Protected learning time for pharmacists…Could it become a reality?

Johnathan Laird

Johnathan Laird

 

THE short answer to this, is that as we develop into more clinically focused areas like independent prescribing and managing lists of patients it really has to become a reality.

Being a professional for me, is largely about managing risk and containing that risk, so that we can deliver a service for patients. My career began in the community sector, and to be honest involved the largely technical supply role familiar to community pharmacists in recent years.

Continuing professional development is of course critical to deliver this role safely. In fact my employer to date has, as far as has been practicable, supported this and for that I am very grateful.

However recently, I have been exposed to the much more dynamic and complex risks associated with being a practising independent prescriber. I am willing to take responsibility for those risks, justify my actions, behave professionally and hopefully have a more profoundly positive impact on patient management. I would love to think some day in the future, that I could help and support other pharmacists to take this step.

The management of a patient requires an array of areas of competence, some of which are quite different to those I personally have become used to previously as a non-prescribing community pharmacist. I love the contact and feedback I get from my new medical prescribing colleagues. So far, all the GPs I have encountered are much better at managing dynamic risk than I am. I really enjoyed observing and getting feedback on how it’s ok to make clinical decisions to effectively manage a patient.

A good example of feedback I got recently was about an asthmatic patient who was a smoker. For a number of months I had been fixated with helping him give up smoking, because I knew that in terms of impact this was probably the most profound way of improving his asthma. On conferring with one of the local GPs, she suggested parking the smoking issue and putting all my effort initially into controlling the asthma. The shift of emphasis worked and control was achieved. The patient is now more receptive to the idea of smoking cessation.

Pharmacists, myself included, are in my view, generally quite uncomfortable with this type of change of tack but sometimes it’s ok to take a risk to reduce the overall risk.

The point I’m trying to make here is that this type of feedback based learning is nearly impossible when working in isolation in the community pharmacy setting. I do wonder if, like the hospital setting, this support network is one of the very attractive features for pharmacists working in GP practices.

With this in mind I was delighted to read about the RPS in Scotland advocating the need for protected learning time. Alex MacKinnon of the Royal Pharmaceutical Society in Scotland recently released the RPS manifesto in preparation for the upcoming Scottish Parliament elections. I picked out the following statement.

“It’s really important that we strengthen pharmacy training and development to build capacity across the profession. That’s why we are calling for protected learning time for the profession, the enablement of experienced pharmacists to become designated practitioners to build the capacity across the profession and the introduction of a single integrated vocational training programme for all newly qualified pharmacists”

Protected learning time and peer review sessions like those enjoyed by doctors are therefore essential as our role as prescribing pharmacists evolves away from the traditional supply role.

The thought of having an afternoon when I could regularly meet with other prescribing pharmacists and discuss our clinical decisions is really quite exciting.

As mentioned, I am very grateful for the feedback and support I have received from my medical prescribing colleagues but perhaps selfishly, I hope eventually I will be receiving this feedback from, and be trained by, pharmacists. In this way, I think we will retain the slightly different pharmacological emphasis to our practice that is not evident in other professions.

More than that, this pharmacological emphasis is the unique selling point the pharmacy profession. I think we should follow the RPS Scotland direction and firstly protect our professional learning time before, in turn, protecting the unique pharmacist skill set.

Johnathan Laird is a community pharmacist independent prescriber with a special interest in asthma. He is based in Aberdeen.

Follow Johnathan @JohnathanLaird

The NHS conundrum!

Aditya Aggarwal

Aditya Aggarwal

 

THE ‘sick man of Europe’ is a term originally coined in the mid-19th century, and was used to describe the Ottoman Empire during the Eastern Question. Since then, it has been ascribed to many other countries within Europe at one time or another.  The thinking at the time was, that if the Ottoman Empire collapsed, then Europe would be in turmoil with countries competing to annex areas of fragmented lands resulting in a multitude of wars.

Another concept to mention before addressing the NHS is the Domino Theory. In 1954, referring to the Indochina political instability, US President Eisenhower said:

“Finally, you have broader considerations that might follow what you would call the ‘falling domino’ principle. You have a row of dominoes set up, you knock over the first one, and what will happen to the last one is the certainty that it will go over very quickly. So you could have a beginning of a disintegration that would have the most profound influences.”

In a nutshell, if one country fell to communism, then acting as dominoes, other neighbouring countries would also succumb to communism.

These two concepts are brought into sharp focus due to the current precarious nature of the NHS, which was highlighted in a joint letter signed by: the British Medical Association; the Royal College of Nursing; the Royal College of General Practitioners; the Alzheimer’s Society; the Anthony Nolan Trust; the MS Society; the Royal National Institute of Blind People; the Teenage Cancer Trust; the Family Doctor Association and the Faculty of Public Health, which said:

“The NHS and our social care services are at breaking point and things cannot go on like this. An NHS deficit of £30 billion is predicted by 2020 — a funding black hole that must be filled.”

Worryingly, 2020 is just four years away, and the UK economy has still not truly recovered from the credit crisis crash of 2007–08, with a stagnating if not slightly shrinking economy. An increase in the NHS budget is extremely unlikely.

If the NHS did collapse, the implications would be catastrophic and result in a collapse of the UK economy as it became a worthy competitor to the Greek financial crisis. Whole communities could be priced out of affordable healthcare caused by the dramatic increase in the UK cost of living. Many treatment options, such as monoclonal antibodies (mABs) would suddenly be too costly for patients to afford – some treatments already cost in excess of £1,000 per dose. Companies would respond to the loss in demand caused by a negative spiralling problem, by downsizing to ensure sustainability. All rather grim.

So, how is the Government hoping to prevent this potential future? I’ll answer that in my next article. Hint: think public health.

Aditya Aggarwal is a pharmacy student at the University of East Anglia, and founder of the Alternative Pharmacy Careers Conference

Follow Aditya @AdkAggarwal

#pharmacy24 Take the opportunity to showcase what pharmacists do!

HERE’S a video about what happened after MohammedSimon, Ravi and I (Alistair Murray) had a quick chat one afternoon last year. It was about nothing in particular, but ended up escalating (with lots of other support) to a national Twitter day for pharmacy within 6 weeks.

We had over 13 million impressions over a 24 hour period.

 

If you’re in the pharmacy world, be sure to get involved in this year’s ‪#‎pharmacy24‬ Twitter event on March 24, to showcase what pharmacy does – details are in the video.

I’m looking forward to involvement again from some great people this year like…

Robin ConibereBabir MalikClaire AndersonJonathan BurtonJohnathan LairdJane Portlock, Luke Anthony Johnson, Samantha BucklandKrupa DepalaNavin SewakAngela AlexanderDodi BehiriOksana ZirkaJustin PhillipsRinka SureshbabuNadia Bukhari UclHala JawadBrendan MurrayJames WoodSunil K. Kochhar and many more!

Pharmacists in care homes…What’s the point?

GREAT video, showing patient-centred care in a care home, featuring pharmacist, Wasim Baqir.

 

Pharmacists working in care homes was specifically mentioned in the Scottish Government’s recently launched National Clinical Strategy, which said that the contribution of pharmacists could be “considerably enhanced”, by using their expertise to ensure that “people with complex medication regimes have their care optimised, and the potential for side effects or harmful interactions reduced,” in care home settings.

According to a new report by the Royal Pharmaceutical Society (RPS), the widespread introduction of a pharmacist in every care home across Great Britain could save the NHS £135 million a year. Read more about it here.

 

 

Every pharmacist is a clinical pharmacist!

Johnathan Laird

Johnathan Laird


HOW
does one move from ‘pharmacist’ to ‘clinical pharmacist’?

In my view, this transition occurs as soon as pharmacists begin to deliver pharmaceutical care with patients…so probably within the first five minutes of being a practicing pharmacist!

Hepler and Strand [1] defined the term pharmaceutical  care as: “The responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life.”

To apply this concept a pharmacist does not have to do anything complicated. It could be something as simple as explaining the importance of avoiding alcohol when taking a course of metronidazole as the drug is dispensed. Or, it could involve a complex series of decisions to de-prescribe drugs as part of a complicated example of polypharmacy.

Both actions have the patient at the centre and ultimately have the goal of improving the standard of care. The definite outcome in the metronidazole example is, of course, avoidance of the disulfiram reaction, and therefore avoidance of the inevitable patient discomfort, not to mention the likely termination of treatment by the patient, if they suffer this potentially nasty reaction.

So, in my view, if you apply pharmaceutical care then you are a clinical pharmacist.

As pharmacists, we have a legal and professional obligation to deliver pharmaceutical care as a matter of course in our day-to-day practice. This is where the Royal Pharmaceutical Society support network comes in to support professional pharmacists in this endeavour.

The term pharmaceutical care is the bedrock upon which modern pharmacy practice must build. I wanted to take a moment to pay tribute to Hepler and Strand who conceived the idea and wrote about it back in 1990.

The concept is as relevant today as it was then and the paper below is a must read for all pharmacists regardless of setting.

There is no such thing as a non clinical pharmacist.

Johnathan Laird is a community pharmacist independent prescriber with a special interest in asthma. He is based in Aberdeen.

Follow Johnathan @JohnathanLaird

[1] Hepler CD & Strand LM. Opportunities and responsibilities in pharmaceutical care. American Journal of Health Systems Pharmacy 1990; 47: 533-543