • Reflect on your practice. If you need some additional training then sort this out as part of your CPD.

What are my aspirations for the future of the service?

Initially, this is about community pharmacy the sector maximising this opportunity. It’s about us ‘knocking this out of the ballpark’ so to speak. That’s my main aspiration!

If we achieve this then the NHS have already outlined an opportunity to work with GP referrals into community pharmacy for minor illnesses.

In the future, what would be good would be some additional training, access to some POMs and some basic equipment (oximeters, BP monitors, thermometers etc.).  This will allow us to see other types of patients as our functionality increases. Why not see patients with suspected UTIs, with impetigo etc? I know my colleagues at the Royal Pharmaceutical Society will be pleased to hear me say that I think the roll out of Pharmacist Prescribers will eventually come on the back of all of this work. We’ll need them as we do more and more in this domain.

It’s all very exciting! Caveat to all of the above? We MUST deliver this first phase of the service well.  Organisations need to support our front line pharmacists and pharmacy teams to deliver quality. They absolutely have the capability to do it, they’re amazing, but they will need our help and support to make it happen!

Our Mental Health and Wellbeing Campaign

By Jonathan Burton MBE FRPharmS, Chair of the Scottish Pharmacy Board

I think we can all agree that being a pharmacist can often be stressful and demanding. My personal experience of managing my wellbeing, in the context of my work as a community pharmacist, has been a journey.

Early in my career (I’m 20 years qualified now) I often struggled to control stress & anxiety when workload was high in the pharmacy, I could be irritable and looking back I’m sure this was noticed by and affected my work colleagues and patients alike. I co-own the company I work for and this had the added effect of causing me to feel a lot of guilt, even in situations in the pharmacy that I couldn’t really exert any control over, as I inherently felt it was always in part my fault if my team and I were struggling. I seemed to carry this with me all the time. 

Further on in my career now I feel I manage these emotions better, but I still notice the negative impact that busy and stressful days and experiences have on my life & general wellbeing. I can control it at work better, but at home sometimes it’s still a struggle. If you ask my wife and children they’ll tell you, I often find it difficult to switch off from work and it sometimes takes me some time after arriving home before I feel I’m the husband to my wife and father to my boys I think I should be. If it’s a tough week at work I often stop looking after myself, my diet worsens and exercise stops. 

I consider myself lucky, I enjoy my job and have always felt fortunate to be a part of a profession that cares for others. But as health professionals we need to look after ourselves and each other as well as the public and patients we care for. We are human, and we will have our struggles with our wellbeing and mental health, but this does not mean we don’t deserve help to manage these challenges. 

If you are a pharmacist reading this, and haven’t done so already, please help the RPS and Pharmacist Support fight for better access for pharmacists to help with their wellbeing and mental health issues by completing our survey. It really will make a difference, thank you.

My first week as an RPS intern

Simi Aguda, Second year pharmacy student

I’m Simi Aguda, a second year Pharmacy student at the University of Portsmouth. I recently had the opportunity to work within the Royal Pharmaceutical Society in Education and Professional Development.

My first week began with an introduction to the different teams at the RPS by Aamir Shaikh, a Professional Development Pharmacist who supports early career pharmacists.

I met with the different departments and organisations within the Royal Pharmaceutical Society, including the BNF, Pharmaceutical Journal, Education, Team England, Events, Marketing and Professional Support. I was immediately welcomed and was excited to see what the professional body of Pharmacists got up to ‘behind the scenes.’

My first project was to review the RPS website from a student perspective, suggest improvements and present my findings to the Marketing Team. I needed to be analytical and precise and further develop my presentation skills, as well as evaluate whether the content of the website matched the needs of Pharmacy students like myself. After the presentation the changes were made to the website and my feedback was taken on board. I noticed how the RPS valued giving and receiving feedback, and that as a student my opinion and thoughts mattered. This has been an integral part of my experience and demystified my preconceptions of the RPS and their culture.

My second project was analysing data collected from Pharmacy students and Pre-Registration trainees and identifying changes and patterns from the data set and how this could improve RPS membership. In addition, I had the opportunity to work with Gareth Kitson, Professional Engagement Lead, whose role is to promote pharmacy across England, as well as liaise with the media and Government to champion and speak up for Pharmacy. This broadened my perception of potential pharmacy careers.

Next, I had the opportunity to meet with the head of Marketing, Neal Patel. I was invited to discuss how the RPS can engage with students like myself, this was an incredibly informative meeting and provided me with insight into how dedicated the RPS is to helping Students, Pre-Registration trainees and qualified pharmacists. The focus was always on how the RPS can support its members. As a student I was unaware of the resources available for me. I have since met other interns who were placed within the Pharmaceutical Journal, and we have worked together to create content for the RPS digital channels.

Uncovering hidden histories at the RPS Museum

by Matthew Johnston, RPS Museum

Part of our work here at the RPS Museum includes researching various aspects of pharmacy history so we can enrich our displays, tours and articles, especially those areas that are currently under-represented in the museum.

A recent focus of this research has been to uncover more stories relating to BAME communities. This isn’t an easy task as historical registers of pharmacists did not record information relating to ethnicity. In addition to this lack of documentary evidence, there is little visual material available, particularly in the early years of the Society before the widespread introduction of photography.

But we didn’t let that stop us. When we look through the records, we can see tantalising glimpses of stories that we can use as a starting point for our research. The earliest specific reference we have found in the Society’s archive is the arrival of the first black African student at the School of Pharmacy in 1847, as noted in the report of the Annual General Meeting of May 1848, which reflects the attitudes of the time:

It is also gratifying to find that some have come from distant countries, and one of these, an intelligent African, is probably the first native of that soil who will apply a knowledge of Chemistry acquired in an English School, with the view of promoting the arts of civilization among his colored brethren.”

But who was this student? Frustratingly he isn’t named, but he may have been Joseph Mailloux. The Society published its first list of ‘Foreign Life Members’ in the Pharmaceutical Journal in 1856 and Joseph is listed as having been admitted to membership in 1847. He was based in Mauritius, which at that time was a British colony. His certificate number of 28 shows that he took and passed one of the Society’s exams, so would have been studying at the School around the time referred to in the above report.

Despite poring over the various resources available to us, we couldn’t find out much more about Joseph Mailloux. He remains on the Society’s register until 1877, so seems to have had a 30-year career. An annotation in the Registrar’s copy of the register confirms that his removal was because he had died, but no obituary was published in either the Pharmaceutical Journal or the Chemist and Druggist, a familiar story with international members of the Society at this time.

There is still a lot of work to do in terms of including more marginalised voices in the museum. Hopefully this blog has shown that there are stories to be told and histories to be revealed – we just need to keep on digging to find them and highlight diversity in the profession.

RPS at Conservative Party Conference

By Sibby Buckle FRPharmS, Chair, Pharmacy Digital Forum and English Board member

Sibby Buckle and John Lunny with the Secretary of State for Health, Matt Hancock

A rainy Manchester was the setting for this year’s Conservative Party Conference. The slogan “Get Brexit Done” emblazoned across the outside of the convention complex to greet the mix of party members, campaigners and lobbyists. It was a recurring message throughout the proceedings, with the party of government looking to focus on issues other than Europe, but Brexit still dominated much of the speeches and debates.

With a new Prime Minister, a reshuffled Cabinet, and continued speculation over a potential general election, the backdrop for this conference was far from usual. Indeed, after a Supreme court ruling, Parliament itself was still sitting while the conference was going on. Would opposition parties try to table votes so that Conservative MPs would have to travel back to London? Would there be a vote of no confidence in the Government? Would the Conference need to finish early? As it was, none of this came to pass and the party managed to set out its agenda largely unimpeded.

The policy announcement on health which received the most attention in the news was for the extra £13.4Bn funding for hospital infrastructure, but there were lots of other events and debates in the conference fringes as well.

I was delighted to join representatives from a number of Royal Colleges at a roundtable on workforce, hosted by the Royal College of Physicians and the British Medical Association, as well as Health Committee member Andrew Selous MP and Marcus Fysh MP. The discussion focused on how to make the NHS the best place to work and how we can support recruitment – a key theme of the Interim NHS People Plan. This is a big focus for the RPS, looking at a range of issues such as education and training, recruitment into new roles such as in primary care networks, and how pharmacists’ mental health can be supported in an often-pressurised work environment.

I also raised the need for funding for Community Pharmacists to train as Independent Prescribers (IP’s) to help ease the pressure on GP’s, and encourage the public to visit their ‘Pharmacy First’. This is becoming more pressing as the move to give prescribing rights to Physicians Associates, Anaesthetists Associates, and Clinical Scientists increases. I don’t want our Pharmacy profession left behind!

Fringe Events

At an NHS Confederation fringe on “The NHS in a post-Brexit world” with Vicky Ford MP, a member of the Science and Technology Committee, I highlighted how pharmacists are key to helping patients access their medicines, particularly in the event of potential shortages. Indeed, we have already had the first ‘Serious Shortage Protocol’ (SSP) announced.

I then hot-footed it to a roundtable with Turning Point on health inequalities and the Government’s prevention green paper, using this opportunity to flag the need for an agreed mechanism for Pharmacists to be enabled to, and fully engage in, ‘social prescribing’.

Health Secretary Matt Hancock MP spoke really positively about pharmacy later that day “in conversation” with the Centre for Policy Studies. When asked about the new announcement on hospital funding, he went on to highlight the importance of supporting prevention and how pharmacists can play a vital role in helping people stay healthy and out of hospital, as well as treating minor ailments in the community and taking pressure off GPs. He welcomed the direction of travel set out in the new community pharmacy contract so that pharmacists can provide more services and said he hoped this would be further expanded in future to make even greater use of pharmacists’ clinical skills.

It was great to hear the message getting through about how pharmacists will be really important to helping deliver the NHS Long-Term Plan. With the “final” NHS People Plan expected in the coming months, we’ll keep talking to Government and the NHS about supporting the profession to get the best results for our patients.

Yes, a conference focused on Brexit, but with Health still firmly on the agenda.

Your introduction to drug safety

By Professor Saad Shakir, Director at Drug Safety Research Unit

We are delighted to be joining forces with the Royal Pharmaceutical Society to provide this course to introduce pharmacovigilance to pharmacists. Pharmacovigilance is defined by the European Medicines Agency as “the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other medicine-related problem.”

Monitoring safety and pharmacovigilance are key activities during the lifecycle of a medicine, both at the pre-marketing stage and once it is licensed for use in humans. No medicine is without risk of adverse effects and the science of drug safety involves assessing and optimising the risk-benefit balance for each medicine.

This course will detail the key role that pharmacists have to play in pharmacovigilance and will explain why it is important to report adverse drug reactions and methods for doing so. Presentations will be complemented by interactive sessions.

Routine risk minimisation measures are required for each drug and include the SmPC, PIL, packet size and the legal state. For products where these are considered insufficient, additional risk minimisation measures will be required in order to optimise the risk/benefit balance and maintain patient safety in everyday use of the drug. Community pharmacists are frequently involved in additional risk minimisation measures usually at the point at which a medicine is dispensed. For example, pharmacists may be asked to keep a log to indicate whether they have provided a patient card to the patient with their medicine (in addition to the PIL) and explained its use. The patient card may list serious potential side effects and actions to be taken in the event of occurrence.

This blog aims to provide you with a glimpse of the course. We do hope that you will be able to join us!

Book your place now

https://events.rpharms.com/website/672/home/

Thinking of a career in drug safety?

By Dania Shamil MPharmS, MSc, PV Manager of International Pharmacovigilance and UK QPPV at Vertex Pharmaceuticals

Having worked in various sectors of pharmacy including hospital, community and academia I found my passion in drug safety and the pharmaceutical industry. I wanted to improve my technical knowledge in drug safety, therefore I completed an MSc in Pharmacovigilance (PV) soon after my MPharm degree at the Drug Safety Research Unit (DSRU). I recognised that I had a great career ahead and my enthusiasm grew knowing that I could ensure patient safety by monitoring the adverse effects of marketed or investigational drugs. It is a great career for a pharmacist as you are still able to use the scientific knowledge gained in a MPharm degree, as well as develop new skills.  drug safety it is a very important role in the drug lifecycle! With the increasing changes in drug safety regulations globally, I am continuously developing my technical PV knowledge as well as my analytical skills, which is the central theme in a PV career. No two days are the same! 

I am the founder and leader of the ‘Thinking of a career in drug safety course’. It is a new and exciting course for anyone interested in a career in drug safety. Previous experience is not required. The course helps pharmacists understand the opportunities that the pharmaceutical industry presents.

The course is taught by leading experts who have extensive experience in drug safety and who will share their insights and provide advice for the array of career options. The course will introduce the importance of drug safety, how this affects patients and what it is like to work in a patient safety department. Practical workshops will give delegates an understanding of the ongoing and proactive drug safety activities which are taking place in the patient safety departments and the key partnerships with health authorities to ensure that the patients are safe whilst they are taking medicines.

Dania Shamil MPharmS, MSc, PV Manager of International Pharmacovigilance and UK QPPV at Vertex Pharmaceuticals.

RPS at Labour Party Conference

by Jonathan Bisby

The Labour Party Conference was back in Brighton for their 2019 event. But this was not a usual political setting. And as the Supreme Court hearing on the Tuesday ruled that parliament had been suspended unlawfully, the conference atmosphere seemed focused on matters elsewhere.

But even in this environment, the party was able to explicitly set out some of its key policy agenda and health received a great deal of traction from figures within the shadow cabinet. Even before I arrived at the conference, the Shadow Health Secretary Jon Ashworth had already announced that a Labour government would scrap prescription charges for patients in England, like they already are in Wales and Scotland. As a member of the Prescription Charges Coalition, a group of nearly 40 health organisations, the RPS has long called for an end to these charges and is something that we would welcome. Leader Jeremy Corbyn used his closing speech to outline his ambition to introduce a state-owned drug company to provide cheaper, generic medicines for the NHS, citing the cystic fibrosis drug Orkambi as a prime example of medicines being too expensive for the NHS to fund. The RPS is now awaiting further details on how this would potentially work in the future.

Fringe Events

As expected, a lot of the events that I attended focused on the challenges to healthcare posed by Brexit. The Shadow Health Secretary, like many other MPs, repeatedly emphasised how a no deal Brexit would leave the UK significant medicine and staffing shortages. Workforce was also a theme across the conference, specifically analysing government funding and the implementation of the NHS Long-Term Plan. At a Fringe on “Wearables, WiFi and Workforce: Is the NHS fit for the future?”, I was delighted to hear from panel members highlighting their concerns to MPs regarding current healthcare conditions, such as why a lack of basic digital capabilities in patient records across sectors may tamper with future NHS development. This is a key topic for the RPS at the moment and we will continue to engage with stakeholders about what new technology could mean for pharmacy.

The high-profile policy proposal made by Shadow Chancellor John McDonnell of a National Care Service, which would provide free care to all over-65s meant there was also many events on social care. At an event titled “Is now the time for a Nye Bevan moment in social care?”, which the panel included Julie Cooper MP, Shadow Minister for Health and an officer on the All-Party Parliamentary Group for Pharmacy, questions were raised regarding staff recruitment in new roles across new NHS systems. It was a great pleasure to introduce myself on behalf of the RPS and speak to MPs about the important role pharmacists play in supporting patient health by preventing and detecting conditions, as well as publicise recent RPS campaigns on a variety of topics, such as our recent diabetes and cardiovascular disease reports. With the ever-growing possibility of a general election in the coming months, we’ll continue to talk to MPs about what they will do to help support and raise the profile of the profession.

Our mentoring relationship

Being a mentee: Aamir Shaikh

I met my mentor Aamer Safdar whilst working at Kings College London. I was the 3rd year Professional Lead, and was introduced to him and he told me about his background, both personal and professional.  Just by listening to him, I knew that his values were similar to my own. 

Challenge

I now work at BUPA as the Chief Pharmaceutical Officer’s Clinical Fellow, but before that I worked within the Education Directorate at RPS.  It was there I worked alongside Aamer in projects involving undergraduates.  You will hear that pharmacy is a small world and this is one such example!  My manager explained how it is important to work alongside colleagues who will challenge your thinking and I found this in Aamer.  Our mentor/mentee relationship first established when we went out for dinner as a post-work group; it was here when I decided to formalise my mentor/mentee relationship with him. 

Benefits

I’ve benefited greatly from the mentor/mentee relationship. It’s given me thinking space but its been advantageous to both my personal and professional life to have someone to challenge my own thinking in whatever situation or scenario I am experiencing.  In our last meeting Aamer and I spoke about authenticity, congruence and integrity.  I found it particularly useful hearing from someone in Aamer’s position, a current GPhC Council member and previous RPS English Pharmacy Board member, about how important it is to stay true to your own values and what these values really mean.

We use the RPS mentor platform to record our meetings and have found that, as well as the normal methods of keeping in touch, the platform has been beneficial in keeping us focused. I couldn’t stress the importance of having a mentor enough.  It has really helped me focus whenever I have found myself in a sticky situation and I’m grateful for the time Aamer has shared with me.

Being a Mentor: Aamer Safdar

I have been a mentor to many people inside and outside of pharmacy and have used a variety of methods with my mentees which have included traditional face to face sessions as well as mentoring exclusively by email and by phone; in the latter two cases, I never met my mentees in real life until much later in our relationships! 

I currently mentor two pharmacists, at different stages in their careers, using the RPS mentoring platform.  The platform is useful because I have outlined the areas in which I would like to mentor in to manage my mentees’ expectations. 

Sharing experiences

In both of my meetings, we spoke about our careers and challenges at different levels and I was able to share my experiences and wisdom from both my day job and from being in national boards.  Much of my wisdom has come from my own mentors, who have been different people at different stages of my career,and with different perspectives and advice.  Without a mentor to bounce things off, I doubt I would have done many of the things I have done in my career.

Find out more about our mentoring scheme exclusively for members

What did I write in my peer discussion?

By Chris John

The windscreen wiper (yes my car only has one) was hypnotically moving back and forth as I waited for the Bournemouth to Swanage car ferry to get me across Poole harbour for the start of my summer holiday. It was 10am, 12 degrees centigrade and lashing down with rain. I opened a flask of coffee and wondered why I had put sandals on that day (no not with white socks). At least I had managed to get my peer discussion written up before driving down the M3.

I’d followed the instructions carefully when writing it (I have been known for not reading exam questions properly). I gave the name of my peer, her role, organisation, contact number and email address. Then I wrote how my peer discussion had changed my practice for the benefit of service users – I began by explaining my role on a panel (committee) that I was part of, which assessed the education of schools of pharmacy, medicine, nursing and other healthcare courses. It was my role to provide advice on pharmacy professional education and help score undergraduate courses (bronze, silver or gold) by using a set methodology looking at lots of data and written submissions. In this case, the other members of the committee were my service users and the advice I gave them was hopefully beneficial as it would support robust decision making and awarding the right medal!

My peer RX had asked in the peer discussion how I knew I was up to date in order to provide appropriate advice. RX had also asked me what the other panel members thought about my input to the panel. So, I went away after our session and re-read the initial education training standards (and the proposed ones) for pharmacy as well as the standards for medicine and nursing. This helped me understand approaches across the professions (there were similarities). I also read some research about pharmacy students’ readiness for practice and education approaches that supported their entry into the profession. The panel had a discussion at the end of all our meetings about my role (and those of the other professional representatives) and described the input as very useful. All decisions were ratified – sometimes with a vote but usually following a discussion of the evidence presented. I had been able to highlight up to date practice and felt satisfied with the advice I had given.

The summer is now nearly over. RX has got a new job so I will need to change all her contact details in my peer discussion record. The car ferry broke down later that summer. I hope the GPhC website doesn’t have a broken drive shaft! I need the inter-webular to ferry my revalidation records off to them before too long…

If you would like more information about Peer Discussion – take a look at our peer discussion tutorial.

https://www.rpharms.com/development/revalidation/peer-discussion/peer-discussion-tutorial