Inclusion and diversity update

by Paul Bennett, RPS Chief Executive

As your professional body, we are now working towards an inclusion and diversity strategy for pharmacy that values difference. We want to recognise, celebrate and encourage all voices and experiences across pharmacy so we can better represent you and our patients.

I’ve had the pleasure of attending three recent events hosted by the RPS to engage with members on this really important issue. The first was a celebration during Black History Month of the BAME community’s contribution to pharmacy and we had fantastic contributions and insights shared on the day.

The second was an Inclusion & Diversity workshop which was a key milestone on the programme of work we’ve embarked on. Being authentic at work, and in turn being able to feel a sense of true belonging, is something that means so much to each of us individually and I’m keen to champion this here at the RPS. I’m a strong believer that you can only be your best self if you are allowed to be the person you truly are in your workplace, so this programme, under the guidance of our excellent Chair, Asif Sadiq MBE, will produce a strategy that we hope will resonate across the profession as well as within the RPS itself.

The third event I attended was the Retired Pharmacist Group of the RPS. It’s clear to me that older age does not mean a decline in drive, energy and enthusiasm for the profession (or for life!) and I came away feeling both inspired and thankful to have among our membership such passionate and professional people who we can all learn so much from. I do hope RPG members take up my invitation to become RPS Mentors!

Our recent I&D survey of members has highlighted that they wish us to do more in the areas of disability, race and age, and we’ll be looking at how we can do this most effectively. We’ve also got a timeline of our activity so you can track our progress.

My view is that we can only be effective at tackling I&D issues if we’re not afraid to hear about the problems and challenges faced and address them. This requires each of us to have the courage to speak up and commit to not walking past inappropriate activity where we see it. Those of us in a position to create the environment for concerns to be raised without fear should do everything we can to enable that to happen.

I said at our I&D workshop that at times I had been self-conscious as a white, middle aged, heterosexual male trying to engage in conversation about BAME and LGBT+ issues as it might be perceived that I had no credibility to do so. Having talked about this with many people, I now realise that I’m not alone in having that concern BUT that it’s better to share my perspective, understand it for what it is, listen to all the other perspectives and actively contribute to this vital agenda. No one individual can profess to speak on behalf of groups of others, as we each have a unique perspective – we are all individuals after all, even though we will identify with certain groups.

RPS can only have credibility in this space if we ‘walk the talk’. Part of our commitment is therefore to do what is right by publishing data that shows our performance as an employer striving to create equal opportunity. We already publish data on our gender pay gap here at RPS and in future I am committing that we will also publish data on ethnicity and pay. We are not required by law to do either but it’s simply the right thing to do, as we believe we should lead by example.

I encourage you to engage with this discussion about inclusion and diversity whenever and wherever you can and to champion everyone’s right to be their authentic self in the workplace. Being authentic, feeling comfortable with who we are and bringing a diversity of perspectives and views to work will enrich the RPS and help us deliver the best possible support for our members, whatever their age, race, gender or sexuality.

Uncovering hidden histories at the RPS Museum

by Matthew Johnston, RPS Museum

Part of our work here at the RPS Museum includes researching various aspects of pharmacy history so we can enrich our displays, tours and articles, especially those areas that are currently under-represented in the museum.

A recent focus of this research has been to uncover more stories relating to BAME communities. This isn’t an easy task as historical registers of pharmacists did not record information relating to ethnicity. In addition to this lack of documentary evidence, there is little visual material available, particularly in the early years of the Society before the widespread introduction of photography.

But we didn’t let that stop us. When we look through the records, we can see tantalising glimpses of stories that we can use as a starting point for our research. The earliest specific reference we have found in the Society’s archive is the arrival of the first black African student at the School of Pharmacy in 1847, as noted in the report of the Annual General Meeting of May 1848, which reflects the attitudes of the time:

It is also gratifying to find that some have come from distant countries, and one of these, an intelligent African, is probably the first native of that soil who will apply a knowledge of Chemistry acquired in an English School, with the view of promoting the arts of civilization among his colored brethren.”

But who was this student? Frustratingly he isn’t named, but he may have been Joseph Mailloux. The Society published its first list of ‘Foreign Life Members’ in the Pharmaceutical Journal in 1856 and Joseph is listed as having been admitted to membership in 1847. He was based in Mauritius, which at that time was a British colony. His certificate number of 28 shows that he took and passed one of the Society’s exams, so would have been studying at the School around the time referred to in the above report.

Despite poring over the various resources available to us, we couldn’t find out much more about Joseph Mailloux. He remains on the Society’s register until 1877, so seems to have had a 30-year career. An annotation in the Registrar’s copy of the register confirms that his removal was because he had died, but no obituary was published in either the Pharmaceutical Journal or the Chemist and Druggist, a familiar story with international members of the Society at this time.

There is still a lot of work to do in terms of including more marginalised voices in the museum. Hopefully this blog has shown that there are stories to be told and histories to be revealed – we just need to keep on digging to find them and highlight diversity in the profession.

Our mentoring relationship

Being a mentee: Aamir Shaikh

I met my mentor Aamer Safdar whilst working at Kings College London. I was the 3rd year Professional Lead, and was introduced to him and he told me about his background, both personal and professional.  Just by listening to him, I knew that his values were similar to my own. 

Challenge

I now work at BUPA as the Chief Pharmaceutical Officer’s Clinical Fellow, but before that I worked within the Education Directorate at RPS.  It was there I worked alongside Aamer in projects involving undergraduates.  You will hear that pharmacy is a small world and this is one such example!  My manager explained how it is important to work alongside colleagues who will challenge your thinking and I found this in Aamer.  Our mentor/mentee relationship first established when we went out for dinner as a post-work group; it was here when I decided to formalise my mentor/mentee relationship with him. 

Benefits

I’ve benefited greatly from the mentor/mentee relationship. It’s given me thinking space but its been advantageous to both my personal and professional life to have someone to challenge my own thinking in whatever situation or scenario I am experiencing.  In our last meeting Aamer and I spoke about authenticity, congruence and integrity.  I found it particularly useful hearing from someone in Aamer’s position, a current GPhC Council member and previous RPS English Pharmacy Board member, about how important it is to stay true to your own values and what these values really mean.

We use the RPS mentor platform to record our meetings and have found that, as well as the normal methods of keeping in touch, the platform has been beneficial in keeping us focused. I couldn’t stress the importance of having a mentor enough.  It has really helped me focus whenever I have found myself in a sticky situation and I’m grateful for the time Aamer has shared with me.

Being a Mentor: Aamer Safdar

I have been a mentor to many people inside and outside of pharmacy and have used a variety of methods with my mentees which have included traditional face to face sessions as well as mentoring exclusively by email and by phone; in the latter two cases, I never met my mentees in real life until much later in our relationships! 

I currently mentor two pharmacists, at different stages in their careers, using the RPS mentoring platform.  The platform is useful because I have outlined the areas in which I would like to mentor in to manage my mentees’ expectations. 

Sharing experiences

In both of my meetings, we spoke about our careers and challenges at different levels and I was able to share my experiences and wisdom from both my day job and from being in national boards.  Much of my wisdom has come from my own mentors, who have been different people at different stages of my career,and with different perspectives and advice.  Without a mentor to bounce things off, I doubt I would have done many of the things I have done in my career.

Find out more about our mentoring scheme exclusively for members

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.

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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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 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

Salbutamol – landmark asthma treatment

by John Betts, Keeper of the RPS Museum

2019 marks the 50th anniversary of the landmark asthma treatment Salbutamol becoming commercially available in the UK. Salbutamol is still widely used today to relieve symptoms of asthma and COPD such as coughing, wheezing and feeling breathless. It works by relaxing the muscles of the airways into the lungs, making it easier to breathe.

Launched in 1969 with the brand name Ventolin, Salbutamol revolutionised the treatment of bronchial asthma.

It treated bronchospasm far more effectively compared with previous bronchodilators and had fewer side effects.

To understand how much of a breakthrough Salbutamol was in the treatment of asthma, it’s first worth comparing it to the drugs that were used to treat asthma before 1969.

One of the main drugs used for treating asthma in the mid-1960s was isoprenaline. This is a powerful bronchodilator and was used to relieve bronchospasm. However, the side effects include a sudden increased heart rate. Between 1963 and 1968 in the UK there was an increase in deaths among people using isoprenaline to treat asthma. This was attributed to overdose due to both excessive use of the aerosols and the high dosage they dispensed.

In the mid-1960s the mortality rate for asthma sufferers had risen to over 2,000 deaths a year. An effective bronchodilator was desperately needed that did not stimulate the heart or affect blood pressure.

Salbutamol was discovered in 1966 by a research team at Allen and Hanburys (a subsidiary of Glaxo). Salbutamol was the first drug that selectively targeted specific receptors in the lungs, inhibiting the production of proteins needed to produce muscle contractions. It works by relaxing the smooth muscle of the airways, opening them up and so lessening or preventing an asthma attack. Not only was Salbutamol a good bronchodilator, it lasted longer than isoprenaline, and inhalation caused fewer side effects.

In addition to the effectiveness of the drug, the method of administration itself was also revolutionary. The Ventolin inhaler was designed to ensure metered aerosol doses of Salbutamol were inhaled straight into the patient’s lungs.

The drug was an instant success.

The only real deficiency of Salbutamol was its short duration of action; at 4 hours it couldn’t prevent night-time asthma attacks. In response to this the pharmaceutical manufacturer Glaxo aimed to develop a longer acting drug. The result of their research was Salmeterol. Launched in 1990 with the brand name Serevent, it had a 12-hour duration of action.

50 years on Salbutamol is still on the World Health Organization’s List of Essential Medicines; a testament to the major role it continues to play in the treatment of asthma. 

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