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The importance of developing clinical services and expertise in community pharmacy

By Hemant Patel

19 May 2020

Hemant Patel, secretary of North East London LPC, discusses why pharmacy must grasp the clinical services agenda and how his area has approached it

Why is the clinical agenda important?

My perspective is that pharmacy is a profession and as a profession we should be committed to lifelong learning and to providing excellent care at the time a patient needs it. In the NHS there is great emphasis on joint working with other colleagues, including GPs. In pharmacy, we now really need to respond to these mega changes, it is not just lip service anymore.

I think the Covid-19 pandemic has exposed some of the weaknesses in the system and people agree that multi-disciplinary working is essential. But the reason for that joint working also needs to be appreciated. We increasingly have populations with multiple conditions and if we’re going to deliver person-centred care, no single person can be an expert on everything.

Back in 2014, I asked my colleagues at the LPC: ‘What would you do if the government said there will be no more dispensing for you in three months’ time? What would you use your set of premises for?’ It was a tough exercise, but we had a discussion and it boils down to two things that pharmacists are actually doing, but don’t always have at the front of their minds. One is to improve people’s health, and the second is to save lives.

When pharmacists are offering a smoking cessation service, for example, it is very clear that they are working to save lives. When they are doing medicine use reviews, it is to improve safety and effectiveness. So, this greater understanding of their role has enabled us to look at clinical services in more depth. If the NHS is going to modernise itself, what should we do? Clearly the under-capacity in the primary care sector is an opportunity for us [as pharmacists] to support doctors and nurses to deliver integrated care.

People are also now willing to take charge of their health and many of them are willing to pay for it, because they don’t want to have to wait to be seen. So, the prospect of private and NHS clinical services has developed, and the question of ‘what else can we do?’ has started to arise more regularly.

How has the North East London LPC approached this?

It started with our vision. People will not like me saying this, but the community pharmacy model as we know it is dead. Either we recognise that, or we painfully get to the answer. We believe that community pharmacies need to be transformed into a ‘high street clinic’ model, which is open access and where our main business is supporting patients to improve their health and save lives.

People have responded to that vision and vision is important, but if you’re creating a new model of care then you’ve got to have a strategy for doing it. We’ve considered what workforce changes are needed, looking at teamwork and all of the pharmacy team being trained, not just the pharmacists.

We also needed to look at working with GPs and extending our vocabulary, because in any communication with health colleagues we need to understand what’s being said. Linking pharmacies to each other and to hospitals and doctors, so they can talk to each other, has been important.

The high street clinic model is futuristic, but the purpose was to create something futuristic and then work towards it step by step.

What are some practical steps you’ve taken to support pharmacists?

We’ve seen pharmacists in North East London enrol, in numbers, for postgraduate qualifications, which includes independent prescribing.

As a result, we now have a ‘clinical army’ of 175 pharmacists. We called it the clinical army because we were trying to get across the point that it needs to be disciplined and organised; it’s not just about ‘let’s do some CPD’.

On our committee we have a lecturer who has a selection of case studies from his teaching days. For example, a case study on an asthmatic: how would you support them? Or ‘a prescription has all these drugs on it: how would you review it?’ These are shared in a WhatsApp group for discussion. It’s spontaneous and informal, but it’s amazing how quickly people learn and build their knowledge from short inputs into the conversation.

We’re used to thinking that if you flick a switch the light comes on, but when people go back into pharmacy after being motivated and learning new things, they still need support afterwards. We’ve also set up a virtual campus, ‘My Pharmacy Campus’, which is designed to get pharmacists together to talk and solve problems. Some of this might be around how to create the time, or space [within premises], to deliver more clinical services.

The LPC has also prioritised service development and innovation, which is important if you’re working towards a service-led model. We have a full-time person in post who is responsible for workforce development.

Moving forward, I think sharing targets and performance more openly will be important – particularly if we are going to be working in teams and with GPs who are more used to this. We need an understanding of performance management and have the discipline to monitor targets and achievements.

What are some of the barriers to delivering clinical services?

One of the biggest problems and a barrier to pharmacy progressing is the attitude of commissioners. They talk about integration and multi-disciplinary teams, but then they put on their old glasses and the myopia comes back.

Our pharmacists did very well before public health budgets were slashed. We had high numbers providing smoking cessation and sexual health services. Another project that showed promise was pharmacists taking referrals from GPs to support patients with long-term conditions. But when commissioners change and money disappears, projects disappear too.

If you take flu as an example though, it has been an outstanding success and beyond our initial imagination. I was staggered that, for a new service, we had engagement from 85% of pharmacies from day one and they produced record numbers of vaccinations in the first winter. It clearly showed that where there is the mentality and ability to reorganise the process in pharmacy to accommodate this additional clinical work, it can be a success.

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