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.


 


.

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. 

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