Senior clinical pharmacist Brendon Jiang is vice-chair of the Royal Pharmaceutical Society (RPS) English Pharmacy Board and leads North Oxfordshire Rural Alliance (NORA) primary care network (PCN), a large team of eight pharmacy staff working across the Cotswolds. Here he tells The Pharmacist how PCN pharmacists are working with community heart failure nurses to upskill, improve patient care and tackle health inequalities.

About a year ago, there was a proposal to employ clinical pharmacists alongside community heart failure nurses, which fell through because of funding difficulties, and the operational complexity of working across system boundaries. But I recognised a real opportunity.

As primary care pharmacy has developed, a lot of pharmacists have moved into and adjusted to this new setting. It's an interesting and exciting place with a lot of training and development. Pharmacists complete their pathway, become prescribers, perhaps move into senior roles and then they think: "Well, what next?"

There isn't always the support available to specialise in interesting and relevant areas and there is a risk of stagnation.

Speaking to colleagues, I knew there was a huge appetite from pharmacists in primary care to be more involved in the management of heart failure, which can be quite complex and difficult. Primary care pharmacists specifically target the management of patients with complex polypharmacy, those living with frailty and at risk of hospital admission, and those taking high risk medication. Patients with heart failure often tick all of those boxes.

The health system has a need and the desire to address that need. The workforce was willing and able, but what was lacking was the means to bring it together, to make those pieces fit.

I seized this opportunity to upskill the workforce and advance patient care and arranged to meet with health system leads. Together with Rebecca Bone, heart failure consultant nurse, we designed a comprehensive training programme.

The programme aims not only to address health disparities prevalent across Oxfordshire but also to build relationships between the community heart failure nurses and pharmacists in primary care. A secondary aim is to provide pharmacists with a pathway for professional development to improve job satisfaction and retention.

To facilitate this initiative, consultant cardiologists conducted face-to-face training sessions, imparting knowledge on heart failure diagnosis, treatment, and management. Additionally, online webinars were organised, complemented by shadowing sessions with community heart failure nurses to provide practical exposure.

While the current evaluation involves a modest cohort of a dozen pharmacists, the overwhelmingly positive response suggests potential expansion across Oxfordshire, West Berkshire, and Buckinghamshire. Moreover, I’m confident that similar programmes could be replicated nationally, it might even be possible to target other therapeutic areas such as respiratory or diabetes management.

The programme's impact extends beyond professional development; it directly addresses the complex needs of heart failure patients, particularly those in rural areas facing challenges accessing healthcare services. By aligning pharmacists in specific geographic regions with high need, the initiative optimises patient outreach and support.

We are still evaluating the project but I’ve been impressed and surprised by the work of participants. It’s clear that knowledge and confidence has improved, as well as relationships and awareness of the patient pathways available. The medicines used to manage heart failure have concrete prognostic benefit as well as improving quality of life. Participants have been involved in identifying patients with suspected heart failure and requesting the tests necessary for diagnosis. They have optimised medical treatment to improve quality of life, reduce hospital admission and mortality risk. They have checked for iron deficiency anaemia, something that half of patients with heart failure might experience. And they are confidently managing fluid balance in the community or referring for IV diuretics when appropriate.

I am very proud of this project and hope to see it expanded to include more pharmacists across the system. Pharmacists are a highly skilled workforce with the capability to make a substantial difference in areas like heart failure. But what has been especially powerful is the relationships formed between those pharmacists and the heart failure nurses to work together and improve the health of our patients.

Read our interview with PCN pharmacist Laura Buckley on how conducting medicines reviews in care homes helped her to connect with an often-overlooked group of patients and deprescribe an impressive number of medications.