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. 

Visit the RPS Museum Mon-Fri 9am-5pm

Improving antibiotic resistance in Ghana

Contributors from Korle-Bu Teaching Hospital in Ghana: Dr Daniel Ankrah, Mark Harrison, Tony Osei, Priscilla Ekpale, Julia Selby, Jennifer Laryea, Asiwome Aggor, Frempomaa Nelson, Helena Owusu, Grace Aboagye and Agnetta Ampomah

The Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) educates, trains and supports overseas health workers to tackle the growing challenge of antimicrobial resistance. Partnerships are running in Ghana, Tanzania, Uganda and Zambia, with the support of UK health workers including pharmacists.

Here, the Korle-Bu Teaching Hospital in Ghana – North Middlesex University Hospital NHS Trust (NMUH) partnership to explore their motivations and hopes for their project.

Read more Improving antibiotic resistance in Ghana

Professional Standards – committing to change and improvement

By Suzanne Scott-Thomas, Chair of RPS in Wales

Professional standards are central to improving practice, creating a more responsive service for our patients and increasing efficiencies.

Part two of this blog on the value of professional standards highlights another example of how using the RPS Hospital Pharmacy Standards has helped reshape a service, along with tips on creating change and improvement.

Read more Professional Standards – committing to change and improvement

Improving care with professional standards

by Suzanne Scott-Thomas, Chair of RPS in Wales

As pharmacists, we need to know that the services we provide are effective, safe, and efficient. This way we can make sure patients are getting the care they need and deserve. We also need to know that the services are continuing to meet the requirements of an ever-changing healthcare environment.

Read more Improving care with professional standards

Social prescribing – linking patients with support

by Hemant Patel FRPharms, English Pharmacy Board member

Today is Social Prescribing Day. So, what is social prescribing?

Social prescribing enables GPs, pharmacists, nurses and other primary care professionals to refer people to a range of local, non-clinical services via a link worker.

Social prescribing schemes can involve a variety of activities which are typically provided by voluntary and community sector organisations. Examples include volunteering, arts activities, group learning, gardening, befriending, cookery, healthy eating advice and a range of sports.

Link workers give people time and focus on what matters to the person, and as part of their care, connect people to community groups and agencies for practical and emotional support.  With the recent publication of the NHS Long Term Plan and personalised care being marked as a priority, the NHS has promised to support at least 900,000 people to benefit from social prescribing by 2023. Pharmacists have a role to play here. Read more Social prescribing – linking patients with support

Women in early pharmacy

By Matthew Johnston, RPS Museum

“There is an impression that women are something new in pharmacy, but nothing could be further from the truth.”

These were Jean Kennedy Irvine’s words on her election as the first woman President of the Royal Pharmaceutical Society in 1947.

Medieval monasteries

In her speech, Jean also mentioned the early beginnings of community pharmacy in the medieval monasteries, where residents would grow medicinal plants to treat themselves and local people.

One of the oldest items on display in the RPS Museum is a stone mortar from a Spanish nunnery (AD 410-1500), used for preparing medicines. The Hanbury Collection of the RPS Library also contains a later copy of the ‘Physica’, a work by St Hildegard, Abbess of Bingen. Originally written in the 1100s, it outlines the medicinal properties of various drugs obtained from the natural world. Read more Women in early pharmacy

I am what I am! LGBT History Month

By Mike Beaman, FRPharmS, retired pharmacist

I am writing this blog in support of the Royal Pharmaceutical Society’s response to LGBT History Month.  Although not a gay activist I have, nevertheless, been generally open about my lifestyle since coming to terms with being a gay man back in the early 1970s.

I was born in 1947 so I was 19 and a university undergraduate when the legislation decriminalising homosexuality became law in 1967. I was already a young adult and therefore having an intimate relationship with another man before that time would have been a criminal act and would also have resulted in my being sent down from university and unable to eventually register as a pharmacist. Read more I am what I am! LGBT History Month

Biosimilar adalimumab is a test of shared decision making in the NHS

Co-written by the National Rheumatoid Arthritis Society, National Ankylosing Spondylitis Society, RNIB, Birdshot Uveitis Society, Psoriasis Association and Crohn’s & Colitis UK

The entry of new biosimilars and the creation of an NHS ‘local market of treatment options’ will see significant numbers of patients switched from the originator product, Humira, to one of four biosimilar alternatives this year.

Adalimumab is one of several biological drugs used in the treatment of autoimmune inflammatory diseases, including rheumatoid arthritis, ankylosing spondylitis, psoriasis, psoriatic arthritis, non-infectious posterior uveitis, Crohn’s and colitis.

While some patients will take this in their stride, for others the change will be met with feelings of apprehension. Read more Biosimilar adalimumab is a test of shared decision making in the NHS

Polypharmacy – what is it and why is it important?

By Clare Howard, FFRPS FRPharmS, lead author of the RPS guidance Polypharmacy: getting our medicines right

What is polypharmacy?
We know that medicines have an enormous, positive impact on the lives of millions of people. But as more of us live longer, with multiple long-term conditions, we take more and more medicines. Taking many different medicines at once can become either a practical challenge or increase the likelihood of harm, or both.

Problems with polypharmacy happen when: 
• Medicines are prescribed that are no longer clinically indicated, appropriate or optimised for that person
• The harm of a particular medicine outweighs the benefit
• The combination of medicines being taken has the potential to, or is actually causing harm to the person
• Where the practicalities of using the medicines have become unmanageable or are causing harm or distress.  Read more Polypharmacy – what is it and why is it important?