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

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 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.

Join the RPS team!

 By Gareth Kitson, RPS Professional Development and Engagement Lead

My role at the RPS is vast and varied, it is a challenging but exciting post that allows me to connect with pharmacists across England.  One aspect of my role is to provide support to our RPS Local groups (Local Practice Forums).  RPS Locals help members engage with the RPS in their local areas.  They aim to give members the opportunity to meet others face to face, provide peer support and networking opportunities (extremely valuable for the upcoming revalidation requirements) and offer professional support to pharmacists regardless of their career stage.  In what other setting can a pre-registration speak to a newly qualified pharmacist about life as a practicing pharmacist, who can also talk to a chief pharmacist about their career pathway?  If you are not involved in your local group thenI’d encourage you to take a look at our website and find a group that is local to you and start to engage!

Since starting in post, I have heard that people are very passionate about the RPS but many members would like us to shout louder about all the great work that we do.  We can do this through a variety of ways, such as the website, emails or social media, however nothing substitutes face to face discussions.  Enthusiasm is infectious and we want people who are enthusiastic about THEIR professional body to help demonstrate the benefits to others and showcase the variety of tools and materials we create to help support all pharmacists.  I, like my colleagues, do this every time we meet a pharmacist, be they a member or not, but I want us to be able to do this as frequently as possible in as many different settings as possible.

Therefore, we’ve put our thinking caps on and created a new role – The RPS Ambassador.  This will be a new way of trying to reach out and engage with members across England.  This role is very varied and will primarily be introduced in areas of England that are geographically large, or areas where engagement opportunities exist and the RPS voice needs to be heard more frequently than we are currently able to support.  The ambassador will be affiliated with the local area in which they either work or live, to ensure that they understand the needs of our local members.  They will work closely with their own existing networks and with any other networks in their areas, including our RPS Locals to promote the excellent work of the RPS.  We would love to invite applications from pharmacists from a variety of backgrounds to represent the true breadth and depth of the profession and would love someone who is comfortable using and engaging with members and non-members on social media.
The role we have in mind can be found here. If you are self-motivated, passionate about pharmacy and also, passionate about the RPS then this role could be for you.  It will be a voluntary role, but we will set aside £1000 each year to say thanks for all your hard work and dedication.

We will provide you with all the resource you need to be a success, including presentations, printed materials and resources to showcase our work.   If you are interested in this role, please send us a CV and tell us something about yourself and how you can help us spread our good work. This might be a blog, a short video, a more traditional covering letter or anything else you think might catch our eye. Be innovative and original and show us your passion for the RPS!

Antimicrobial resistance – Are we losing the battle against bacteria?

By Dr Claire Thompson, RPS Deputy Chief Scientist

Meeting with world health officials in October, Prof Dame Sally Davies, England’s Chief Medical Officer, repeated her warning that if antibiotics lose their effectiveness it would spell the end of modern medicine.

It has been 18 months since Jim O’Neill made his final recommendations on how we can tackle antimicrobial resistance (AMR) globally.  These included the need to:

– Increase public awareness of AMR;
– Reduce the over/inappropriate use of antibiotics;
– Prevent the spread of infections;
– Increase research into new antibiotics by generating a $2bn Global Innovation Fund.

Since then, little has changed within the UK.

At the BioInfect 2017 event Jo Pisani, Pharma & Life Sciences Partner at PwC, gave her state of the nation address on antibiotics and was disappointed to see that little has changed in the pipeline of new antibiotics since the O’Neill reports. “The UK has opportunity to be world leader in antibiotic development, but with so few companies involved in antibiotic R&D, how do we advance the pipelines?” she said.

Source: Antimicrobial resistance: The state of the nation report on UK R&D. PwC. https://www.pwc.co.uk/industries/healthcare/insights/antimicrobial-resistance.html

Where are the new antibiotics?

At the moment, there are less than 100 scientists in the Pharma Industry who are working on new antibiotics. This is mainly due to the lack of reimbursement models for antibiotics.

There have been calls for new models and incentives for developing antibiotics, such as exclusivities on market entry akin to those which are in place for orphan drugs or paediatric medicines, but these are yet to come to fruition.

This means that organisations such as the AMR Centre, charities such as Antibiotics Research, and small companies like Auspherix are leading the charge in developing new antibiotic medicines.
In order to progress the development of new antibiotics, we need to stop focussing on what they are going to cost and start thinking of cost of not having them.

What are we doing to combat AMR?

The key to overcoming AMR is not just about new antibiotics; improving stewardship and raising awareness are imperative. As a profession, these are some of the activities we are involved in.

Public engagement and awareness
With 1.6 million pharmacy visits per day, pharmacists are perfectly positioned to talk with patients and the public about what antimicrobial resistance is, when antibiotics are required, and how to take them. The Test and Treat service at pharmacies is under-utilised. Currently, people aren’t aware of it and don’t know they can talk to their pharmacist.

Antimicrobial Stewardship Programme
In September, the RPS launched the Antimicrobial Stewardship programme  which contains reference, guidelines and support tools for pharmacists.

What impact can we have?

In 2016, Government set a challenge of reducing inappropriate antibiotic prescribing by 50% by 2020. Pharmacists are integral to this. As a profession, we still have some work to do to ensure that the public know that they can talk to pharmacists about health concerns and to get advice on medicines. But the impact we can have as pharmacists (on raising awareness and providing stewardship) and as pharmaceutical scientists (in developing new antibiotics) is enormous.

A tweet from the BioInfect 2017 summarised this perfectly “Great way to cut queues at your GP. Talk to your pharmacist and conserve our antibiotics”.

Contrary to the saying, resistance is not futile – it is rife. But the war on bacteria is not over! Please play your part.

Mother was right!

“Wash your hands when you come in”, “Make sure you wash before dinner”, “Show me your hands” – just some of the echos of my childhood which I’m sure many of you recognise.
Ahead of World Antibiotic Awareness Week  and European Antibiotic Awareness Day  I spent much of my time at the RPS researching, collating and checking resources to support antimicrobial stewardship for the RPS AMS Portal.
I learnt a lot and guess what – our mothers were right!  One of the simplest ways to reduce the use of antimicrobials is hand washing (or hand hygiene as it is referred to in healthcare settings).  Not just to remove visible dirt but to remove bacteria and viruses which could cause infections such as upset stomachs, coughs, colds or pneumonia. Washing your hands properly should take 20 seconds, as long as it takes to sing “Happy Birthday to you” twice.
Simple you think – but wait – the RPS Handwashing essential guide states that 84% of British adults don’t wash their hands for long enough and 65% of people don’t always wash their hands before eating. The infographic below has other figures which make uncomfortable reading.

I mentioned these gruesome figures one evening at home and an unexpected consequence was that my daughter, who teaches a Year 2 class, was interested in using this information at school in some way.  I suggested having a look at the e-bug resource (another resource found during my AMS research) and together with the ‘handwashing and mouldy bread experiment’ (look it up on youtube!) she formulated a lesson plan.  The children loved it – and it became a feature of their end of term assembly.
So, what started as a literature review style research project on antimicrobial stewardship and resistance ended up as a theme for a school assembly.  It illustrates that antimicrobial stewardship belongs to us all – organisations, health professionals and all ages of members of the public.  Now, during World Antibiotic Awareness Week, take some time to have a look at the AMS Portal.  This is essentially a signposting resource linking to antimicrobial stewardship resources under six key categories: strategy, policy and guidance; clinical and technical guidance, initiatives and campaigns, training and educations resources, journals; and organisations.  The AMS Portal focuses on GB resources for pharmacists and pharmacy teams although we recognise the need to signpost to worldwide information and resources from outside GB are also included.
Have a browse – you might even find yourself influencing another school lesson or even humming ‘Happy Birthday to you, Happy Birthday to you………………….’!

Integrative medicine approach to treating cancer patients

By Louisa Davies, Senior Clinical Oncology Pharmacist at University College of London Hospital

I love my job! I’ve been a qualified clinical pharmacist for 12 years and am very fortunate to work at the wonderful Macmillan Cancer Centre at University College Hospital in London as a specialist oncology pharmacist. I find it immensely rewarding as every day is an opportunity to support someone along their cancer journey.

I have a personal interest in wellness and the growing use of supplements for health and over the past few years I have seen more and more patients adopting an integrative approach to their cancer care. At UCLH we recorded that around 35% of patients we saw in clinic were taking or wanted to start taking supplements to improve their side effects or boost their immunity whilst on anti cancer therapy. Read more Integrative medicine approach to treating cancer patients

Revalidation for pharmacy professionals

By Nigel Clarke, Chair, General Pharmaceutical Council

Over the past three years, the General Pharmaceutical Council has done a great deal of work on professionalism – how to ensure that the standards we set support professionalism; and, as important, how to assure patients and the public that registrants are upholding these standards and keeping up with their knowledge and skills, and with new developments in the professions.

This work has coincided with a period of change in the pharmacy sector – changes in the healthcare landscape, the role of pharmacy and the expectations placed on pharmacy professionals; and changes in the core knowledge and skills required to deliver safe, effective, person-centred care.

As a part of this effort, we have engaged with members of the profession, with patients, and with other healthcare professionals to hear their views on professionalism, and, in particular, how they can be assured that pharmacy professionals have up-to-date knowledge and up-to-date understanding of issues affecting healthcare, pharmacy and the way care is delivered.    Based on their feedback, and underpinned by the findings in the pilot programme we undertook last year to test our approach, we have proposed to introduce revalidation for pharmacy professionals.   That proposal is the subject of our recent consultation on revalidation.

.    Our approach aims to do away with exhaustive record keeping and ‘tick-box’ exercises – which many registrants felt were no longer fit for purpose, and the public find hard to equate with professional development – and introduce a more thoughtful approach to ensuring that professional development is not just documented, but embedded in practice.    Our proposal incorporates peer discussion, and reflection on the GPhC’s standards for pharmacy professionals and registrants’ individual practice to provide meaningful reassurance to the public that real learning and improvement are taking place.

Among the key changes we are proposing with revalidation are: reducing the number of required CPD records from nine to four; conducting a peer discussion with a colleague or someone who understands your work; and writing a reflective account detailing how you are meeting one or more of the standards for pharmacy professionals. We are also proposing that, rather than ‘calling’ records periodically for review, the GPhC would require them to be submitted annually; with a small sample (about 2.5 per cent) randomly selected for review.

This approach is designed to underpin the professional approach of pharmacists and pharmacy technicians, and reflects too the way in which other professions are now engaging in revalidation. It is based upon the view that a consistent pursuit of improvement in practice is the best way to ensure ongoing high standards within pharmacy, and with it greater safety for the public and patients. During our initial pilot, this approach has been widely supported by the professionals who took part.

I would encourage all pharmacy professionals to weigh in with their views on our proposal.  Have there been any points or considerations that we’ve missed?  Are there any changes that we need to make?  Are there emphases that we’ve not properly understood?

And while it is likely that the final plan will not come into effect until 2020, pharmacy professionals can and should begin to prepare themselves now for the inevitable changes that will come from this effort.

As a start, I would encourage all registrants to read the new standards for pharmacy professionals, which sit at the heart of the proposals for revalidation.   Understanding the standards and thinking how they can and should be embedded in practice will be an important best practice to embrace in preparation for revalidation when it comes into effect.

Registrants can also begin to talk about their practice with their colleagues and peers.  The idea of a ‘peer discussion’ may feel daunting at first, but many of our pilot volunteers realised they were already having these kinds of conversations, albeit informally, and that the candid insights and advice they received helped to improve their practice.    So, I would urge you to reach out to colleagues and peers, or perhaps tap into the resources available to pharmacy professionals, such as the RPS Faculty, and start these conversations.

Revalidation will be an important step for the pharmacy sector and for the GPhC as its regulator.   Aside from assuring the public that pharmacy professionals are maintaining high standards of practice and improvement, our revalidation proposal represents our commitment to regulating in a way that is flexible, that supports professionalism and that is fit for today’s pharmacy and healthcare environment.  I look forward to sharing some of the feedback we hear from our consultation when I speak at the RPS conference in September.   I hope to see you there.

Better information on patient information leaflets

By Professor D.K Theo Raynor, Professor of Pharmacy Practice, University of Leeds
A new report published by the Academy of Medical Sciences says that medicine information leaflets are too scary with too much focus on the potential side-effects of medicines and not enough on their benefits. The report calls for them to be rewritten to give a more balanced view.

This is a comprehensive and thoughtful report looking at enhancing the use of scientific evidence to judge the potential benefits and harms of medicines. Of particular interests to those working in Pharmacy are the recommendations relating to patient information leaflets (PILs) – found in the pack of every medicine dispensed in the UK. The key recommendations relating to ‘Improving the content of PILs’ are:

• All parties to improve the comprehension and readability of patient information leaflets in line with the current legislation.
• This should ensure a balanced appraisal of the medicine’s potential benefits and risks is made accessible in these documents.

These recommendations echo the recent report for the European Commission on the ‘shortcomings’ of PILs produced by the Universities of Utrecht and Leeds.(1) Not mentioned in the Academy’s report is that for more than 10 years, manufacturers have had to ‘user test’ their PILs with lay people – so they are already ‘revised in consultation with patients and carers’. Despite this testing, further improvements are needed, with a more rigorous application of the user testing process, ensuring that it is iterative – with repeated testing and improvement until the required level of readability is reached. Read more Better information on patient information leaflets

A medicine review is about stopping medicine as much as it is about prescribing

By Dr Mahendra Patel, English Pharmacy Board Member

The RPS has published a joint report with RCGP on polypharmacy “The challenge of polypharmacy: from rhetoric to reality”. The report is a practical guide for the delivery of improved care and increased safety of our patients.

Multimorbidity is perceived as an inevitable consequence of an ageing population, with increasing ‘polypharmacy’ necessary to prevent complications arising from long term conditions.  Patient conditions are often treated individually and they are prescribed medicines accordingly. However, medicines that were once prescribed may no longer be necessary as well as in some instances new medicines may not be required. Pharmacists have a key role in supporting patients to get the most out of their medicines and ensure that they are only taking the medicines that they actually need. Read more A medicine review is about stopping medicine as much as it is about prescribing