Asking patients using pharmacy services what they need

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’.

Asking patients

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?

Shared decision-making

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.


 


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The role of pharmacists in preventing cardiovascular disease

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 report.

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.

Read our roundtable report on pharmacy and cardiovascular disease.

It’s not business, it’s personal!

by Nicola Gray, RPS Regional Liaison Pharmacist

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.

Making connections

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.

Developing relationships

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 pharmacists

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.

Diabetes: the team approach

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 more whether 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.

We’ve got two things to ask of you:

  • If you are a pharmacist, and you are interested in supporting people with diabetes then please ensure you have thought over what competencies you need to develop using the UKCPA Integrated Career and Competency Framework for pharmacists in Diabetes
  • 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.

How my pharmacist helped with my diabetes medicine

by Mike Schofield

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.

Diabetes care – get involved!

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.

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

Every day is a school day for Chris

By Chris Maguire, pharmacist and marketing manager at Beckton Dickinson

I studied pharmacy at Queens University, Belfast.

I completed my pre-reg in community pharmacy, in a small chain, in the same town I went to school. Once I had finished, I did a few locums for the same company and was offered a relief position. I had friends in England who told me about the offers they’ve been receiving. I was tempted…and made the move to the “mainland”. I applied for few jobs and got one with Lloyds pharmacy, living in Liverpool. I moved from relief manager, to pharmacy manager to cluster manager. I was really enjoying work and career progression, but I had always wanted to travel so I took a career break for a year and travelled.
I even got to work in a hospital in Sydney for 6 months of my 14 months adventure.

When I came home, I got a job at Interface Clinical Services, working in primary care. Delivering services such as osteoporosis, diabetes and asthma reviews. Again, I started making my way up – from service development, to a national lead pharmacist.

I managed a team of 90 pharmacists running reviews, clinics, hospital work and made sure they were trained.  I had always been focused on delivering care based on NICE guidance or the latest evidence in disease areas.
I think that with more responsibility, pharmacists can help make a change on a bigger scale.

In my roles in primary care, I learned how clinical systems work in GP land, how the mechanics of QOF work.  I strongly believe that with up-skilling pharmacists to be experts in specific disease areas and pharmacy integration we can create better primary care services. 

I’d been working on a diabetes service specifically for quite a while and think there is so much more pharmacists could do.  It was because of my experience in primary care that I was approached by industry to join as a project manager and help to deliver value based health care. A concept where value is the outcome for the patient over the cost. I thought this was an amazing opportunity to help on a bigger scale and to gain experience in industry.

I had been approached by industry before with an MSL opportunity. I looked into their portfolio, their evidence, the guidelines and felt that it wasn’t a good fit and I couldn’t hang my pharmacist hat on that. So, I stayed with Interface for another 2 years, gaining more experience and exposure working with federations, CCGs, hospitals, AHSNs, NICE and others. It’s not always how fast you can get to the new job but going for the right job.

After working for a year as a project manager, I applied for a marketing manager job. I didn’t have any experience in marketing, but I do understand how the NHS and the supply chain works.  I understand how the use of data can help improve outcomes, which helped me get the job! I’ve now also enrolled on a course to become CIM (Chartered Institute of Marketing) certified at diploma/degree level to make sure I have all the basics and grounding needed.

Every day is a school day! 

Find out more about how to get a job in pharmaceutical industry

Peer Discussion day has arrived

The moment has arrived.  RX and I are sitting opposite one another in the Bell Room at RPS HQ.  Messrs Squire and Hills, grandees from pharmacy history looking down at us from the wall and behind us the artefacts of the museum (I’m hoping there isn’t a thumbscrew in the museum and that this is going to be a free flowing discussion).

Read more Peer Discussion day has arrived

How Pharmaceutical Journal Publications are helping you meet your planned and unplanned learning requirements for revalidation

Michael Dowdall – Executive Editor, Research & Learning


April 2019 marked a year since the launch of the RPS MyCPD app, which contains content from The Pharmaceutical Journal and Clinical Pharmacist. Its aim is to meet the needs of members and pharmacy professionals undergoing revalidation. And it seems to be doing just that – in quarter one 2019, around 1,000 users were accessing content through the RPS MyCPD app every month, completing over 1,400 records of their learning and CPD activities. With updates scheduled over the coming months, the additional revalidation requirements for peer discussion and reflective accounts, as well as over 330 articles from Pharmaceutical Journal Publications now available, this number is certain to grow.

Read more How Pharmaceutical Journal Publications are helping you meet your planned and unplanned learning requirements for revalidation