North East London LPC chief : ‘At the moment, we’ve got a series of services that aren’t properly connected’


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By Lea Legraien

11 Dec 2018

Hemant Patel is North East London’s local pharmaceutical committee (LPC) secretary.

He talks to Léa Legraien about leadership, artificial intelligence (AI) and how care delivery is changing in his area.

 

Q Do you think pharmacists have the necessary leadership skills?

 

A We’ve got young people leaving universities without demonstrating leadership or soft skills. My experience is that many people in leadership positions at local and national levels haven’t had any leadership training. They’re well-intentioned but not necessarily well equipped to work better.

The relevance of the training needs to be demonstrated to teacher practitioners so that they can understand why leadership skills are required now more than ever because we’re working in a multi-disciplinary setting and will soon also work in primary care networks.

 

Q How will artificial intelligence transform pharmacy’s future?

 

A AI is beginning to influence different ways of life, not just in pharmacy.

How we converse with and support patients will change – we’re approaching a data-driven healthcare system and we need to recognise that. We could start to see a world where medicines are delivered from a factory using a drone and AI is used in the diagnosis of disease.

As people begin to get Amazon deliveries to their home using drones, they will ask the question,’if I can get anything I want, such as food, delivered to me via drones why not medicines?’

 

Q You’ve said before that you think pharmacy should provide 24-hour coverage. Why is that?

 

A Patients fall ill 24 hours a day and A&E [departments] are open 24 hours a day. If we’re going to divert work away from A&E, so that they can deal with emergencies [only], then a lot of urgent care work could easily be done in pharmacies.

There have been some discussions about 24-hour GP coverage, particularly for urgent care, to reduce A&E admissions. There’s no point giving GPs coverage 24 hours a day and then having no one to supply medicines.

 

Q How do you think pharmacists can help patients with disabilities?

 

A We’ve got a population that is getting increasingly older and it’s important to support people who have some disabilities to live independently at home.

At the present time, trusted assessors provide that assessment but often the wait for is between six and eight weeks.

We could train pharmacists as trusted assessors so they could prescribe the equipment, help patients and reduce the burden on the state. From my point of view, pharmacists should be involved in three categories: the assessment, social prescribing and independent prescribing.

 

Q How are you redesigning care in North East London?

 

A If you look at people suffering from atrial fibrillation (AF), one in 10 often don’t know that they’ve got it. A lot of the time, they either end up with a stroke or other cardiac conditions that require hospitalisation.

So five years ago, I worked with a company now called Vital Care, which makes blood pressure monitoring devices. We did a piece of work where about 20 pharmacies in Waltham Forest clinical commissioning group (CCG) detected AF in patients and instead of referring them to a doctor they referred them directly to a cardiologist.

Going forward, I’d like to see more patients referred back to the pharmacy so we can support them to lose weight, give up smoking and make sure they’re compliant with their medicines.

Secondly, only about 28% of the mentally ill patients attend a physical health check. So as part of a pilot funded by the Health Foundation, 10 pharmacies in Barking and Dagenham are working with a local mental health trust.

The trust refers those patients in need of physical health checks to the pharmacies where they do a number of checks. These include physical, AF and medicines checks. We also check whether the patients smoke and provide them with a flu jab.

So instead of having to go to the pharmacy for different things, we assess the holistic needs of patients using the bio-psycho-social model. This means that we look at the person as a whole rather than just focussing on a particular need. We aren’t just providing a service and walking away. We’re providing care and are following patients up, making sure they are taking charge of their own health.

We also worked with a paediatrician and trained our pharmacists in assessment skills, as around 40% of children presenting at A&E could easily be seen in a pharmacy. If the child requires antibiotics and the pharmacist cannot prescribe antibiotics, they’ll pick up the phone and a 111 GP will take over the consultation and send a prescription via email. As a result, it saves a visit to the GP or A&E and means less worry for parents.

 

Q How are you transforming pharmacies in high-street clinics?

 

A When 50 to 60% of patients on long-term conditions aren’t taking their drugs correctly and when many of them are smoking, have obesity or don’t comply with their medicines, how do you change people’s behaviours?

It’s no good telling people ‘you mustn’t do this’ because we still see, for example, people driving with their mobile phones attached to their ears [even though they know they shouldn’t]. They don’t understand the personal risks and think that something will happen to somebody else and not them.

What is required is a significant mindset change and the only way to do that is through health coaching. So we’ve trained 180 pharmacists in health coaching who sit down with the patient and talk about what needs to be done.

We believe that bringing powerful therapeutic and psychological tools into one-care package can produce new outcomes.

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