World AIDS Day 2018: When a friend has AIDS

by John Betts, RPS Museum, Keeper of the Museum Collections

The history of pharmacy is usually thought of in terms of drug development and its ability to transform patient’s lives. Rarely do museums have an object in their collection that communicates what it was like to live with a life-threatening illness before there were any effective treatments.

The RPS Museum has a leaflet published by GMHC (Gay Men’s Health Crisis) in 1984, at the beginning of the HIV/AIDS epidemic, which does just that.

When A Friend Has AIDS provides advice to the friends of people living with AIDS on how they can offer them support.

Written with a great deal of compassion, it gives a moving insight into what living with HIV/AIDS was like at this time, from both the patient’s and friend’s point of view. Reading it never fails to move me to tears. Read more World AIDS Day 2018: When a friend has AIDS

How does the Faculty help Pharmacist Independent Prescribers?

By Rob Davies, Pharmacist Independent Prescriber and member of the Welsh Pharmacy Board.

Practice as an Independent Prescriber (IP) involves continuous learning, continuous quality improvement if you like, to ensure that practice always advances to meet patients’ needs.

I see the link between the RPS Faculty and the IP role as a virtuous circle. Prescribing helps my Faculty portfolio, which in turn helps my continuous development as an IP. My prescribing role, subsequent mentorship of colleagues and teaching contributed to my Faculty portfolio, particularly in clusters 1 and 5, ‘Expert Professional Practice’ and ‘Education, Teaching and Development’. Read more How does the Faculty help Pharmacist Independent Prescribers?

Putting antimicrobial stewardship in a global context

By Diane Ashiru-Oredope, Global AMR lead, Commonwealth Pharmacists Association

The independent Review on Antimicrobial Resistance estimated that at least 700,000 deaths each year globally are attributable to drug resistance infections such as bacterial infections, malaria and HIV/AIDS. Unless action is taken, it is thought the burden of deaths from AMR could balloon to 10 million lives each year by 2050 and cost the global economy up to $100 trillion US Dollars.

To help address this, the Department of Health, through the Fleming Fund, has just launched the new Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) scheme. This pioneering pharmacy-led initiative will send up to 12 volunteer teams of NHS pharmacists and specialist nurses to Ghana, Tanzania, Uganda and Zambia to work with local health workers to jointly tackle AMR. The scheme is now open for applications.

CwPAMS will help improve the detection and monitoring of resistant infections at the hospital level, take measures to reduce infection and put in place steps to use antibiotics effectively – all of which will help to keep antibiotics working better for longer whilst helping to stop the emergence of superbugs. The scheme is being led by The Tropical Health Education Trust and the Commonwealth Pharmacists’ Association (CPA) and is looking for multi-disciplinary approaches that involve pharmacy.

How will CwPAMS build capacity in AMS?

The CwPAMS programme will apply skills and knowledge from UK pharmacists to support capacity building for AMS in partner institutions. One important aspect of this is improving monitoring of antimicrobial consumption.

Robust monitoring mechanisms are required to help make informed decisions on where to focus efforts to reduce unnecessary use of antimicrobials, and assess the impact initiatives are having. Whilst monitoring both antimicrobial consumption is included in all national action plans on AMR, the capacity to implement this in most low and middle income countries is low. Enhancing monitoring capacity for AMS can also support building wider systems capacity and enable more effective stock control.

How will the CwPAMS scheme benefit pharmacists in the NHS?

There are important benefits for NHS pharmacists not to overlook when considering whether to apply, including:

  • opportunities to develop frugal yet innovative solutions to share with the UK 11/9/2018
  • improved leadership capacity
  • increased job satisfaction
  • improved understanding of digital technology in health
  • greater understanding and experience of working with limited resources and appreciation of the cost of resources within the NHS
  • opportunities for professional development.

How can you get involved and what support is available?

CPA are encouraging pharmacists to apply for this new and exciting opportunity. We recognise applying for grants can seem daunting to those not well immersed in doing so; the RPS are able to offer a range of valuable support in preparing applications. Contact the RPS Research Support Service or email research@rpharms.com.

CPA & THET will also be providing training for those who are awarded grants. To find out more visit the CPA website which includes access to the grant call documents. The grant call closes on 4 January. You can also email the CPA team directly via amr@commonwealthpharmacy.org.

 

Edward Frank Harrison – a pharmacy war hero

by Matthew Johnston, RPS Museum

If asked to list influential figures in the history of the First World War, few would probably know the name of Edward Frank Harrison. But it was Harrison who was responsible for saving the lives of thousands of Allied soldiers thanks to his work to combat the threat of chemical warfare.

Born in 1869, Harrison began his career as an apprentice pharmacist in North London aged 14. He was awarded the Pharmaceutical Society’s Jacob Bell Scholarship and won prizes in the subjects of chemistry, botany, and materia medica. He passed both the Minor and Major examinations at the Society’s School of Pharmacy and registered as a pharmacist in 1891. Read more Edward Frank Harrison – a pharmacy war hero

Setting the standards for information sharing

by Stephen Goundrey-Smith, RPS Pharmacy Informatics Advisor

We are moving towards better integrated health and care in the UK. As part of the drive to support this, new pharmacy services are useful for helping people with long-term and complex conditions to stay well in the community and take their medicines properly. This in turn means people are able to take more control of their own conditions and manage them better from home, with the support of professionals when needed. However, this system can only work if it is supported by good information sharing. Read more Setting the standards for information sharing

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.

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?

Supporting System Leadership

by Amandeep Doll, RPS Regional Liaison Pharmacist

I’m one of four Regional Liaison Pharmacists at the RPS, working on system leadership for pharmacy and medicines optimisation in England, delivering national strategy at a local/regional level.

We know there is a need to bridge the gap between the strategic and operational levels of healthcare and mobilise the profession to get involved with system leadership to improve health outcomes for patients. It’s vital to ensure that medicines optimisation and pharmacy services are considered core criteria when planning and implementing healthcare services.  Read more Supporting System Leadership

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