Mental health pharmacy is all about the person and their story

Wendy Ackroyd Mental Health Pharmacist

 

Wendy Ackroyd is the lead pharmacist at the mental health directorate in NHS Dumfries and Galloway. We were delighted to welcome her to share her experiences working as a pharmacist working in the area of mental health.

 

 

Why did you become a pharmacist?

 

The brutally honest truth?

 

I’m a failed medic, kind of.

 

I was about 4 years old when I decided I wanted to be a doctor. No one in my family had ever been to university so this was quite the ambition. My parents always encouraged me to believe in myself. So that’s what I was going to do, and I worked hard.

 

Having always been studious and quite well behaved I became a teenager all of a sudden at about age 16. I got a part-time job and a boyfriend. At that time I took my eye off the goal. I messed up my A levels and withdrew from PCAS in a fit of a teenage strop after a fall out with my parents. My school careers advisors didn’t even know what Pharmacy was. I didn’t know what to do and just gave up a bit. I was just going to get a job.

 

My form teacher suggested I applied to a pharmacy for a job to stay in a “medical like” field instead. And I did. The local Boots was looking for a trainee dispenser. I passed my Society of Apothecary’s dispensing technician course, and loved training counter assistants and talking to patients. I was told by many pharmacists I worked with that I could easily manage a pharmacy course. And by this time I had a better idea of what it was, so I applied. Most universities wouldn’t touch me with my A level results, but Sunderland took my dispensing qualification into account and gave me a chance.

 

I loved it.

 

Could you describe your career pathway so far?

 

In short falling in at the deep end. Thankfully I can swim. My first manager was a dispenser not a pharmacist, pretty much the only one in Boots back then. I was the only full-timer in the pharmacy department three months into my dispensing training, so was effectively running the department at that point.

 

My first job once qualified as a pharmacist was in a very busy Boots store in Cleveleys. My technician left a week after I started (not my fault). We did about 450 items a day.

 

I did relief management in the Lakes region of Boots for a couple of years after that and, frankly, I love patients. I have all the time in the world for them. I don’t like customers much. The shopkeeping part just wasn’t for me and I craved a clinical role. So I took a huge pay cut and a B grade job in Westcumberland Hospital with a 1 in 3 on-call from where I lived – 45 miles away – to get some hospital experience. I loved the hospital role but I couldn’t afford to stay at a B grade for more than a year. It was an £8k difference in salary back then 20 years ago.

 

So I asked about locally (within 60 miles) to see what was available. I was invited to “come for a chat” at Dumfries hospital pharmacy department. I had said chat with Mike Pratt and was then offered a job, temporary D grade in mental health. Their usual guy was in New Zealand on sabbatical. HR was not quite as involved in recruitment back then. I thought “why not?” and took it.

 

He saw me coming, or he saw potential, who knows? I had never heard of the Crichton Royal Hospital and it wasn’t mentioned at all in our “chat”. Westcumberland mental health wards were in the infirmary itself. I thought that’s how it worked everywhere. So was somewhat surprised to be handed a passkey and told to go look after “The Crichton”. No induction. No mental health background. And this was a victorian psychiatric hospital with 11 wards left in it, mid-transformation, in a different Trust and nobody could tell me what I was actually supposed to do. I was the only pharmacist for mental health of any kind in the entire region. It was a steep learning curve.

 

I had a six-month temporary contract. That was in January 2000. I loved it. I still do.

 

Don’t get me wrong it has almost broken me once or twice. But I love working in mental health. I love the challenge and the patients I work with and I am happy, even proud, to be a voice for what is still a Cinderella service, although it’s improved a lot in 20 years. We now have 2 pharmacists and recently added a part-time addictions post; I am expending our empire bit by bit.

 

You have an interest in mental health pharmacy. Why?

 

It’s more than an interest, it’s a passion. What is more fascinating than the mind? How fragile it can be in some, and yet how robust in others. We can all break mentally under the right, or wrong, circumstances. One in three could be affected in their lifetime. And yet it’s poorly studied, funded and supported. I’ve always been a sucker for the underdog. Mental health and wellbeing are multifactorial, it’s hard to measure, and treatments are complex and evidence isn’t always especially robust. Pharmacists are often quite black and white. We like details and guidelines and protocols. It’s about how we’re trained.

 

In my spare time, I’m an amateur artist, I think that creativity spills into my work. Once the evidence runs out the question remains  “what can we do for people that makes some sense to try – and how can we keep them safe at the same time?” It’s all about the person and their story at the centre of it all.

 

Every day is different. There are puzzles to solve and problems to fix. It is endlessly fascinating and challenging at the same time. It’s a huge jigsaw puzzle with medication forming a teeny tiny part of all that, but an important piece, and a potentially toxic one if you mess it up. Medicines can’t fix everything but they can have a huge impact on someone’s ability to cope with life.

 

Have you completed any additional qualifications in the area of mental health?

 

My postgraduate education route was a bit messy. I was in the first cohort of community pharmacists offered the postgraduate certificate in community clinical pharmacy. I then changed to a hospital diploma and overlapped that with the Aston certificate in psychiatric therapeutics, before finishing my MSc in clinical pharmacy. I did a study on satisfaction with medicines information in mental health. I’m a pharmacist independent prescriber too, but used CVD and diabetes as mental health wasn’t offered at Strathclyde.

 

My development was very much shaped by the College of Mental Health Pharmacy (CHMP). Their email group for answering questions and absorbing discussions and the conference was a great opportunity for learning. It was a lifeline for someone like me early on with no mental health background, and working in an isolated position. I even did a stint on Council and as Secretary for CMHP a wee while back. We have a group Scottish Pharmacists in Mental Health, for educational activities too, and did my part on the committee for that a few years back too.

 

Could you describe a typical working day for you?

 

Not really, no. No such thing. And honestly, I like it that way. There are elements of the week that happens, like ward rounds, and my dispensary duty, but each day is so varied. I’m pharmacy lead for mental health directorate which also includes psychology, substance misuse, and the local prison. This is quite a remit. We have an 80 bedded hospital, 4 CMHNTs and geography of 150 miles by about 60 miles for a population of 150k.

 

I’ll give you an idea with what’s on my desk just now:

 

  • This week I’ve been involved in my very first interviewing for the addictions pharmacist. That was exciting but quite stressful.
  • I’m trying to set up a mental health prescribing subgroup (again) as our new Director of Pharmacy is bringing things up to date.
  • Our national contract for Clozapine has changed and I managed the switch for that. I had some paperwork to organise to ensure all teams know what’s going on.
  • I’ve answered a variety of clinical questions today on treatment options for a few outpatients and in the infirmary.
  • I’ve had dispensary duty in the infirmary this morning for a couple of hours.
  • I’ve had an email discussion about managing pharmacist independent prescribers in substance misuse and the appropriate way to direct funding for the medicines prescribed that service.
  • I’m considering how we might introduce esketamine if and when it gets its licence.
  • I have ADTC this week and have papers to go through for that. Our ADTC is regional so it’s not just mental health. I also sit on our exceptional prescribing panel.
  • I had to find info on haloperidol drops to liquid/tablet conversion for someone just here from Poland.
  • I’m involved in the, almost completed, review of our alcohol detoxification pathway to ensure it goes through the various governance hoops to go forward for approval.
  • I’m trying to figure out how to improve mental health knowledge and confidence in talking to people with mental health problems for the new general practice clinical pharmacists (GPCP). Thinking also how that fits with our new GP based psychiatric nurses and how we get them all working together.
  • I’m looking at developing or buying in some joint training but as a first step I want some “talking about suicidal thoughts” input for the GPCPs so I had a meeting about getting that going.
  • I need to arrange a 1:1 and review with my junior pharmacist. She’s on holiday just now so I’ve also been clinically checking pass prescriptions.

 

Are you a member of any professional bodies? Which ones and why are you a member?

 

I am a supporter and member of Royal Pharmaceutical Society (RPS). I think they do a lot of great work to support pharmacy as a profession and get us seats at tables we wouldn’t always be on. I am an associate member of College of Mental Health Pharmacy. My performance and development plan this year includes credentialing and accreditation for next year. To be honest it’s about time I got on with it. I’m a member because of the education and support they offer in my specialist field. Once I was a newbie needing support and advice, now I have the opportunity to give some of that back at times.

 

What is credentialing and why does it matter?

 

Credentialing is about proving you are working at a certain level. The RPS offers to credential at different levels of practice in general. CMHP offers advanced level but just in mental health. To complete CMHP accreditation is to show I’m a specialist in my field. I’ve considered both RPS and CMHP. I am a staunch supporter of CMHP and I feel it fits me best, and my Director of Pharmacy is in agreement.

 

I guess we all have that feeling that we’re going to be “found out”, maybe we’re not that great after all – “Imposter Syndrome” it’s been described as. In many ways, I don’t need to prove to my colleagues that I’m good at what I do. They already appreciate what I bring to the table. For me, it’s about proving it to me, about challenging myself and a little bit of masochism perhaps. If I’m honest I’m apprehensive about it but it’s the same for everyone I’m told. It’s also a huge CPD opportunity. If I do find out that I need to improve it’s a way of identifying that. That can only be good for the patients I care for because if I need to do better I will because I owe them that.

 

Everyone’s reasons for credentialing may be different. Maybe it’s about getting a specific job. Maybe it’s about challenging yourself. Maybe it’s about learning and reflection. You reflect and decide what it is to you.

 

What are the big issues that concern you at the moment in mental health pharmacy?

 

There isn’t enough of me to do everything, that’s always been an issue. I need to find creative ways to support and develop mental health knowledge and confidence in managing mental health conditions in a wider audience of pharmacists. Primary care, addictions and acute liaison are areas I’d like to target. We’re making progress bit by bit. I like the jigsaw analogy. I need more pieces of the jigsaw fitted together. A small health board has many challenges but working together creatively is something our pharmacy team is especially good at doing.

 

The government document Achieving Excellence in Pharmaceutical Care gives us a direction to work towards. Although it doesn’t specifically mention mental health it is entirely applicable to anyone with mental or physical health needs.

 

Stigma is still a problem. And I feel we could do more to protect the mental health and wellbeing of those that work in healthcare. Austerity and staff cuts take their toll on those of us working in the system and we need to be mindful of that.

 

What are the risks of pharmacists taking on more responsibility in the area of mental health pharmacy?

 

I don’t think the risks are greater for mental health necessarily than for any other area of health. Our role is expanding, possibly down to fewer doctors qualifying creating gaps.

 

We need good governance, across the board to ensure we work appropriately and within our competence. We also need appropriate multidisciplinary skill mix so we have the right people working where their skills and knowledge best meets the needs of our patients. We need to ensure we don’t just absorb the work of other staff groups to stick a plaster over a gaping wound. It is important that we put things in place to improve services for patients and manage risks without losing what makes us unique, our expertise in medicines.

 

We need to look at risk differently and some of that is down to how our governing body behaves. Doctors accept risk in what they do, pharmacists try to avoid it. But of the two we’re the only ones who can go to jail for making a genuine mistake. If we want pharmacists to work in broader roles and the risks that come with that, we need to fix that disparity.

 

I think we need to stop thinking of mental health as a separate being and think holistically, and think broader than medicines. Mental and physical health and wellbeing are broader than drugs. It’s also about diet, exercise, smoking, stress, meaningful activity and our social circumstances. Loneliness, family support and many, many other things. Pharmacists have a talent for being able to see the whole individual with regards their treatments, but we need to look broader than the medication.

 

I went to a public health event a year or so ago when they told us. Mental health patients die on average 20 years sooner than the general population. Like that’s a new thing. That’s not news; I knew two decades ago. What is sad is that the wider audience were surprised by that and that in two decades we haven’t affected it. This is what holistic, patient centred care is about. Not silo-based care fixed around a service or profession but looking at all the needs of the individual and how best to meet them in a way that fits that person.

 

Are there any particular traits or skills that pharmacists who specialise in mental health need?

 

Be compassionate, non-judgemental but boundaried. Negotiate and educate, don’t dictate. See the whole person and their lifestyle and how that impacts on them. Listen. Be open-minded. Be aware of and educate yourself on the illnesses and the treatments. Motivational interviewing techniques wouldn’t go amiss. Be creative if necessary. People don’t always fit in boxes, neither does how they manage.

 

And be aware of your own triggers. Many pharmacists will also have mental health difficulties. Look after yourself too. I’m not sure any of these are specific to mental health though.

 

What contribution to caring for people with mental health issues would you expect from a community pharmacist?

 

The same as they’d have in caring for anyone else. Community pharmacists are the most involved in anyone with a medium or long term condition. They see them more often than a psychiatrist anyway. Ask people how they’re getting on and listen. Be able to give advice on what to do about side effects, or if someone wants to come off their treatment help them weigh the pros and cons. Know where other services are if you need to signpost. Know how to contact someone if you have concerns.

 

Do you think suicide prevention techniques should be taught to community pharmacists?

 

Absolutely. And everyone else. Just like we should all learn CPR. In some ways working in mental health is about having confidence and compassion, to want to have difficult conversations and know how to deal with them.

 

It is not someone with a mental health problem in front of us. It’s a person.

 

People get thoughts of suicide. They don’t need a mental health diagnosis for that. Asking someone if they have those thoughts does not make them more likely to die by suicide. People have them or not. You can’t make someone suicidal by asking them about their thoughts. But you need to have some idea how to respond appropriately if they say they do. Asking and responding to the situation could give that person the pause that changes their mind.

 

What has been your proudest moment so far as a pharmacist?

 

I was walking my dog a couple of years back and I bumped into another dog walker and got chatting, as you do. He said he expected I didn’t recognise him (and I didn’t) but he’d been at a meeting I was at when his daughter was an inpatient in our mental health hospital.

 

He said I’d said something to her that had really helped her and it made a huge difference to how she felt. I’d helped her understand what the medicines could do for her but also was honest about what they couldn’t do, and as a consequence, she decided to start taking them and they made a huge difference to her. At the time of this conversation with her Dad, she was well and planning her wedding.

 

We all have days when we wonder if we really achieve anything, but knowing I made a difference to that one person makes it all worth it. We don’t often set the world on fire as pharmacists, and may not always see the impact we have but something small, said with honesty, compassion and confidence can make a huge difference to that one person.

 

As a profession how should we reward pharmacists for outstanding practice?

 

I know a lot of pharmacists who like gin. Perhaps not in keeping with health lifestyle advice though. I don’t know, we’re awful as a profession for blowing our trumpets. I think that harkens back to what I’ve said before. A mix of imposter syndrome and not recognising the impact we can make. Most of us don’t do it for rewards or recognition. Acknowledgement at least challenges us to feel better on the days we wonder what we do it for, and boosts us to keep doing better. It makes us feel like we matter.

 

Are you optimistic about the future of pharmacy in the UK?

 

Yes, absolutely, we’re taking over the world. Pharmacists have lots of skills and we are adept at finding solutions to gaps in services, to adapting to different environments and bringing something unique and meaningful.

 

What’s next for you?

 

Short term – I’ve been writing this for ages. I think I’ll eat, take a walk, maybe do some painting; that’s how I look after my mental health and wellbeing. I’m trying to develop my oil painting skills.

 

Professionally – CMHP accreditation next year (eek!) and then probably some leadership stuff after that. We’re working as a team on how we can meet Achieving Excellence in Dumfries and Galloway. I’ve got a new addictions pharmacist starting soon to get up and running. I’d like to see if we can develop a liaison psychiatry pharmacist role here. Developing primary care skills, knowledge and confidence in mental health management is on my list too.

 

Longer-term I’ve got a yearning for a role in patient advocacy, perhaps in the Mental Welfare Commission. They don’t currently employ a mental health pharmacist, but I think they should.

 

What advice would you give to pharmacists who wish to pursue a career in mental health pharmacy?

 

All pharmacy involves mental health pharmacy, but if you want to specialise or just want a taste of what specialist mental health is, speak to your local specialist pharmacist, join CMHP, and get on with it. I love it.

 

 

 

Secrets from a pharmacist on the front line

Robert Liddington

 

Robert Liddington was kind enough to join us on the podcast to talk about his extremely interesting career so far. Robert spent almost 18 years in the army as a pharmacist and more recently has taken roles in the MHRA and also the Care Quality Commission.

 

He took us through his experience in the army and he shared his insights about how pharmacists can have a very interesting and fulfilling career in the army or the army reserve.

 

  • How does a pharmacist get into the army?
  • What has your role involved over the years and what positions have you held?
  • Are the pharmaceutical issues that you encounter in the army similar to those that you come across in civilian life?
  • Your role has placed you in some very difficult situations abroad. Have you ever felt fear when in a war zone?
  • What is the difference between the regular army and the reserves?
  • How did you coming back into civilian life after serving time in the army?
  • Can you you think of a situation when you were really under pressure to find a solution to a problem fast? What happened and how did your army training help you cope?
  • You have been deployed abroad on a number of occasions. Where was the nicest place you were deployed to?
  • What could community pharmacy learn from the military?
  • What is your advice to newly qualified pharmacists?

 

 

If you are interested to talk to Rob about a role in the army feel free to drop him an email by clicking here. 

If you prefer to never miss an episode you can subscribe on your preferred podcast platform. Just click on the links below to get going.

 

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Career spotlight: Dolly Sud on her role as a mental health pharmacist

Dolly Sud Mental Health Pharmacist

 

Why did you become a pharmacist?

 

During my childhood whenever I visited friends and family in a hospital who weren’t well or when I went to the pharmacy which wasn’t far from our house I was struck by how very well respected the pharmacist was as part of the healthcare team. I also noticed how well they worked alongside other healthcare professionals and had so much expertise and knowledge about medicines. I was impressed by how much they helped people take care of themselves and manage their medication. Later on, at school, I developed a keen interest and ability in chemistry which propelled my interest further. That all sounds very idealistic and viewed through rose-coloured glasses but I was very young.

 

Could you describe your career pathway so far?

 

On the face of it, I think if someone was to read my CV they might think that my “pathway” has been planned or strategically thought through. This is not the case. On balance I would say I have made the very best use of opportunities that I have come across or have been presented serendipitously. I have been very lucky to have a wonderful range of experiences and a variety of jobs in different healthcare settings and with many different teams. In addition, I have also been lucky to been provided with opportunities to undertake postgraduate qualifications which have been funded in terms of money, time and support from the pharmacy departments and managers with whom I have worked.

 

I have had roles in primary care, secondary care and at the interface in both general medicine and mental health/psychiatry. In addition, I have been exposed to opportunities to lead on innovative service developments and be autonomous in making decisions on initiating and pushing projects forward. In fact, my career to date has been split approximately equally between general medicine and mental health/psychiatry and my postgraduate diplomas also reflect this. I am at the point now where I am embarking on the next steps and adventures in my career undertaking research as part of a PhD with Aston University whilst continuing clinical practice.

 

You have an interest in mental health pharmacy. Why?

 

If I might I would like to rephrase this if I may? I would say I have always had an interest in mental health, mental ill-health and the treatment and care of mental health. The main reason from this, if I am honest, stems from my personal experience of witnessing first-hand the impact of (untreated) mental illnesses from a very young age. Since I started practising as a pharmacist I have felt the call to work in mental health. I was lucky to be provided with an opportunity to work at a mental health trust around 11 years ago and since then I haven’t looked back. I feel that I should use my expertise, knowledge and understanding of medicines and how they work as well as my personal experience in a positive way to improve care. (Hope that doesn’t sound like I am trying to be too heroic)

 

One key factor that I would say that has been pivotal in my current role is that I currently work in a department that is led by a fantastic management team and I have been supported and pushed to improve my work. The people I work with across my NHS trust are wonderful and I have been privileged to have formed some good professional relationships which have blossomed.  In addition, I feel that I have had many doors opened to allow me to fulfil my ambitions and aspirations as well as do things that I had never thought of before.

 

Are there any particular traits or skills that pharmacists who specialise in mental health need?

 

They are no different from the traits or skills that I would expect from a pharmacist working in any other area of patient-facing healthcare setting. I would say that mental health pharmacists compared to other pharmacists may over time develop a greater degree of emotional resilience, compassion and empathy as a consequence of the particular challenges faced within psychiatry. Other skills that are honed during practice, that facilitate a better quality of interaction with service users, their carers and the rest of the team, include perception and sensitivity as well as being able to reason both inductively and deductively. My subjective experience is that I have used and applied my pharmacological knowledge more in psychiatry than in any other setting that I have worked in.

 

What contribution to caring for people with mental health issues would you expect from a community pharmacist?

 

Community pharmacists are the most frequently visited healthcare professional in the UK. They have a role to play in asking someone how they are having to provide a point of contact where someone feels comfortable to ask for advice. In addition, community pharmacists often come in to contact with community psychiatric nurses, who visit the pharmacy with service users, their carers on their behalf. As such community pharmacists can be the first link to pick up on the fact that a service user might have stopped taking their medication or is acting out of character. Community pharmacists can provide advice on side effects and their management as well as encouraging adherence.

 

Interestingly I am exploring this as part of my PhD research. We are exploring the role of pharmacy in physical health in mental health. It is vital that we get the views of community pharmacists and technicians on the role of pharmacy in supporting the physical health of individuals with severe mental illness (e.g. schizophrenia).  If you would like to know more about my PhD research project and/or be involved please have a look at our webpage.

 

CARDIOPHITNESS research study

 

Do you think suicide prevention techniques should be taught to community pharmacists?

 

You should have a look at work from Hayley Gorton (Senior Lecturer in Pharmacy Practice, University of Huddersfield) – she is the expert on this. Hayley’s PhD was about the pharmacoepidemiology of suicide and self-harm. From this work, there was reflection on what community pharmacy teams can do to raise awareness and help prevent suicide and self-harm.

 

In my opinion, yes, absolutely. Community pharmacists are the most frequently visited healthcare professional in the UK. Patients often choose to visit a particular pharmacy regularly for many years and have a trusted therapeutic relationship with the pharmacy team and the pharmacist. The position of the pharmacy team within the community means that they may be able to identify changes in medical, social and personal factors as well as the wellbeing of their patients. Pharmacy support staff may enhance this as the first point of contact in the community pharmacy where the pharmacist might not be the same person every day. The opportunity exists to signpost to national support groups or local services.

 

Red flags such as excessive quantities or frequency of over the counter medication could be picked up by the community pharmacy team. In doing so this could prevent poisoning by accident or suicide. Straightforward interventions of reminding of the maximum doses of, for example, paracetamol could be effective. In addition, pharmacist identification of medication implicated in overdose during a clinical check would be very valuable and trigger additional counselling of the patient and their carer and discussion with the prescriber if necessary. Counselling of patients who have been started on antidepressants is another important role that should not be overlooked – there is a need to emphasise time take to get the full benefit as well as the increased suicidality that may occur.

 

I would also include pharmacists who work in A&E as they might encounter individuals who have taken overdoses and they may be involved in post-discharge care. Pharmacists who work in GP practices might have a role with regards to reducing risk where smaller quantities of medication are prescribed by the GP to reduce risk. All pharmacists can be involved in recommending medication which has lower toxicity in overdose.

 

What has been your proudest moment so far as a pharmacist?

 

I was able to sit down with a service user and discuss different antipsychotic drug choices and discuss the pros and cons of each. After this discussion, the service user was able to make an informed decision about which one might be the most suitable and this was discussed with the multi-disciplinary team in the ward round. I was able to follow this up and the service user has been adherent to the medication since that discussion took place.

 

As a profession how should we reward pharmacists for outstanding practice?

 

Highlighting and reporting achievements and good practice in-house, locally, nationally and internationally– but not restrict this dissemination to pharmacy world only – share across disciplines.

 

Increase investment in training and opportunities

 

A lot of this lies fundamentally in individuals and teams reporting or having opportunity and platforms to report on the outstanding practice. As well as recognising that it is outstanding in the first place – I think traditionally pharmacy hasn’t always been good at “blowing its own trumpet”. So instilling this early on in pharmacy training is fundamental to achieving this. Pharmacy teams do a lot of goodwill and a lot of goodwill as business as usual.

 

 

 

What advice would you give to pharmacists who wish to pursue a career in mental health pharmacy?

 

Go for it. It is a rewarding and fulfilling career. It will provide you with an opportunity to have a very positive impact on the lives of your service users/patients and their carers. You will be presented with new and interesting challenges each day, but you will face them with the support of your colleagues around you. You will learn and grow as you practice both in terms of skills and knowledge and as a person.  There are also plenty of opportunities and support for further professional development and you will feel and be supported.

 

Have you completed any additional qualifications in the area of mental health?

 

As well as a postgraduate diploma in pharmacy practice I also have a postgraduate diploma in psychiatric pharmacy. I am currently undertaking a PhD which is focused on mental health.

 

Could you describe a typical working day for you?

 

That’s a difficult question to answer as currently my time is split equally between clinical practice and research. Currently, on a practice day, I am responsible for leading on a service which is focused on improving the physical health for those with severe mental illness – ensuring monitoring is done and followed up. On a research day, this might be anything from undertaking a qualitative interview with a participant recruited to my research study, reviewing data collected, networking with others, reading, reviewing or research governance or conferences.

 

Are you a member of any professional bodies? Which ones and why are you a member?

 

GPhC (obviously!)

 

I am also a fully credentialed member of the College of Mental Health Pharmacy

 

What is credentialing and why does it matter?

 

In short….

 

Credentialing is the College of Mental Health Pharmacy’s process for assessing members’ knowledge and experience. It allows a member to demonstrate that they are experts in the field of mental health pharmacy. (It does allow me to put the following letters after my name MCMHP). This type of membership is available to pharmacists and pharmacy technicians who have attained an expert level of working.

 

To be eligible for full membership the associate CMHP member pharmacist has to demonstrate their expertise. To this end here are certain criteria related to years of practice within psychiatric/mental health pharmacy and/or relevant qualifications. Further information can be found here for those who might be interested: here.

 

I had to demonstrate my expert level of practice by submitting a portfolio of evidence and sitting a viva.

 

What are the big issues that concern you at the moment in mental health pharmacy?

 

Effective utilisation of our knowledge and skillset to improve care for mental health within a rapidly changing NHS on the background of increasing calls for pharmacists to be involved. In my opinion key to this is the maintenance of core services but increasing time spent in patient-facing medicines optimization roles and as part of the multidisciplinary team.

 

What are the risks of pharmacists taking on more responsibility in the area of mental health pharmacy?

 

We need to ensure that the fundamentals of our role are understood to ourselves and others as far as is possible. This will avoid the threat to these fundamentals when we move forward and undertake new roles and activities. In addition, avoiding our role being seen as a gap-fill where there is a lack of resource in other areas but establishing and demonstrating what we can do well and what we know.

 

We are faced with the environment of increasing public expectations, workforce pressures, and advances in technology and medicine. Without this clarity, we will not be able to select, educate and train pharmacists or focus on what the workforce might look like going forward.

 

We must be clear that we do not lose our way or lose our identity. If we aren’t clear about our own professional roles and the boundaries of those roles this can lead to friction and the best interest of our patients/service users and the public might not be met. We must also make sure that in order for us to fulfil our potential we must work in harmony across disciplines (i.e. with doctors, nurses and other healthcare professionals).

 

Are you optimistic about the future of pharmacy in the UK?

 

Yes as long as we become more visible and provide more patient-facing and multidisciplinary care that is in the location convenient to those two key stakeholder groups. The main focus would be towards medicines optimisation for those on multiple drugs those with long term conditions, public health and provision of services for minor ailments. I am yet to fully understand the impact of primary care networks on primary care pharmacists so cannot really comment on this recent development.

 

What’s next for you?

 

I am currently in the throes of the third year of my PhD research and developing a whole new set of skills and understanding. Not only is this challenging but very exciting and it is really testing my resilience. I want to fulfil my responsibility to the participants who have given their time and effort to provide their data for my research. In addition to attain a level of writing that both I and my supervisory team are proud of I want to do justice for the core of the research – address the inequality that exists for those with mental ill-health.

 

I have a very general idea of where I might see myself going – hopefully in some sort of clinical academic role. I don’t have a master plan. I just want to continue to enjoy what I am doing and allow serendipity to have its hand in my future career.

 

Career Spotlight: Chris Maguire on his journey to become a marketing manager

Chris Maguire

 

Where did you study?

 

I studied pharmacy at Queens University Belfast. I completed my pre-registration year 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.

 

Why did you venture across the Irish sea?

 

I had friends in England who told me about the offers they had been receiving and it made me feel quite undervalued. So I decided to move to the “mainland”. I applied for a few jobs and ended up with Lloyds pharmacy and living in Liverpool.

 

Did you enjoy your early managerial experiences?

 

I moved from relief manager to pharmacy manager to cluster manager. I was really enjoying work, really enjoying progressing in my career 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-month adventure.

 

What did you do on return from your year out?

 

When I came home I got a job at Interface Clinical Services. This job involved working in primary care. Delivering services such as osteoporosis, diabetes, asthma reviews. Again I started making my way up the company, first into service development, then regional lead for the north-west, then a national lead pharmacist.

 

At one stage I had a team of 90 pharmacists running reviews, clinics, hospital work and making sure they were trained. Also developing a QOF service helping practices identify patients they should be receiving QOF credit for, but due to coding errors or other factors had missed out on.

 

I had always been focused on delivering care based on NICE or the latest evidence in disease areas and saw that with more responsibility I could help make that change on a bigger scale. And through understanding how clinical systems work in GP land, how the mechanics of QOF work, of delving into guidance from ESC, SIGN, ADA I could create services that could help primary care. And the best part, it was by upskilling pharmacists to be experts on those disease areas and primary care to deliver some outstanding care.

 

Can you tell us about your first encounters with the pharmaceutical industry?

 

I’d been working on a diabetes service for quite a while and really saw that there was so much more pharmacists could do in that regard. And it was that point I had been approached by industry to come work as a project manager to help deliver value-based health care. A concept that value is the outcome for the patient over the cost. As opposed to value being the lowest cost available. I thought this was an amazing opportunity to help with a bigger population set again and to gain experience in the industry.

 

I had been approached by industry before to become a Medical Science Laison (MSL) for a company working in the area of pain. I looked into their portfolio, their evidence, the guidelines and felt that it wasn’t a good fit. It didn’t feel like it was best in class or evidence-based enough 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 to the right job.

 

How did you get into marketing?

 

After working for a year as a project manager, I ended up applying for the marketing manager job. I didn’t have any experience in marketing, but by having exposure in the company, understanding how the NHS receives messages, how data could help identify the areas who most needed help or could benefit from improved outcomes and an understanding of the supply chain from prescriber to community pharmacy it showed I had the skills to succeed (or hope to succeed, it’s still only a year in!).

 

I’ve now also enrolled in 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.

 

Chris is the newest member of the Pharmacy in Practice Editorial Board. The purpose of this voluntary position is to provide guidance and advice on the editorial direction of Pharmacy in Practice. You can see who else is on the board by clicking here.

Friday: A week in the life of a Rheumatology and Biosimilars Specialist Pharmacist

 

Friday 

 

Friday mornings are spent authorising clinic letters, assessing blood results, communicating with patients and following up on any consultations if need be. I approve my clinic letters online and once approved, they are sent to the GP and patient by the secretary.

 

 

I also spend time on Friday to ensure that any urgent tasks or objectives for that week have been addressed and completed. If not I find out why not. Furthermore, I check plans and meetings for the following week to ensure any work needed for said meetings is produced and ready to be presented if need be. I also screen any outstanding sc mtx prescriptions or any new prescriptions that land on my desk.

 

I have an email asking for advice from one of the specialist registrars on the best drug to use for a patient who would like to become pregnant. She has severe rheumatoid arthritis and is eligible for biologic treatment. I, therefore, use my knowledge to select the safest drug available to treat her disease as well as allowing her to conceive. I feel appreciated and respected when asked for my opinion and enjoy how this promotes the role of pharmacists as experts in medicines use.

 

Today I have several other meetings, one is a tutor meeting where all pre-registration tutors meet to discuss the progress of their trainees and identify any ways in which the training we deliver can be improved. We do this regularly so any issues or training needs are resolved in a timely manner.

 

I also meet one of our Homecare providers to look at key performance indicators (KPIs) and if these are being achieved or not. We go through patient complaints, failed deliveries to patients and other complaints or issues. I also invite the nursing team to our meetings so that they can share any problems they encounter with the provider.

 

The week doesn’t quite end there. I am down to work late duty so off to the dispensary I go.

 

So this was a typical working week condensed as much as I possibly could. I hope you have found it insightful and realised that you can be a clinically focussed pharmacist without having to visit the wards. My job encompasses many facets of a pharmacists role and I am lucky I have the support and opportunities to develop new services. I get to see the best of all worlds and have the pleasure of working alongside a fully functioning MDT.

 

My advice to anyone looking to move into a specialist area is the possibilities are endless. Find your niche and the rest will fall into place.

 

No matter what some people say we truly are indispensable and the NHS needs us now more than ever.

 

Kalveer Flora is Lead Rheumatology and Biosimilars Specialist Pharmacist, Deputy Chair, Rheumatology Pharmacists UK (RPUK).

 

Kalveer Flora

Thursday: A week in the life of a Rheumatology and Biosimilars Specialist Pharmacist

 

Thursday

 

Thursday is clinic day. This is the day I put my pharmacist practitioner hat on. I work in the early arthritis clinic alongside a consultant, registrar, extended scope physiotherapist, GP trainee, nurse specialist and a team of HCAs. This is a truly collaborative approach, bringing together the skills and expertise of each profession to offer the patient a holistic service. As a pharmacist practitioner, I review patients with a diagnosis of early arthritis and ensure their disease is being controlled on current drug treatment. When assessing, I look at the patient’s current health, the level of inflammation in their blood (ESR/CRP) and how they are coping with treatment. I review compliance and concordance and ensure that the medicines prescribed for them are optimised fully.

 

 

I physically assess patients by feeling for hot, red, swollen joints and synovitis. Synovitis and swollen joints suggest poor disease control and active disease. When I first began assessing joints, I struggled with physical assessments but was reassured when told it takes years to master – even by doctors. In the clinic, as a measure of quality control, we always peer review joint counts to ensure our assessment skills are adequate. After counting the number of swollen joints, we calculate a disease activity score (DAS) score to guide us in treatment.

 

Today, I see an interesting patient in clinic who has rheumatoid arthritis. He had been taking methotrexate and hydroxychloroquine for eight months now at the maximum tolerable dose (including sc mtx). On assessment, he has 15 swollen joints, producing a DAS score of 7.65 (any score above 5.1 is severe and qualifies for biologics treatment). I consider his options and inform him that his treatment needs escalation to a biologic. He understands and agrees he needs more help. The patient was born outside the UK so I refer him to infectious diseases for the screening of tuberculosis to ensure he is clear to start treatment. I also explain to the patient we have to run a series of baseline tests to ensure he is safe to take biologics – this includes screening him for HIV, Hepatitis B/C and a chest x-ray. He consents. I run the plan by my consultant who comes and assesses the patient and agrees he needs stronger treatment. I refer the patient as above and give him an information pack. I complete the patient’s written medical notes and dictate a letter using our dictator phone programme. I then see four other patients and perform similar tasks, referring one patient to physiotherapy and another to podiatry. One patient requires amitriptyline to help with nerve pains before bedtime. She also takes levetiracetam as she is epileptic. I, therefore, advise her on the potential for the amitriptyline to lower her seizure threshold and report back any increased frequency of seizures. I prescribe the drug with caution, having weighed up the pros and cons, documenting my rationale and advice to the patient too.

 

Thursdays are busy days indeed, clinics take up the whole morning and by the time I get back to my desk, it is sometimes 2 pm. I then check any emails from the morning, any queries or outstanding results. I go back to the Arthritis centre at around 3 pm to touch base with the specialist nurses and see if they need help with any medicines-related issues. I work very closely with the nurses, providing support and expertise on medicines which they thoroughly appreciate.

 

I then start planning on a new project I am working on involving biosimilars and how I can continue to save money by adopting up and coming biosimilars into our practice. Project management is a large part of my role and I enjoy this element of the job too.

 

Should pharmacists be able to physically assess patients?

 

Kalveer Flora is Lead Rheumatology and Biosimilars Specialist Pharmacist, Deputy Chair, Rheumatology Pharmacists UK (RPUK).

 

Click here to continue the week

 

Kalveer Flora