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The Royal Pharmaceutical Society held "Over to you" roadshows on three consecutive evenings last week for pharmacists in Society regions in the north of England. The roadshows - part of the Society's Pharmacy in a New Age initiative - took place on March 27 in Sunderland for the Border region, on March 28 in Leeds for the Yorkshire region and on March 29 near Tarporley, Cheshire, for the Mersey region. Each roadshow was chaired by a member of the Society's Council - the Border and Yorkshire evenings by Mrs Gillian Hawksworth and the Mersey evening by Mr Hassan Argomandkhah.
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 At the Yorkshire Region road show, left to right, Mr Odd, Mrs Hawksworth, Mrs Adams, Mr Choo and Mr Acomb |
Mr Roger Odd (the Society's head of professional and scientific support) said that roadshow had already visited various parts of Britain, attracting hundreds of pharmacists and stimulating positive and revealing feedback. A major spin-off had been the building of a relationship between the Society and the Doctor Patient Partnership. Part of this work had seen pharmacists and doctors getting together to discuss openly the issues that both helped and hindered better communication between the two professions. Further campaigns and initiatives with the DPP were being planned.
Mrs Anne Adams (the Society's national co-ordinator for Pharmacy in a New Age) said that, as the new NHS structures continued to take shape, it was more important than ever for pharmacists to work together and in partnership with other health professionals. Pharmacy development groups had now been set up across the profession in England. They represented a real pharmacy network with pharmacists working together and working closely with local pharmaceutical committees, having the potential to take pharmacy forward, giving individual pharmacists support and the profession a concerted voice at local level.
The main focus was on communicating across the profession and with others, to provide the highest quality service for patients, which involved PDGs in preparing bids for services and getting pharmacy integrated into local strategies. PDGs had enormous potential to provide additional services locally working within a multidisciplinary network as part of a PCG.
In late April or early May, the Society was to launch pdgtalk.net, a closed internet discussion group for local PDGs which could feed into a national group and would help spread ideas and good practice. The Society would also shortly be announcing the recipients of the professional development awards for 2000 - awards of up to £500 to develop a PDG infrastructure and up to £3,000 to take forward a local initiative.
"Over to you" was the logical extension of the PIANA initiative for an NHS in which services and responsibility were being devolved to an ever more local level. The Society did not intend to relax and take a back seat. It would continue to look at new ways to help pharmacists take forward their initiatives, and advice and support was always available from the PIANA helpdesk.
At the Border region roadshow, Dr Sheila Woolfrey (principal pharmacist, clinical services, at Wansbeck general hospital, Ashington) described a project looking at clinical governance in pharmacy, involving hospital and community pharmacists across Northumberland.
The aim of the project was for pharmacists to deliver a high standard of care to the patient, working alongside other health care professionals. After looking at how people were sharing best practice and how they were learning from their errors, the Northumberland pharmacy development group had given all hospital and community pharmacists in the county a "significant event reporting form" so they could report any incident that might be important to their own personal practice and that, if analysed, could change the way they operated.
Dr Woolfrey went on to describe a recent project in which community pharmacists were used to provide clinical services for a community hospital which was over 60 miles from its base hospital. The doctors and nursing staff had welcomed the chance for face-to-face contact with pharmacists and had said that they found the service helpful and productive.
Dr Woolfrey said that improving the service pharmacists provided required some effort, determination and communication. Her advice to anyone who had those fundamental qualities was to start with something small for which one could see an outcome. This would give one "the buzz factor and positive vibe" to move on to bigger things.
Also at the Border region roadshow, Miss Zahra Irannejad (pharmaceutical adviser, Newcastle East PCG) described work on a "brown bag scheme" community medication review.
She that pharmacists were paid £25 an hour and asked to do three-hour sessions. The patients recruited were people over 75 years of age who were confused about their medicines or were taking a lot of medicines. Originally they had been recruited only through GPs, but the scheme had been extended so that pharmacists could identify patients they believed to be appropriate and carers were able to bring in medicines for patients.
The patient made an appointment with the pharmacist, and they spent about half an hour together reviewing the medication and filling in the form. This was then sent off with suggestions to the GP to be evaluated and signed off.
There was a good relationship between the pharmacists and GPs, who supported the pharmacists' professional input into medication management and appreciated that pharmacists could make huge financial savings for them.
The scheme had cost £500 to run but had resulted in savings of £4,000 in a reduction in medicine wastage. It had gone so well that another scheme was planned this year, with the multiprofessional input widened to include district nurses and social services.
Feedback from patients showed that they thought they were receiving a useful and worthwhile service. They appreciated the length of time they could spend with the pharmacist. Feedback from community pharmacists showed that they welcomed being involved with the patients and having the opportunity to improve patient care.
Miss Irannejad felt that the scheme had been good for the motivation and ego of pharmacists in Newcastle. Not least because they realised that they could have a relationship with GPs in which they were valued and appreciated.
At the Yorkshire region roadshow, Mr Gary Choo (community pharmacist, Braford) described his work in setting up and running anticoagulant clinics in a GP surgery. He said that starting such a service required self-belief. But it also needed support in breaking new ground. With the backing of the pharmaceutical adviser and far-sighted hospital pharmacists, he had set up two weekly clinics running side by side and covering two of the five Bradford PCGs. His clinic had had 407 appointments in the past two years with 36 patients.
The GPs had initially toyed with the idea of a nurse running the clinics but, after talking the project through, had understood the value of a pharmaceutical input. Consultations with the patients included the total medicine needs, looking at all the medicines the patient was taking, the medicine mix, the regimen of taking the medicines - a whole professional pharmaceutical service.
While community-run clinics could ease the workload of hospital pharmacists, the biggest impact was on the patients, who were reluctant to go back to being treated at the hospital because of the inconvenient travel and long waits to be seen..
Mr Choo accepted that not every pharmacist would want the responsibility that came with running an anticoagulant clinic. His biggest challenge in providing this service was realising that he was responsible for making important decisions about a patient's treatment. But he enjoyed the challenge of every patient's needs being different.
If other pharmacists were thinking about doing something similar, there was nothing to stop them, provided they had support from the hospital pharmacists and GPs and the right attitude to do it.
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p>The setting up of an anticoagulant clinic was also discussed at the Mersey region roadshow, when Mr Mark Pilling (head of clinical governance and prescribing, Kirby PCG) described the setting up of a clinic in a general medical practitioners' surgery in Kirby.
Mr Pilling said that in 1996 Sefton health authority had provided training for community pharmacists to undertake anticoagulant monitoring. The GP commissioning group had been interested in providing an anticoagulant clinic in a local community health service centre which had no GPs on site. |  Mark Pilling |
There had been much scepticism about community pharmacists providing such a service. The hospitals had felt threatened because 300 patients would be taken away from their care. Some patients had been worried that they would receive a substandard service. However, patients had appreciated the service because it was convenient, because the process took only about 15 minutes, because it used a relatively painless device instead of the hospital's "big needle", because it offered greater flexibility, and because it was friendly and in pleasing surroundings. Audits had shown that anticoagulant control was as good as, if not better than, in hospitals.
Providing new services also meant having to be open to adopting new skills. Being able to communicate with other health professionals over concerns about patient care or repeat medication had had a massive payoff. Pharmacists were seen to be providing a quality service as an integrated part of the primary care team. Providing the service had given pharmacists greater credibility as health professionals.
A team of three pharmacists now covered eight clinics a month with 25 patients in each clinic. Other health professionals had said that the service was one of the best things that had happened in the health suite from which it was provided. It had shown that pharmacy could make a bigger contribution that was recognised and financially rewarded.
Setting up a clinic in a community pharmacy setting might sound daunting, but it was a great opportunity for pharmacists. And if they did not do it, others would. It took confidence and competence to manage the patients, counsel them and make a decision about changing treatment. But it was good to know that one could always turn to pharmacy colleagues if one needed to discuss a patient or needed support.
At the Yorkshire region roadshow, Mr Chris Acomb (deputy director of pharmacy, Bradford hospitals) spoke about the Yorkshire clinical pharmacy audit group and its structured approach to clinical pharmacy practice on wards.
Hospital chief pharmacists from around the Yorkshire region had set up the group three years ago. Initially they had decided to audit all clinical services provided by hospital pharmacy departments. The audit had identified weaknesses in a number of areas of practice across the region - especially in documenting pharmaceutical care plans.
With a representative from each trust within the region, the group had defined a framework for pharmaceutical care for inpatients - targeting the pharmacy resource, screening for pharmaceutical care issues and documenting care plans.
Every documented care plan recorded identified actual and potential pharmaceutical care issues - wrong drug, drug used without indication, indication not being treated, under- or overdosage, adverse drug reaction, drug interaction and failure to receive drugs. The action taken by the pharmacist was also recorded in a standard format.
The audit had paid off in terms of improving pharmaceutical care for individual patients. There had been massive improvements in standards of service and there was now a more standardised approach to clinical pharmacy in the hospital service in Yorkshire.
Mr Acomb added that pharmacists tended to feel threatened by audit. But it was not "policing" or "checking up"; it was about professionals taking responsibility, knowing exactly what their role was and providing quality systematic care.
His advice to others who might want to do something similar was to collaborate with one's fellow professionals and not think one could do it all oneself.
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At the Mersey region roadshow, Mrs Gail Thomas (senior pharmaceutical adviser, South Cheshire health authority) described the setting up of a project to integrate pharmacy into the activities of the PCG through a link person paid for six hours of protected time each month.
|  Gillian Thomas |
The remit also included promoting a clinical governance action plan that had been developed following a "capability and capacity" survey of community pharmacists in summer, 1999. This project was one of the key ways in which it was hoped to support community pharmacists in embracing clinical governance throughout South Cheshire.
The clinical governance questionnaire had shown that only 6 per cent of pharmacists considered they had any relationship with a PCG and only 25 per cent knew their local health improvement programme topics, while 60 per cent had heard of clinical governance but did not know how it affected them. The minimum aim of the links project was for every pharmacist to know what a PCG was and to understand clinical governance and how it affected them.
The links project had set out to achieve five key things: promoting pharmacists' role in PCGs; facilitating pharmacy's inclusion in health improvement programmes; releasing pharmacists to attend PCG meetings in pursuance of the above; involving pharmacists in clinical governance and audit; and involving pharmacists in the potential development and implementation of new services. The project was all about getting a unified voice heard locally.
A major concern in setting up the project had been pharmacists' lack of experience in communicating at different levels. Pharmacists did not understand the political sensitivities and complexities of having to prove themselves and court people whom they thought should already understand and value pharmaceutical services.