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. 

Visit the RPS Museum Mon-Fri 9am-5pm

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

From community pharmacist to Medical Science Liaison

Sinead Monaghan, Medical Science Liaison, Sanofi

I graduated with a master’s degree in pharmacy from Queen’s University Belfast.I undertook my pre-registration year in a community pharmacy chain in Northern Ireland. I was employed as a pharmacist manager with the same company post pre-registration year. I spent a further four years as a community pharmacist.

I thoroughly enjoyed this role, especially being a pharmacist tutor. This very much sparked my interest in training others. I had always been curious about alternative pharmacist roles, but felt my knowledge of career paths was limited.

Read more From community pharmacist to Medical Science Liaison

How Sarah became a Medical Science Liaison

Dr. Sarah Anne Goffin, Medical Science Liaison at Sanofi

I come from a family of healthcare professionals and have always been passionate about science, so pharmacy seemed to be a perfect fit for me. 

I undertook my undergraduate at the University of East Anglia between 2006 and 2010 and completed my pre-registration year in 2011. As I worked part-time as a counter assistant in community during my degree I wanted to take the opportunity to increase my experience in hospital pharmacy. 

Read more How Sarah became a Medical Science Liaison

Routes to industry roles

By Tarquin Bennett – Coles, Principle Consultant at Carmichael Fisher

This image has an empty alt attribute; its file name is Tarquin.jpg

The Life science sector is a vibrant and constantly changing environment that can suit those who like to take educated risks with start-up ventures or those who want a more secure long-term career within a large organisation. Getting into the sector is still people/connection based so establishing a network and reliable advocates will help you make the first step. If you can find a person you can interact with rather than using an online portal then this will improve your chances. 

Deciding on the right role and company for you will require some due diligence on the company values and culture. Most of this can be achieved online. Glassdoor is a useful tool to see what people say about a business, good and bad.

Nevertheless, having someone you can talk to who actually works at the company you are interested in is even more useful. If you can use your network to help you achieve this,  then it will give you a head start.  

To make the right step also requires some realistic self-assessment.  

You can use online tools for this or If you can find someone you work with and ask them how you come across in meetings or day to day you can find out a great deal about how you are perceived. It is also worth thinking about what motivates you, what will drive you to get up for work or travel a long way for a meeting? Do you like to work in a group or independently? Even at an early stage it is well worth thinking about where you would like to land after the role you are applying for. Having this in mind will help you weigh up the potential of the position now and as part of your broader career aspirations even if they change. 

Some individuals choose to join the sector via a service organisation then move across to biophama or MedTech businesses once they have their network in place. This includes joining life science teams in the large consulting houses (PwC, E&Y, McKinsey etc), boutique players (Huron, Cambridge Consultants, Sagentia), outsourcing businesses like a Contract or Clinical Research Organisations (CROs – IQVIA, Paraxel, Covance etc) or biopharma sales companies.  
 
Others, choose to start out in a corporate setting via the City (equity analysis), private equity or venture capital businesses and then transition across.  

In addition, the emerging data and digital space means some technology players (Amazon, Google, Apple, Samsung etc) are moving into the healthcare sector and they require experts with an understanding of life sciences sector so this may also offer a way in.  
Hot areas of growth also include diagnostics & biomarker businesses, AI/Machine Learning, data science and digital health companies. 

Once you have gained some experience, or if you want to make the step immediately, then there are some key skills and experiences that companies most value. If you can highlight these when you apply or at interview then they will help differentiate you and increase your chances of an offer. 

  • Demonstrable track record of success. 
  • Examples of persuasion and influence whilst working outside your area of management control 
  • The ability to prioritise between the urgent and important. 
  • Expertise at working to tight deadlines and dealing with a fast paced environment for service delivery & communication (this should suit all pharmacists). 
  • Project management skills & the ability to switch focus/direction due rapid market shifts or new convergent technologies. 

Right now certain functions and disciplines are in particularly high demand. These include, analytics, data science, informatics, medical affairs and information, toxicology, pharmacology, business development, clinical development, regulatory affairs, market access and pricing and reimbursement. 

Another thing to consider before you join the industry is to choose a location where there is a cluster of companies and sector support businesses already located there. This will increase the opportunity for you to progress and find alternative work if the position does not work out or the company goes through a major transformation or acquisition. In 2019 we are seeing some major merger and acquisition activity. Most successful clusters (Cambridge, London, Oxford, Edinburgh, Manchester, and Cardiff etc) will also have good transport links, access to funding streams, academic and research hubs, hospitals and service businesses nearby.  

Once you make the step do remember you are likely to be joining a sector where there will be five generations in the workplace (Gen Z – 18yrs old in 2018). Each generation defines success and working habits with a slightly different perspective so it is worth considering that if you are working in a cross-generational team or have a line manager from a different era. 

In terms of what lies ahead you have a myriad of choices once you break into the sector so keep checking in on your own plans. Leadership agility is being highlighted as a future “must have” and so is some international experience so if you can add those to your existing skill set, then you will be in a good place to progress. Similarly, there are now more industry collaborations and partnerships than ever before so involvement in such projects will help you stand out. Good luck, you have an exciting future ahead.  

More information

https://www.rpharms.com/development/how-to-get-a-job-in-the-pharmaceutical-industry

What is a Qualified Person (QP) and how can I become one?

What is a Qualified Person (QP)?

QPs assure the quality of our medicines, so it’s important they’re well trained and fully understand how pharmaceuticals are manufactured.

As a QP you’ll be legally responsible for certifying batches of medicinal products before they’re used in clinical trials or available on the market. You’ll also need to understand the factors that can affect the safety of medicines and supply chains.

Read more What is a Qualified Person (QP) and how can I become one?

Social prescribing – linking patients with support

by Hemant Patel FRPharms, English Pharmacy Board member

Today is Social Prescribing Day. So, what is social prescribing?

Social prescribing enables GPs, pharmacists, nurses and other primary care professionals to refer people to a range of local, non-clinical services via a link worker.

Social prescribing schemes can involve a variety of activities which are typically provided by voluntary and community sector organisations. Examples include volunteering, arts activities, group learning, gardening, befriending, cookery, healthy eating advice and a range of sports.

Link workers give people time and focus on what matters to the person, and as part of their care, connect people to community groups and agencies for practical and emotional support.  With the recent publication of the NHS Long Term Plan and personalised care being marked as a priority, the NHS has promised to support at least 900,000 people to benefit from social prescribing by 2023. Pharmacists have a role to play here. Read more Social prescribing – linking patients with support

Women in early pharmacy

By Matthew Johnston, RPS Museum

“There is an impression that women are something new in pharmacy, but nothing could be further from the truth.”

These were Jean Kennedy Irvine’s words on her election as the first woman President of the Royal Pharmaceutical Society in 1947.

Medieval monasteries

In her speech, Jean also mentioned the early beginnings of community pharmacy in the medieval monasteries, where residents would grow medicinal plants to treat themselves and local people.

One of the oldest items on display in the RPS Museum is a stone mortar from a Spanish nunnery (AD 410-1500), used for preparing medicines. The Hanbury Collection of the RPS Library also contains a later copy of the ‘Physica’, a work by St Hildegard, Abbess of Bingen. Originally written in the 1100s, it outlines the medicinal properties of various drugs obtained from the natural world. Read more Women in early pharmacy