The Pharmaceutical
Journal Vol 266 No 7148 p671-672
May 19, 2001
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The Pharmaceutical
Journal Vol 266 No 7148 p671-672 |
CHI calls for more pharmacists to sign up to the review teams |
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The Commission for Health Improvement (CHI) was set up in April, 2000. A year on, the CHI is calling for more pharmacists to become involved in its work. Clare Bellingham talks to three pharmacists about their roles there |
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Many opportunities exist for pharmacists to join the Commission for Health Improvement (CHI) review teams. The CHI aims to help improve the quality of patient care in the NHS in England and Wales. Its four main functions are to:
The largest component of CHI current work is conducting clinical governance reviews. Steve Collins, assistant director and a pharmacist, said that over the next four years, the CHI will review over 500 NHS organisations: acute trusts, health authorities, primary care and ambulance organisations will all be subject to the process. “The programme is currently loaded towards the acute sector but over the next year or two will be moving much more into primary care,” he said. “At the moment, we are developing the methodology for primary care reviews and have completed three pilots in this area.” Mr Collins is one of three pharmacists working full-time at the CHI who spoke to The Journal. The other two, Raliat Onatade and Yasin Rahim, are review managers. Each review manager is in charge of a clinical governance review at an NHS organisation. The assistant director’s role is to oversee all the reviews in one area of the country. Ms Onatade was previously principal pharmacist at Lewisham Hospital. She had been the clinical audit and clinical governance lead there so when CHI was formed the role of review manager attracted her. Mr Rahim's background had also been in clinical governance at a trust level. Following a meeting at which the principles of CHI were discussed, he knew that the CHI was “where he wanted to be, to make a difference in the NHS”. Before working for the CHI, Mr Collins had been private secretary to a health minister and been involved in clinical governance at the Department of Health. All three pharmacists emphasised that the CHI measures itself against six operating principles. They are to:
The same standards apply to employees of the CHI as the organisations under review, said Mr Rahim. “If people ask if we are open and accessible, the answer is yes.” He added: “We regularly challenge the directors on the principles and ask them what exactly is it that they are doing.” Mr Collins agreed: “Every day or so someone challenges me on the principles; everyone knows them.” What happens during a review Three months before a review starts, the target organisation is contacted by the review manager and the process explained, said Ms Onatade. For 15 weeks, information, such as trust board meeting minutes and patient administration data, is collected and analysed in preparation for the review visit. The information is collated into a “pre-visit brief” which gives an overview of the trust and its clinical governance arrangements. It also provides an idea both of the areas of weakness and of good practice in the trust. The brief is used to decide what areas to focus on in the review, she explained. Week 16 of the review process is the visit, which is conducted by five or six reviewers and the review manager. “The aim of the visit is to find out whether arrangements for clinical governance are in place and whether or not the patient in the front line is gaining benefit from them,” Ms Onatade said. The majority of time in the visit is spent interviewing staff and patients and observing processes at the organisation. The review team consists of a manager, a doctor, a nurse, a pharmacist or allied health professional, and a lay person. There is no hierarchy on the review teams, said Mr Collins; all team members are seen as peers with different areas of strength. Pharmacists are essential on the review team, said Ms Onatade. “As far as possible, we want a pharmacist on every review team because there are issues that only pharmacists can deal with, especially in medicines management,” she said. “It is a hard week but it is hugely rewarding,” said Mr Collins. “It is like going on an interactive clinical governance course, In fact one of the ways that clinical governance is improving is that after the review, the reviewers go back to their own organisations and are able to apply their new understanding of clinical governance.” The report writing stage follows the visit. Reviewers input information and the review manager compiles the report. It takes eight weeks to complete and the organisation has an opportunity to check the report for factual accuracy. After a further two or three weeks the report is available on the CHI's website (www.chi.gov.uk). The final part of the process is an objective-setting
day when the organisation agrees an action plan to address points raised
in the review. Once this has been agreed and published, the CHI role is
finished and monitoring of implementation of the action plan is conducted
at a regional level. The CHI's next involvement will be four years later
when the review process starts again. However, it would be possible for
a review to take place after two years if a need was highlighted. “We
are also identifying areas of best practice and when a number of reviews
have been carried out, we will put organisations in touch with each other
as a means of spreading best practice,” said Mr Collins. |
At the receiving end: a personal experience of a CHI reviewNorwich primary care group (PCG), now a primary care trust (PCT), was one of the first PCGs to undergo a CHI review. Ian Small, head of prescribing, said that it was not obtrusive and general feedback was that it had been a useful exercise. He explained that initially, questionnaires have to be filled which form part of the pre-visit brief. Questionnaires were sent to each general practice in the PCG. Three questions related particularly to pharmacy. They were:
“It was interesting to get the practices' responses and see what they said about my advice,” said Mr Small. Most responses were good, including comments about being able to get regular advice. A pre-visit report was sent to the PCG. Part of the report was about prescribing behaviours, highlighting five parameters:
“The report did not say that the patterns were good or bad, it just specifically stated the differences,” said Mr Small. The PCG was allowed to comment on the report at this stage. For instance, one variation highlighted by the report was a four-fold difference in NSAID prescribing between practices. Mr Small said. “I was able to comment that the reason for this is the different types of practices in the PCG, for example, a university practice.” Another prescribing area that the CHI report examined was the ratio of 2.5mg:5mg bendrofluazide prescriptions. “The CHI identified one practice that it said had a high proportion of 5mg prescribing and I disagreed with this because I was unable to find the evidence for it,” said Mr Small. In January, the review visit was conducted. Five reviewers met various people in the PCG. “My visit lasted for about an hour and a quarter and was with a prescribing adviser from another part of the country,” explained Mr Small. The reviewer discussed areas such as clinical governance, dissemination of information and implementation of guidance. Specific questions were asked about what the PCG was doing to implement the national service frameworks, what it was doing to eliminate postcode prescribing, what it would do if money was no object, and about the interface between primary and secondary care. The review was conducted in a straightforward and professional manner, he added. The CHI review was well accepted within the PCG and there was no hostility, Mr Small said. “It emphasised that the Government is keen on clinical governance and that the reality of this is a CHI review,” he added. Norwich PCT has been sent a draft report from the CHI and was allowed to comment on the report. “The report was keen to use plain English,” said Mr Small, “and cost effectiveness had been turned into cheap prescribing — I commented that I did not think the two were synonymous!” The PCG is now waiting for the final report to be published. “The review involved a lot of paperwork and it was a long process,” Mr Small said. “I advise other organisations to have one dedicated person to co-ordinate the review and take hold of the paperwork.” |
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Four pilot studies completed Four acute trust pilot studies have now been carried out and the reports published. The next set of reviews will be published after the general election. Publication cannot take place before because Government officials cannot comment on the findings during the election campaign. “Most organisations have welcomed the CHI,” said Mr Collins. “They understand the need for the review and want to move forward.” Ms Onatade added that it should be seen as a positive experience for the organisation being reviewed. “Our role is in development and support, not blame,” she said. “We are not naming and shaming,” added Mr Rahim. “But where there are hard messages we will say them,” explained Mr Collins. The CHI aims to complete 170 reviews per year, although current numbers are lower as the organisation has only recently been established. There are currently 50 on-going reviews and 102 are expected to be completed this year. Call for reviewers “We want to call for more pharmacists to contact us and become reviewers,” said Mr Rahim. “At the moment, we especially need hospital pharmacists but we have an increasing need for community pharmacists, too. We would like many pharmacists to become involved [on a part-time basis]. If you are committed to the principles of the NHS then become a reviewer,” said Mr Rahim. Pharmacists make good reviewers because they are trained to look at things from an evidence-based perspective, and can bring analytical skills, said Mr Rahim. They are also independent and their judgment is not biased, which matches the CHI principles, added Ms Onatade. In addition, their skills in medicines management are useful, she said. Pharmacists also had a significant input to offer in the area of risk management around drug errors, said Mr Collins. The general skills that CHI is looking for in reviewers are:
Reviewers are employed on the basis of a secondment from their main job and their employers are reimbursed for the secondment period. All potential reviewers attend a half-day event at a selection centre to find out if they meet a set of competencies. Once selected, they attend a two-and-a-half day training course at the CHI headquarters in London, said Ms Onatade. Each review takes 24 weeks and each reviewer works with the CHI for up to 12 days per review. This includes the review week, preparation before and de-briefing following the review, explained Mr Collins. “We would expect reviewers to complete two reviews a year but we do not want people to become professional reviewers,” said Mr Rahim. The CHI is also looking for pharmacists to participate in longer secondments involving series of reviews and special projects lasting three or four months. “This is a huge opportunity for pharmacists
to influence what the CHI does,” said Ms Otande. Mr Collins agreed:
“CHI is a place for people who thrive on change.” |
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Pharmacists interested in becoming reviewers should contact
Edward Porter-Hodges (tel 020 7448 9467, e-mail reviewer@chi.nhs.uk).
They will be sent an application pack containing more information about
the process. |
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Clare Bellingham is on the staff of The Pharmaceutical Journal |