No Images? Click here Pharmacy and Medicines bulletinIssue: 1 Date: 12 November 2018 Welcome to the Pharmacy and Medicines bulletinIt’s good to have the opportunity to talk directly to colleagues who work with medicines, and at an important time of year – thanks for tuning in. This new bulletin reflects the value that pharmacy skills bring to the NHS. Through it I’d like to encourage you to collaborate and integrate across the NHS system to ensure we get better health outcomes from medicines. It’s an exciting time to be a pharmacist and pharmacy technician in the NHS, with new opportunities from the increased demand for our clinical skills. I want to ensure the NHS as a whole makes the most of those skills and that all sectors are included. NHS England, NHS Improvement and Health Education England are working together on national programmes to deliver this important agenda, and to ensure patient safety remains at the heart of everything we do. Right now, the challenge is to work together, with a unified voice, to manage urgent care needs well for patients this winter and prevent unnecessary hospital admissions. Pharmacy has so much to offer in this space. Which is why this month NHS England will be launching the Digital Minor Illness Referral Scheme – involving referral to community pharmacy from NHS111 – in three new areas, providing better care for thousands of people across England. We have recently published a Pharmacy and Medicines Optimisation: A Toolkit for Winter for the acute hospital sector and today sees the launch of the annual Stay Well This Winter campaign. I urge you to find out how you can best play a part in plans to support your local health community this winter. I’ve chosen to launch this bulletin during the World Health Organisation’s World Antibiotic Awareness Week to highlight the imperative for us all to improve antimicrobial stewardship (AMS) in the NHS. Over the last five years, the UK has taken a lead role internationally, led by the Chief Medical Officer Dame Sally Davies; and has recorded significant achievements in its fight against antimicrobial resistance (AMR). However, resistance in terms of the burden of infections which cannot be treated by antibiotics continues to increase globally. If this increase continues unchecked, our efforts domestically will, ultimately, be of limited value. The refreshed national strategy, when published by the Department of Health and Social Care, will again put pharmacy professionals, in every branch of our profession, at the centre of delivering improvements. The Midlands and East Regional Medicines Optimisation Committee (RMOC) is developing the next stages of the work on AMS on behalf of all RMOCs. Meanwhile, if you want to get involved internationally, see below for a call for applications for grants from the Commonwealth Partnerships for Antimicrobial Stewardship Scheme. Finally, the new Long Term Plan for the NHS is likely to be published in December and will provide a clear route forward for us all, and this bulletin will return in February 2018. Thank you for all you do. Please share comments/ideas at england.PharmacyBulletin@nhs.net or @keithridge1 or via #pharmacyintegration Keith Ridge World Antibiotic Awareness WeekWorld Antibiotic Awareness Week (WAAW) runs from 12-18 November 2018. The week aims to increase global awareness of antibiotic resistance (AMR) and to encourage best practices among the general public, health workers and policy makers to avoid the further emergence and spread of antibiotic resistance. To get involved in World Antibiotic Awareness Week see the many resources provided on the website. New collaborative for tackling inappropriate urinary tract infection (UTI) managementTo support the two national ambitions to halve inappropriate antibiotic prescribing and halve healthcare associated gram negative bacteraemias by March 2021, NHS Improvement has invited trusts to join a UTI collaborative. To access the UTI collaborative learning via an online platform please contact Emma.Cramp@nhs.net. Pharmacists can support delivery of both national ambitions through the implementation of the new PHE UTI Diagnosis Guideline, TARGET UTI resources and NICE Common Infections Guidance for UTIs. Call for applications: Commonwealth Partnerships for Antimicrobial Stewardship GrantsA new partnership scheme to support implementation of antimicrobial stewardship (AMS) activities in four low-middle income commonwealth countries has opened with a deadline for applications of 5 January 2019. The funding available will support multi-disciplinary teams from UK NHS trusts to develop partnerships with hospital institutions in Ghana, Tanzania, Uganda and Zambia in order to share learning and develop AMS initiatives. This health partnership scheme is being led by The Tropical Health Education Trust (THET) and The Commonwealth Pharmacists’ Association (CPA) and is looking for multi-disciplinary approaches from 12 UK trusts that involve, or are led by, pharmacy. Keep Antibiotics Working Campaign Year 2Public Health England is asking NHS colleagues to help safeguard antibiotics – and all the patients that rely upon them – by ordering or downloading campaign resources from the PHE Campaign Resource Centre. The high profile Keep Antibiotics Working campaign was relaunched on 23 October with the message: Taking antibiotics when you don’t need them puts you and your family at risk. CPPE Antimicrobial Stewardship CampaignThe Antimicrobial Stewardship (AMS) campaign element, which launches today, is available as a short e-learning programme. CPPE has highlighted opportunities to use this learning to support your portfolio for professional revalidation. Primary CareMaking the most of clinical skills in community pharmacyA new referral option goes live this month which will provide quicker access to healthcare and help the NHS to make best use of the clinical skills of community pharmacists this winter. Under the Digital Minor Illness Referral Scheme, trained NHS111 call handlers in London, East Midlands and Devon will refer people with minor health concerns to their chosen community pharmacy for a clinical assessment and confidential consultation during the day, at the weekend or out of hours. Details of the call to NHS111 will be securely transferred electronically to the receiving pharmacy and the patient will be given the address and asked to attend within a timeframe. The pilot, which is funded by the Pharmacy Integration Fund, and already running successfully in the North East of England, will continue until March 2019. New criteria for pharmacists in general practiceOver 800 clinical pharmacists are currently working in general practice, with hundreds more sites approved and in the process of recruitment. This means that 1,834 surgeries in the country – covering a patient population of more than 15 million – now have a pharmacist in a patient-facing role as part of the multidisciplinary team. In response to feedback from stakeholders, from 23 October 2018, NHS England has changed the criteria for the programme to make it easier for sites to operate across a smaller population size, and allowing pharmacists to work part-time. Application deadlines via the portal are:
Your local AHSN can support you with PINCERAcademic Health Science Networks (AHSNs) across England are working with local CCGs to help primary care staff identify and review patients who are at risk from clinically significant medication errors using the pharmacist-led information technology intervention for medication errors (PINCER) methodology. See this Lancet article for more information. The evidence-based intervention uses a pharmacist to work with GP practices and has been proven to reduce medication error rates. The AHSNs’ work on Transfer of Care Around Medicines helps hospitals highlight to pharmacists in primary care that certain patients may need additional help, advice and support. The AHSNs have also developed three public-facing videos, covering polypharmacy, transfers of care around medicines, and electronic repeat dispensing, featuring the character of ‘Mo’. The AHSN network is leading national medicines optimisation workstreams to help people get the best possible outcomes from their medicines. For more information contact julia.carthew@wessexahsn.net. Fully funded training for community pharmacyIf you are a community pharmacy professional working in a community pharmacy setting, take advantage of fully funded NHS training to grow your career and your practice: Mary Seacole Leadership Programme for community pharmacy: This programme is aimed at pharmacy technicians and pharmacists and will enable you to lead an effective team and really get the best from the people you work with. You will learn how to place patients at the centre of everything you do, driving quality services and exploring new opportunities. The programme is delivered by CPPE working with the NHS Leadership Academy and courses start regularly until March 2019 across the country. Fully funded postgraduate courses for pharmacists: Whether you’re an early career or more
experienced pharmacist, employer or employee, working in an independent, multiple or as a locum, this training will help you learn and grow – or simply refresh your skills.
Accuracy Checking Pharmacy Technician (ACPT) Programme: Dashboards to improve prescribing in primary careThe NHS Business Services Authority (NHSBSA) has developed several dashboards for use by the NHS, based on patient-level primary care prescribing data. They help identify unwarranted and warranted variation in prescribing, and improve patient outcomes and safety. The dashboards can be viewed in ePACT2 and are designed to support:
The national Medicines Optimisation Dashboard brings together a range of data to inform the strategic medicines optimisation plans of CCGs and trusts. There is training and support available on NHS Business Services Authority website. Adjuvanted Trivalent vaccine rolloutNHS England has written to GP practices and pharmacies to highlight the support in place to manage this year’s phased delivery of the adjuvanted trivalent vaccine (aTIV) for flu which is recommended for people over 65. For the first time, this vaccine is being delivered in stages from September to November 2018, so it is important that patients are aware of the adjusted timescales for their annual vaccination. The manufacturer, Seqirus, has confirmed there is enough vaccine supply available to the NHS in England to meet expected demand. By 17 November 2018 the complete order for 8.3 million doses of aTIV will have been delivered to GP practices, pharmacies and other providers. As flu usually becomes more common from December onwards, people over 65 who receive their flu jab in November will still benefit from its protective effect. Community pharmacies are being asked to:
Public Health England has published a leaflet that will support communication with patients aged 65 years and over. The Pharmaceutical Services Negotiating Committee (PSNC) recently issued a patient leaflet for use in community pharmacies. Secondary CareGet ready for adalimumabBiosimilar versions of the original biological medicine adalimumab (brand name Humira®) are due to be introduced in the NHS as part of a formal framework agreement from 1 December 2018 after the patent for Humira® expired in October 2018. To get the latest update on the procurement, which will be published shortly, see NHS England’s regular briefing which provides an update for provider trusts, clinicians and commissioners. There’s also an implementation toolkit and a series of resources to use with patients. Pharmacy aseptic services: short term guidanceFollowing the NHS Improvement review of aseptic services, completed in February 2018, the next stage of the work is being finalised. It is recognised that there are currently capacity and resilience challenges in terms of the aseptic compounding (NHS and commercial) specialities resulting in significant additional work for pharmacy teams to maintain patient care. As an interim response, the National Pharmaceutical Supplies Group has issued guidance on making the best use of restricted aseptic compounding capacity. There have also been meetings with the commercial compounders to look at joint working to maximise current capacity. All sectorsMedicines supply and EU ExitNHS England is working closely with the Department for Health and Social Care (DHSC) on the planning for EU Exit. In August 2018, the Secretary of State wrote to the health and care system on no-deal Brexit planning:
More information will become available from DHSC in the near future. Falsified Medicines Directive guidanceNHS Digital is producing guidance toolkits to support the NHS in implementing the Falsified Medicines Directive (FMD). The first toolkit, developed for secondary care providers, is now available on the NHS Health Developer Network. Toolkits for community pharmacies and GP practices (including dispensing doctors) will be published soon. More useful resources are available on the gov.uk website. Anyone with an NHS email address is also invited to join the FMD Google+ community. Please email FMD@nhs.net to request an invite. Enabling data driven careTo truly optimise the use of medicines an additional dimension is required – structured data systems to allow the capture, analysis and clinical use of patient level informatics. To deliver data driven care, requires a culture change in how pharmacy professionals view their roles and skills for understanding the science of clinical informatics. This new report includes recommendations across educators, regulators, the NHS and employers to support data driven care. Caring for the person is at the centre of what we do...I’m keen to highlight the patient focused role of pharmacy professionals and our first story is from Katherine Le Bosquet, the current Chief Pharmaceutical Officer’s clinical fellow at NHS England. If you’d like to share your story about person-centred care please get in touch. Before joining NHS England, I worked as an integrated care pharmacist with Guy’s and St Thomas’ NHS Foundation Trust in London, completing domiciliary reviews using shared decision making to optimise medicines for people living with frailty. I wanted to learn more about person-centred care and reducing inappropriate polypharmacy so it was a perfect job for me. Working with housebound and often vulnerable people highlighted how poor communication directly affects patients. Many didn’t understand their medicines and with multiple care providers it was difficult to identify key issues. Changes made by one provider and not communicated to everyone involved could lead to issues. However simple changes could also have an enormous impact on the person’s life when well communicated. Patients really appreciated the time and input both in education about and optimisation of their medicines, often opening up and really getting involved in shared decision making where previously they were not engaged in their care. Some of my most memorable experiences involved:
These experiences led me to investigate how we can improve communication and transfer of care for everyone. I found working on one area is not enough; you need whole system change requiring strong leadership and vision. This inspired me to apply for the fellowship to learn how changes are made nationally, and to develop myself as a clinical leader. Further information for the 2019/20 cohort of CPhO clinical fellows will be released in February 2019 with applications in March. And finally...
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