Strengthening Antimicrobial Stewardship through training

by Vincent Ng, Professional Development Pharmacist

The challenge   

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

Earlier this 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 involve?

  • Face-to-Face training day delivered by national experts
  • Quality improvement project in the workplace, supported by online group feedback sessions facilitated by UKCPA Pharmacy Infection Network tutors
  • Structured self-assessment and self-directed learning
  • GPhC revalidation entries
  • End of training assessment with experts from our Antimicrobial Expert Advisory Group

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

Getting started

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?

Update! We’ve been commissioned to provide AMS training in England in 2020. Find out more and book your place.

We are undefeatable: join the campaign to get active!

by Suzanne Gardner, Sport England

You may have seen the “We Are Undefeatable” campaign from 15 leading health and social care charities and Sport England.

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 activity.

And if the campaign inspires you to get active yourself it’s a bonus!

Further copies of these resources can be accessed through the Public Health England Resource Centre  https://campaignresources.phe.gov.uk/resources


[i] (Sport England (2019) Active Lives Survey 2017/2018). 

Women in leadership: believe and achieve!

by Amandeep Doll, RPS Regional Liaison Pharmacist

This year I am delighted to be co-chairing our Women in Leadership event on 3rd October 2019 with the RPS President Sandra Gidley.  We had an incredible response to our event last year and want this year to be even bigger and better!

Believe and Achieve

The theme of this years event is Believe and Achieve. The day is full of practical advice and workshops to help you believe in yourself, celebrate your successes and be comfortable with your ambition. We have sessions with Clare Howard and Frances Akor who are current leaders; they will be sharing who their role models are and what values they believe you need to be successful.

Women are often negatively labelled according to their personality traits such as ‘too aggressive’ when they’ve demonstrated confidence in their roles, and others have included ‘too serious’, ‘too questioning,’ ‘too emotional’ and ‘too caring’.

You’ll learn how to achieve your next leadership role by challenging these stereotypes, as well as getting practical advice on how to overcome difficulties, increase your resilience and craft a winning CV.  We have workshops by Harpreet Chana and Heather Fraser from IBM on increasing your confidence and position yourself to get that leadership post.

To embrace the diversity of experiences and beliefs that women bring to leadership teams we also have a men as allies session, to celebrate the differences between men and women and how we can work together to be a successful team.

You’ll leave the event feeling more confident to apply for and take on leadership roles and also to support female colleagues to take those steps to becoming a great leader. 

Come and take part in our Women in Leadership event on 3rd October.

A question of confidence

by pharmacist Harpreet Chana, certified professional coach, speaker, trainer and founder of the Mental Wealth Academy

I am so excited to be leading a workshop on confidence at the RPS Women in Leadership Event! After attending the event last year and learning that the main barrier we face as women in progressing up the ranks within our sector was confidence, I wanted to run a workshop to address this issue and am delighted to be doing so.

Never too late

From my own experience, I understand that confidence, resilience, emotional intelligence and better outer/inner communication are essential life and leadership skills. They enable us to be mentally tough, deal with life’s challenges and are core skills that help reduce the impact of mental health on performance and life fulfilment. We are not taught these at school or university, but the good news is, it’s not too late! We can still learn these vital skills and how to apply them to our daily lives so that we are all much healthier and happier individuals as a result.

Confidence matters

How confident are you really? Has there ever been a time where a lack of confidence has stopped you from going for what you really want? From speaking up? From asking for a pay rise/promotion? From putting yourself forward for opportunities at work or at home?

How do you talk to yourself on a daily basis? Are you very critical of yourself if you make a mistake or can you forgive yourself and seize the opportunity to grow and learn from every slip-up? No matter how confident we think we are, there are always times when a lack of confidence or our biggest fears can hold us back from achieving our true potential. My confidence mini masterclass will help you to address how you see yourself and to appreciate how truly awesome you really are!

Come and take part in Harpreet’s workshop at our Women in Leadership event on 3rd October.

Advocating for change – the unseen work

Ross Gregory, Head of External Relations, RPS Wales

by Ross Gregory, Head of External Relations, RPS in Wales

Discussions at the recent Welsh Pharmacy Board meeting reminded me of the sheer breadth of advocacy work we are taking forward on behalf of our members. The quality and volume of work is quite incredible, as is the commitment of the RPS team and our Board Members. Yet, much of this hard work is unseen until a final outcome is arrived at.

As quick wins in the world of advocacy are rare (see previous blog on our influencing work) I wanted to take this opportunity to outline some of the key work that is currently underway in Wales to influence change and improvement for the profession and our patients.    

Your voice at the top tables

We continue to work with the Welsh Government to ensure our members interests are represented in national policy and guidance as well as strategic decisions.

Read more Advocating for change – the unseen work

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.

Bring your whole self to work

By Robbie Turner, RPS Director for Pharmacy and Member Experience

Pharmacy is a very diverse profession, especially in terms of gender and ethnicity.  As your professional body, we want to recognise, celebrate and encourage a variety of voices and experiences across pharmacy to better represent you.

The diversity we see is not necessarily represented at senior and leadership level though. Things could be better, and as an organisation we recognise we could also do more in this space.

That’s why I’m so excited we have launched a new programme of work on inclusion and diversity. 

Pharmacists often work in isolation, and especially in the case of community pharmacy, may often be the only healthcare professional on the premises. It can be hard to bring your authentic self to work when your environment means you don’t feel comfortable expressing who you are.  When we don’t bring our whole selves to work we can suffer – in terms of our wellbeing and our work.

We are about to go out to the profession as a whole to get your views on how inclusion and diversity can be improved and celebrated. There will be opportunities to engage with us on this to make sure that our strategy is truly created hand in hand with you.

We’ll be launching a survey at the end of the month as a starter. It’s incredibly important that as many of you as possible complete it – it’s your chance to be in at the start and ensure you inform what we do, both in the short and longer term.

After that we’ll be creating and celebrating some key events such as Women in Leadership and Black History Month in October.

We’ll be sharing our initial thinking at our annual conference on 17th November. 

I’m convinced this programme is the right way forward for the profession, as is everyone at the RPS. Who you truly are matters. We want you to feel able to bring your whole self to work and experience a sense of belonging. I hope you join us on this journey. 

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.