The Royal Pharmaceutical Society's "Over to you" roadshow has now been seen by pharmacists in the Anglia, West Midlands and Wessex regions. The roadshows, part of the Society's Pharmacy in a New Age initiative, took place on May 15 in Ely, Cambridgeshire, for the Anglia region, on May 16, in Birmingham, for the West Midlands region, and on May 17, in Winchester, for the Wessex region. Each roadshow was chaired by a member of the Society's Council - Mrs Helen Remington in Ely, Mrs Linda Stone in Birmingham and Mr Sultan Dajani in Winchester. At each event, the CHAIRMAN explained that the roadshows were designed to help pharmacists think about their professional future and work towards that future in a constructive way. Speakers at each roadshow would share their feelings about stepping into new territories.
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At the Anglia region roadshow: (left to right), Ms Brit Cadman, Mrs Helen Remington, Mrs Anne Adams, Mr Roger Odd and Miss Rita Devi Bali |
At the Anglia region roadshow, Miss RITA DEVI BALI (manager of a local Lloyds pharmacy) said that the Cambridge PDG had arisen out of a request from the local primary care group pharmaceutical adviser to the local pharmaceutical committee asking if it could look into setting up an anticoagulant clinic in the community. "There was nobody who could really take that on board alone locally so I agreed to set up a PDG to do it," said Miss Bali.
At first, she had not known what to expect from local pharmacists, but they had turned out to be enthusiastic. However, setting up the clinic had not been completely without its challenges. Local doctors had been sceptical initially about pharmacists taking over anticoagulant monitoring. But, now, GPs were beginning to realise how valuable their pharmacy colleagues were.
Another area that pharmacy was better placed to deal with was repeat prescribing, which freed GPs' time to take on more secondary care tasks, such as performing minor operations.
Miss Bali said that having an understanding of each others' roles was helpful. Did pharmacists know what GPs, their receptionists and their nurses did? Did they know what pharmacists did?
"It has shocked me when I have been talking to other health professionals locally just how little they know about what pharmaceutical services are available in the community," said Miss Bali. "We all work more or less in isolation and it is up to us to get out there and network with others from within and outside of our profession."
She concluded by saying that, if pharmacists were to be included in primary care in the modern NHS, it was important that they kept in touch with changes that were going on and networked as much as possible with everyone possible.
At the West Midlands region roadshow, Mr MIKE WILLIAMS (Pharmacy in a New Age local co-ordinator) described his involvment in the setting up of a pharmacy development group in Solihull.
He said that the need to set up a PDG had been identified about a year and a half ago when he and other pharmacists had wanted to develop a range of novel services. The group set up included practice pharmacists, local pharmaceutical committee members, hospital pharmacists, independent contractors and employee pharmacists.
Many issues were being tackled, including hospital discharge for coronary heart disease patients, which had made the PDG look at the cross-boundary issue of communication. Another area of interest was extending pharmacy services locally through pharmacist prescribing and the supply of emergency contraception. The PDG was working on this area currently along with the chief executive of Solihull health authority. "If we achieve this, we really will be one of the first groups of local pharmacists to push the boundaries of community-based pharmaceutical care. And I believe this task is made possible because of the strength and support of the PDG," said Mr Williams.
He went on to say that pushing the boundaries forward was not without its personal challenges. "I attended one of the initial ‘cat-mat' discussions with local pharmacists in Birmingham and couldn't believe the lethargy I was faced with. There was very little awareness of the wider picture facing pharmacy from those who attended, and the meeting seemed to concentrate on navel-gazing at the small detail instead of looking at the bigger picture. It soon became apparent that, although some people advocated the setting up of a PDG, they expected someone else to do it."
The impact the PDG was having on relationships locally was now becoming apparent. For instance, traditionally, if the health care trust was running a smoking cessation campaign through pharmacies, there would have been no consultation and no prior pharmaceutical input. "Now, however, the trust will come to the PDG at the outset and ask us what issues we think should be included in a campaign. This message is disseminated throughout the health authority and, because of the prior consultation with the PDG, every pharmacist is giving the same message to everyone across the region," said Mr Williams.
Another example was Sun Awareness week, where the health care trust had approached the PDG first to give professional input.
Speaking about his involvement with the PDG, Mr Williams said: " I can't deny it's been hard work and it's taken some getting used to. But I've been pushing it and I've seen the results and I have to say I really feel it has all been worth it."
In conclusion, Mr Williams said that times had changed. Services were changing. He now spent 10 to 12 hours a day dispensing prescriptions for less and less return and he was sure this would deteriorate. "I for one would much rather be doing something interesting to progress my career and serve my profession," he said.
The future was service-based. Pharmacists needed to do something to push the services they were skilled to deliver and have them recognised. The PDG was a great way to do this.
At the Wessex region roadshow, Mrs Jane Portlock (senior lecturer, University of Portsmouth school of pharmacy and biomedical sciences) said that the Portsmouth PDG had been set up two years ago. On the PDG were hospital, academic, industrial and community pharmacist, including contractors, employees and locums. There was also the health authority pharmaceutical adviser and other advisers. In total there were about 14 people on the main PDG and 25 associated with or planning projects from the many different sectors working in partnership.
As word had got out about the interesting work being done under the PDG umbrella, so the group had grown. "In fact," said Mrs Portlock, "it is now getting so big that the next stage has begun, which is to create subgroups to work on specific projects."
Some of the work so far undertaken by the PDG included looking at the treatment of minor ailments. Between September and December, 1998, meetings of GPs, nurses and pharmacists had been held to talk about how they could collaborate on the management of minor ailments. GPs had been very enthusiastic. The realisation had been that it was necessary to work as a partnership. "We all need better working relationships - and if we achieve them, it makes life easier for all of us," said Mrs Portlock.
Nurses, too, had been enthusiastic. Triage nurses realised that they did not always have the required over-the-counter drug knowledge. All professionals had been open to learning from each other.
Other projects had come out of these meetings. Referral guidelines (for headache, respiratory and gastrointestinal conditions) had been produced at each meeting and these had been sent to all registered pharmacies and contractors.
The PDG was also carrying out a referral form pilot. This was a form for pharmacists to give to patients to take to their GPs, giving details on the patient/pharamacist consultation.
It had also produced, with health authority funding, a "Pharmacists first for minor ailments" leaflet for use in GP surgeries. The idea for that had come from a local pharmacist who had presented it to the PDG.
"All these relatively small initiatives add up to an important impact - and that is, I think, the most important thing - that, collectively, we can make a difference," Mrs Portlock told the meeting.
Concluding, she said: "I really don't think that, as a profession, we are prepared to blow our own trumpets enough. When do we ever publicise what we do? We have to be brave and prepared to put our feet into new areas because, believe me, it will pay dividends."
At the Anglia region roadshow, Ms BRIT CADMAN (pharmacist, Addenbrookes hospital, Cambridge) described a hospital medicines self-administration programme. The project, which had been set up two years ago on two surgical wards, involved asking patients to bring in their own drugs which were kept in a bedside locker to which the patient would have a key. A pharmacy technician checked the medicines and talked to the patient about them.
What had been found was that, prior to the project, there had been about a 13 per cent error rate in prescribing because junior doctors were making prescribing errors when admitting patients. The inpatient prescription did not match the medicines that the patient was taking at home. This excluded any new hospital therapies like antibiotics or analgesics.
The self-administration initiative had started as a six-month project, but had been so successful that it was now partly funded from the surgical directorate. Medical and nursing staff liked the scheme because it saved money. Patients, too, had been extremely appreciative of the scheme.
Ms Cadman said that the scheme had been extended to the hospital's transplant ward, where "patient enthusiasm was amazing". She explained that most transplant patients were given patient medication cards which showed all their medicines. It had to be appreciated that transplant patients were having to come to grips with new and complicated medication regimens which they had to learn in about 10 days, so the cards were very important to them. The patient was helped to learn and understand the regimen by pharmacists and nurses. "However, when I was on the ward, when patients' regimens had changed they were all very insistent on having new cards with updated information. I found this very positive. In fact, I think that if we took the cards away from them now the patients would create an outcry - and so would the nurses."
Ms Cadman found her work "a lot more rewarding" than the traditional clinical pharmacy role she had been used to, where she would deal with clinical issues away from the patient. "Solving little problems for a patient can make a huge difference to them and it is very satisfying," she said.
Looking to the future, Ms Cadman said that, with the advent of electronic prescribing, pharmacists needed to have a role which included the patient. Pharmacists would always be needed to interpret advice "pumped out" by a computer, but the patient-focussed approach was becoming ever more important. "I think that if we, as a profession, concentrate on the patient we will have a successful and rewarding future," Ms Cadman concluded.
At the Wessex roadshow, Mr JEFF WATLING (Pharmacy in a New Age local co-ordinator) discussed the benefits of multisector working in PDGs. He said that the North and Mid Hampshire PDG had had its problems but, in recent months, a few community pharmacists had carried out small audit projects with considerable promise.
One of them had conducted a repeat prescribing project. He had reviewed prescriptions from a three-doctor practice, highlighting potential for savings on the basis of identifying the most cost-effective dosage of pharmaceutical products for patients. He had made recommendations based on the dose that was written on the prescription. The pharmacist had identified potential savings of £2,600 per annum for this relatively small practice and had fed details back to the GPs on a "next time you prescribe you may consider this" basis. The GPs had welcomed the feedback and appeared to be changing their prescribing as a result.
The PDG's two hospital pharmacists had added two other target areas:
Extension of the initial repeat prescribing exercise could achieve potential savings of £130,000. Adding in isosorbide and PPIs could save as much as £250,000. "This could be achieved without reduction in quality of care. In fact, it can be argued that there would be improved quality of care as a result of prescribing appropriate doses of these pharmaceutical products," said Mr Watling.
Involvement of hospital pharmacists and primary care pharmaceutical advisers opened routes for obtaining funding for this additional pharmaceutical service. The local drug and therapeutics committee could be informed and asked to support similar exercises with the same target products in the hospital service. This had the added benefit of ensuring that hospital prescribing took account of the knock-on effect in primary care and prevented the hospital being accused of referring patients back into primary care on medicines that were less cost-effective and not included in local guidelines.
This example was not revolutionary or unique, said Mr Watling. "It is, none the less, local real life and illustrates the benefit of pharmacists working together and sharing ideas within and between pharmacy development groups."