Stephen Goundrey-Smith explains how pharmacists can benefit from mentoring and gives his recommendations for ensuring mentees and mentors get the most out of a mentoring relationship
Mentoring is a useful tool for those interested in career progression or simply anyone wanting support.
Mentoring is a one-to-one relationship of professional development, usually between someone seeking professional progression and a more experienced practitioner. This could also include someone seeking to develop new expertise and a practitioner already active in that area.
Mentoring is different from coaching in that mentoring is concerned with professional development, rather than learning specific skills but many commentators argue that there is considerable crossover between the two.
Mentoring has been shown to have a positive impact on career development in healthcare, helping to improve confidence and interpersonal skills of mentors as well as mentees. It also improves career retention rates and work performance. Moreover, work among psychiatrists showed that mentoring greatly benefited professionals who worked in multidisciplinary teams or who were isolated from their peers in daily practice. Read the full article here
by Katie Perkins, Medicines Management Adviser Hastings & Rother Clinical Commissioning Group
At the end of 2018 I took on the role of CCG medicines
management lead for antimicrobial prescribing (alongside promotion to Medicines
Management Adviser and respiratory lead). I work across two CCGs which cover 43
RPS AMS training
The RPS AMS training programme became available at just the
right time in terms of my new role and immediately before the start of our
2019/20 prescribing support scheme. I was already out and about talking to GPs
about their antibiotic prescribing and in particular three out of the 10
practices that I look after were particular outliers for antimicrobial prescribing.
The learning that I undertook as part of the course, particularly in Quality Improvement
(QI) methodology was invaluable and we were given a brilliant opportunity to
“try this out in practice” with tutor support.
My QI project
The QI project I chose was to reduce inappropriate
prescribing of antibiotic rescue packs for COPD exacerbations and ultimately
for this to help reduce the total number of antibiotic items (per STAR PU)
prescribed by the practice.
I carried out a patient level search at the practice to
identify people with COPD who were prescribed an antibiotic rescue pack on
repeat prescription. 22 people were identified and 9 of these had received six
or more courses in the preceding twelve months.
In preparation for presenting this to the practice I met
with a nurse at another practice which had robust and effective processes in
place for the issue and follow up of COPD rescue packs – this was helpful in
ensuring that I had a realistic handle on what is reasonable to expect in
I met with the four practice GPs, pharmacist and practice
manager and presented them with the list of these patients. I asked them to
review each one to determine if the antibiotic remains appropriate. I provided
them with current national guidance from NICE on this area as well as our local
Where an antibiotic rescue pack was appropriate, the GPs
were asked to consider only prescribing this as an acute prescription (not on
repeat) or, as a compromise, if they would prefer to keep them on repeat, to
consider a maximum of two issues before the patient was reviewed. I was
surprised that the practice agreed to
move all prescriptions to acute and for all new rescue pack prescribing to be
issued only on acute.
They also agreed to include instructions in the rescue pack
directions for the person to contact the surgery when they started taking it.
The practice already had a leaflet that they give out to people when they are
first prescribed a rescue pack – they now aim to give this out more
Results and impact of
my QI project
Before the QI project (February 2019) the practice was the highest prescriber of antibiotics in the CCG (total items/STARPU). The latest data from PrescQIPP (August 2019) shows that the practice has dropped to the 9th highest (out of 23 practices) and reduced their total antibiotic prescribing by 10%.
Practice bar charts Antibacterial items/STAR-PU showing 12 months rolling data to August 2019
This is likely to be in part due to the reduction in rescue
pack prescribing but I suspect that the project may also have provided a
renewed focus on reducing inappropriate antibiotic prescribing more generally.
Getting all the GPs and the practice pharmacist together
and presenting the data to them face to face really got them thinking about the
possible consequences of these repeat prescriptions. They all committed to
reviewing these patients and they have changed their behaviour when it comes to
managing COPD rescue pack prescribing.
As mentioned previously the response to my QI project proposal by the practice pleasantly surprised me and this has given me the confidence to roll the QI out to the other 42 practices across the CCGs. I also plan to look at other areas of repeat prescribing of antibiotics such as UTI prophylaxis and long term prescribing for acne and rosacea.
by Vincent Ng, Professional Development Pharmacist
This year the
UK Government updated its 5 year action plan on Antimicrobial Resistance (AMR),
which details ambitious goals such as reducing antimicrobial usage in humans by
15% and halving gram negative blood stream infections by 2024.
A major part of this plan involves improving how antimicrobials are used through Antimicrobial Stewardship, for example by reducing inappropriate prescribing. As experts in medicines and advocates for medicines optimisation, all pharmacists have a role to play.
Supporting pharmacists through training
year, we delivered a 3-month training programme to pharmacists from primary and
secondary care in London, Kent, Surrey and Sussex, funded by the Health
Education England AMR Innovation Fund. This was an exciting opportunity for us
to support pharmacists from a range of settings and scopes of practice to learn
about Antimicrobial Stewardship and get involved in their workplace.
What did the
training day delivered by national experts
improvement project in the workplace, supported by online group feedback sessions
facilitated by UKCPA Pharmacy Infection Network tutors
self-assessment and self-directed learning
of training assessment with experts from our Antimicrobial Expert Advisory
What our learners are saying
“I was given
the opportunity to be part of the AMR programme this year and found the programme
very useful. It has propelled me in the right direction with regards to leading
on AMR within my organisation. The key
resources provided during the programme and the link to a tutor gave the
confidence I needed to complete my project. My quality improvement project
involved the review of patients with UTI to ensure appropriate prescribing and
accurate documentation process. Although
the project was only focused on a small cohort it was very useful to see the changes
and improvement that was made. I have not just stopped with the project but
have also made myself an AMR champion with AMR now formally included in my work
plan. I am now creating a training matrix to increase awareness within my organisation.”
Jenkeo Olowoloba, Community Health Specialist Pharmacist, Medway Community Healthcare
“The training helped me develop my
skills as a competent and confident AMS practitioner. Participating in this
training programme enabled me to significantly improve my quality improvement
skills, extending my skills beyond audits and re audits. I demonstrated QI
methodology and embedded behavioural interventions to improve the quality of
the 72-hour antibiotic review carried out by clinicians. I also designed
a scoring tool on the Perfect Ward App to measure the quality of an antibiotic
review which led to reducing data collection time from 15 minutes to 5 minutes.
I enjoyed the entire experience and valued the constant support provided by our
tutors, RPS team and colleagues. The practice-based discussions benefitted my
practice significantly, being able to share ideas and learn from experts as
well as each other. Thank you RPS for an amazing opportunity!
Bairavi Indrakumar, Senior Clinical Pharmacist, Royal Free London NHS Foundation Trust
Take the first
step by finding out more about how your organisation is doing against key AMS indicators.
Work with your peers and colleagues to better understand how things are working.
PHE Fingertips and OpenPrescribing.net are examples of useful
open-access sources of data that you can explore.
Talk to your key stakeholders to come up with shared objectives and work together on a plan to make improvements.
Inspire and get inspiration
Why not link up
with others who are also working on AMS and AMR?
I am part of the team that has developed Sport England’s “We Are Undefeatable” campaign. It aims to support people living with health conditions to build physical activity into their lives, in a way that their condition allows, and to celebrate every victory big or small.
The TV adverts
you’ll have seen are inspired by, and feature, the real-life experiences of
people with long-term health conditions getting active despite the ups, downs
and unpredictability of their condition.
Pharmacists already play a key support role for
the 1 in 4 people now living with at least one long-term health condition. People
with health conditions are twice as likely to be inactive[i]
despite the compelling evidence for the role of physical activity in the
prevention and management of long-term conditions.
Want to get involved? Check your activation pack!
Many pharmacists are already supporting people to get active through the Healthy Living Pharmacy scheme. To help you make the most of the national campaign 12,000 Community Pharmacies in England have been sent activation packs, which include:
An activation brief providing details about the campaign and links to resources to support you to have physical activity conversations with customers. These include the Faculty of Sport and Exercise Medicine’s Moving Medicine resource (developed in partnership with PHE and Sport England), the Royal College of GPs Physical Activity and Lifestyle Toolkit and the PHE E learning for health physical activity modules.
2 A4 posters featuring Jo and Heraldo (Two of the Undefeatables).
100 conversation starters and a dispenser for these for use in the pharmacy.
Access to a campaign film for use on screens
Social media content.
Healthy Living Bonus
The great news is that these resources can also be used to help meet
the Healthy Living Pharmacy requirements linked to lifestyle advice and physical
And if the campaign inspires you to get active yourself it’s a bonus!
by Stephanie West, RPS Regional Liaison Pharmacist
In our previous blog, Nicky Gray spoke about the ‘strength and authenticity’ of relationships between stakeholders as central to successful integrated working. The same holds true when engaging the populations we serve. Promoting a positive patient experience of health and social care services, through providing integrated out-of-hospital care for patients, is a central aim for PCNs.
Community pharmacy has firm foundations to build upon. The National Healthwatch Report 2016 found that:
Three quarters of people say they would go to a pharmacist, rather than a GP, to get medication for a minor illness.
Over half would go to a pharmacist to seek advice for a specific minor illness or injury.
A third of people would consider using a pharmacy instead of visiting a GP for general medical advice.’
Community pharmacy was also the healthcare service of choice for ‘traditionally harder to engage groups.’ Significantly, the report found that participants ‘trusted the pharmacist’.
One thing that strikes me is – how are patients being consulted and educated about the increasing clinical services delivered by pharmacists? How is the patient voice being captured?
GP Practices have engaged with patients through Patient Participation Groups for many years, to make sure ‘that their practice puts the patient, and improving health, at the heart of everything it does’ These could be a useful forum to capture patient views on new ways of accessing care from the wider PCN team. If you are part of a group focussing on the role of pharmacists in the practice, please get in touch.
Community pharmacists have to conduct an annual patient survey. This focuses on traditional services and advice-giving and could be developed to raise awareness of different clinical services.
The Berwick Review called for the NHS to ‘Engage, empower, and hear patients and carers at all times’. NHS Trusts have patient and public engagement strategies, recognising the importance of capturing patient views. There are opportunities to do this, many trusts will have patient representation on their Medicines Safety Committee, but can we engage them more widely as strategies for pharmacy and medicines optimisation are developed across Integrated Care Systems?
Liberating the NHS: No decision about me without me focussed on shared-decision making. How are pharmacists ensuring that patients are fully involved in decisions about their own care and treatment? How is pharmacy linked with local communities, groups and networks? NICE Guidance identifies Shared decision-making as ‘an essential part of evidence-based medicine’ and the NHS Patient Safety Strategy 2019 commits to: ‘Commission shared decision-making (SDM) training for clinical pharmacists moving into PCNs, to work with patients with atrial fibrillation (AF) on anticoagulants’.
Get in touch
Our new System Leadership Resource section on ‘Culture Change’ includes a focus on meaningful engagement with local people. If you have a case study showing how you have improved health outcomes or developed a service through patient engagement, shared-decision making and/or co-production we would like to share your insights so please do contact us.
By Dr Duncan Petty, Member of the English Pharmacy Board
It was great to see the news this week about how the NHS plans to make greater use of community pharmacy to help prevent 150,000 strokes, heart attacks and cases of vascular dementia, supporting earlier detection and management of cardiovascular risks.
Cardiovascular disease incidence can be
reduced through better lifestyles and the optimisation of preventative
medicines, such as antihypertensives and statins to prevent vascular strokes
and ischaemic heart disease / myocardial infarction, and anticoagulants for
stroke prevention in atrial fibrillation.
NHS plans will include using pharmacists in
the community (community pharmacy and general practice-based) to work on
identification of at-risk individuals; offering lifestyle advise and supporting
long-term changes in poor lifestyle; offering or optimising preventative
medicines, and helping patients remain on these medicines. Pharmacists having
been doing this work around the UK for many years. The difference going forward
is that these services will be done in a systematic way and on a wider scale.
The community pharmacy contract could see
(subject to successful pilots and roll-out) screening services for hypertension
and atrial fibrillation. In general practice pharmacists might already be
familiar with using tools such as AlivecorR to detect AF and most
pharmacist will be able to measure blood pressures. However, to advise patients
on 10-year cardiovascular risks a cholesterol level will be needed as will skills
in using risk calculators such as QRISK 3.
For patients with a high cardiovascular risk
score, overall risk can be reduced through lifestyle (especially smoking
cessation support); reduced blood pressure (from lifestyle changes and
introduction on antihypertensives) and offering statins at an evidence-based
dose. There are plenty of examples where pharmacist have been involved in case
finding untreated and undertreated patients and offering medicines optimisation
and lifestyle support, which you can read about in our roundtable
Offering oral anticoagulants (OACs) for stroke
prevention in AF (SPAF) is more complex and requires skills and knowledge on
what are true contraindications to OAC (actually there are very few); access to
the full medical history and team work with the GP and specialist pharmacy
anticoagulant services. Most patients when they have had risks and benefits of
OAC explained to them are keen to accept therapy but pharmacists need to be
skilled in running these types of consultations.
Once patients are prescribed OAC, statins and
antihypertensives ongoing reviews are required. Community pharmacy will be well
placed to support adherence and to offer patients ongoing advise on reducing
bleed risks from OACs (e.g. using the HAS BLED tool) but to perform a full
clinical review of most CV medicines access to the clinical record will be
required e.g. to check monitoring parameters such as U+Es, full blood count
etc). There is nothing to stop community pharmacists performing these reviews
if they are given access to the patient’s clinical record. Whether community
pharmacy access is granted or not is dependent on local arrangements and
funding, but examples exist across whole communities such as in Fleetwood.
Cardiovascular medicines optimisation services are already running in
parts of the NHS. What we need now is to share the learning and adopt
standardised services at scale to help improve patient care, safety and value
to the NHS.
I have no doubt that the success of
forthcoming integration across systems and sectors is going to be determined by
the strength of personal relationships between stakeholders. Human beings crave
connection with others above all else and the strength and authenticity of
these connections will influence partnership working.
These connections cannot be formed ‘on demand’. Sometimes people meet and immediately recognise a ‘soul mate’, personal or professional, but this is rare. And even then, we have to hope that the first flush of exhilaration for a strong new connection settles into something enduring and mutually enriching.
I was recently a guest of Greater Manchester LPC at the NPA Conference in Manchester, and a thread about relationships became apparent across a number of presentations. Ed Waller from NHSE highlighted the importance of developing relationships and collaborative networks to enable community pharmacy to play its optimum role in PCNs. Simon Dukes from PSNC reflected on why partnerships fail, including lack of trust, stalemate, and the perceived power of one party over the other.
Later, Rose Marie Parr, Chief
Pharmacist in the Scottish Government, countered that good relationships are
built upon a shared vision, effective leadership and trust. Russell Goodway
from Community Pharmacy Wales spoke of delivering a shared ambition through a
willing partnership, and our own Paul Bennett spoke of unprecedented co-operation
among representative bodies through aligning on the major issues facing
Focus on what’s real
I think it is time to reflect on the strongest connections and most enduring, authentic relationships that each pharmacist has made – without exploiting them but focusing on mutual benefit. An obvious source of many enduring connections for pharmacy is with patients. How can pharmacists really tune into those connections to find out what is most relevant and valuable to their local population? Is that not the foundation on which our ‘offer’ to the local health system must be based? How, can we then share this common vision and facilitate strategic change at local level? NHSE is sending a strong message through PSNC that a ‘tsunami’ of separate pharmacy approaches to PCNs will not be welcomed. What is needed is a coordinated effort from contractors within each locality.
Make use of support
We should also reflect on wider support from the pharmacy system that we can draw upon. From connections with colleagues in local hospitals, and our ‘academic hubs’ in our Schools of Pharmacy. Reminding us who we are, where we have been, and where we are going – not least with what we have to offer to the health system of our understanding of new medicines and new science. For those who already have strong and enduring relationships with multidisciplinary partners in primary care and beyond, try to anticipate the turbulence that they must also be experiencing and consider how you can help them to achieve shared objectives for your community.
So let’s take stock now of our best
and most enduring connections, and pool our knowledge to make maximum impact
when the time is right.
Our new resource on system leadership helps point the way. It includes case studies from pharmacists working in different levels of the system and links to tools, standards and guides to develop the leadership qualities required to work collaboratively across boundaries within your local health and care systems.
By Philip Newland-Jones and Anna Hodgkinson, Consultant Pharmacists in Diabetes
People with diabetes need the support of a full multidisciplinary team more than ever, and utilising pharmacists trained in diabetes care are an essential part of this vision.
Statistics from Diabetes UK show that one person is diagnosed
with Type 2 diabetes every three minutes in England and Wales, and 500 people
with diabetes die prematurely every week.
It is estimated that the NHS currently spends 10% or £10 billion of its annual budget on diabetes
and its complications.
We know that
over 65 year olds with Type 2 diabetes have on average six to seven other
health concerns, often needing multiple medicines. Both the Long Term
Plan and the NHS Interim People Plan recognise the value and impact pharmacists
can have to improve outcomes for people living with long term conditions,
including diabetes. This paper outlines a clear vision for pharmacy and the need
for the NHS to utilise pharmacists alongside other healthcare professionals
across all care settings to improve the care of people with Type 2 diabetes.
In the past, pharmacists have held a more traditional but key role in the management of diabetes, including being an integral part of improving medicines safety and supporting medicines optimisation. Over the past few years, recognising the skills and positive impact on care pharmacists can have both with individuals and at a population health level, we have seen a change in mindset. Increased numbers of pharmacists are now working in diabetes and Consultant Pharmacist posts have been developed. Although this is a start, as highly trained and skilled professionals, we know we can do morewhether this is at a GP practice, care home, a community pharmacy, hospital, or Integrated Care System level.
The direction of travel for pharmacy in the management of
Type 2 diabetes is clear. We have a huge role to play alongside our healthcare
professional colleagues in improving outcomes for people with Type 2 diabetes,
after all supporting people with diabetes needs the full multidisciplinary team
more than ever.
We are excited for the opportunities that the RPS policy document, The Long Term Plan and NHS Interim People Plan will bring for pharmacy and we look forward to working with the profession over the coming days, months and years to promote and support the role of pharmacists within all care settings to improve outcomes for people living with Type 2 diabetes.
It is important to note that pharmacists cannot do this
alone, we need the right environment for development, the support and mentoring
from colleagues with experience in diabetes care such as practice nurses,
diabetes specialist nurses, GP’s, specialist dietitians, podiatrists. The only way we are going to be able to
effectively tackle diabetes across all care sectors is to ensure this seamless
teamworking and collaboration is encouraged and cultivated.
If you are a healthcare professional working in diabetes in any sector of the NHS, think if your team would benefit from the support of a pharmacist, and if you work with a pharmacist embrace and support their development to ensure they are the best they can be for your team and your patients.
Although my type 2 diabetes was diagnosed more than 12 years ago, it is only in the last 15 months that I have been medicated. Prior to that, I had controlled it through diet and exercise.
On collecting my first prescription for metformin, the pharmacist went to great pains to explain that I should take one tablet each morning and a second tablet each evening on a regular basis and to contact them immediately if I suffered any ill-effects after taking them. We also discussed dietary factors and the need for regular exercise.
The pharmacist then phoned me the following day, on the third day and after one week, to again check that I was taking the medication as prescribed, not suffering any ill-effects and had no questions about the medication. One month later, when I collected my next prescription, the pharmacist again checked that I was following the instructions and had not suffered any ill-effects as a result of taking metformin.
For the next 12 months I collected my prescription on a regular basis until at the annual renewal the pharmacist asked that I had a consultation with him. He then asked if I was taking the metformin as prescribed, not suffering any side effects and was following dietary advice and taking regular exercise. He also asked me to confirm that my feet were being checked by my diabetic nurse and that I received an annual check for diabetic retinopathy. I as able to confirm that it was the case with both.
In my opinion I have received excellent service from my local pharmacy and am most impressed at the level of care that I have received.
by Professor Mahendra G. Patel, Diabetes Lead, English Pharmacy Board
Today we’ve published our new policy ‘Using pharmacists to help improve care for people with Type 2 Diabetes’. Aimed at policy makers and service commissioners within the NHS in England, it calls for pharmacists in various care settings to be fully integrated into services for those with Type 2 diabetes. This makes way for increased prevention, earlier detection, and better access to diabetes care tailored to individual needs.
More than five million people in the UK are expected to have Type 2 diabetes by 2025. This is a national challenge in terms of poor health outcomes, economic burden to the NHS, and ever-widening health inequalities largely driven by factors such as ethnicity and deprivation. Each year within hospitals, there are thousands of patients with diabetes experiencing medication errors that could be avoided.
Significant numbers of people are failing to meet the nationally recommended treatment targets in reducing risk of complications associated with type 2 diabetes. Many are not understanding their condition nor adhering to prescribed treatment. In my opinion, this is a critical time to make more effective use of the extensive clinical skills of the pharmacist.
The NHS Long Term Plan recognises the vital role of
pharmacists and their clinical skills in supporting patients to achieve better
health outcomes, improving patient safety and reducing medication errors. The recent
establishment of new Primary Care Networks and the growing maturity of local Integrated
Care Systems, together provide unparalleled opportunities for people to receive
better access to their pharmacists, more personalised support, and joined-up
care at the right time in the optimal care setting.
In line with new and emerging roles for pharmacists and
advancing practice, and at a time when technology is set to command a pivotal
role in healthcare, our new policy
on diabetes builds on our previous national campaigns.
It translates the latest evidence into practice,
focusing on helping people to live longer and lead healthier lives whilst
ensuring effective and safe use of medicines. It further highlights the need to
support services within and across different care settings, where pharmacists
can make significant and meaningful differences in improving health outcomes.
It also shows how pharmacists, who are integrated
within a specialist diabetes multidisciplinary team, can provide added value and
synergy across care pathways as routine daily practice.
Professor Sir David Haslam, Chair of NICE, one of the many organisations supporting our policy states, ‘Diabetes is a public health emergency’. We will continue to press these recommendations to progress this crucial national work.
The Royal Pharmaceutical Society is the dedicated professional body for pharmacists and pharmacy in England, Scotland and Wales.
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