How I've put Pharmacy: Delivering a Healthier Wales into action

Green prescribing: your nature prescription
by Lloyd Hambridge, Neighbourhood Care Network Pharmacist for Caerphilly East

Independent Prescribing: A Game Changer for Community Pharmacy
by Jon David, Community Pharmacist in Pembrokeshire

Being a perinatal mental health pharmacist
by Alice Evans, Perinatal Pharmacist

Thinking about a move into pharmacy education?
by Helen Davies, Primary Care Team Leader for Education, Training and Workforce Development

Prehabilitation pharmacy: Preparing patients for their cancer recovery
by Marian Jones, Prehabilitation Pharmacist, Cardiff South West cluster

Pharmacists are central to supporting mental health care
by Emily Laing

Treating patients with blood-borne viruses in the community
by Paul John, All Wales community lead pharmacist for blood-borne viruses

Virtual working: A shift in perspective
by Dave Edwards

Multisector Pre-Reg Blog
by Chloe Evans

Green prescribing: your nature prescription

By Lloyd Hambridge, Neighbourhood Care Network Pharmacist for Caerphilly East

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Pharmacy: Delivering a Healthier Wales states that by 2030, pharmacy services will be designed around patient needs.  Key to this is for care to be delivered in local communities with pharmacy teams integrated with other services to improve the health and wellbeing of the population.

I have always been a keen advocate for encouraging people to use their local green spaces; connecting with nature and being active outdoors brings benefits to both health and wellbeing. The COVID-19 pandemic has shown the value of using outdoor spaces to relax and to exercise. However, the pandemic has also highlighted the inequality of access to safe green spaces in our communities.

I linked with my colleague David Llewellyn, Service Development Lead within the Caerphilly Integrated Wellbeing Network, to explore how we could encourage people to increase their engagement with nature and the outdoors to support them with their mental health and wellbeing.

We are delivering a pilot project in conjunction with GP surgeries and third sector organisations within the Caerphilly Borough of South Wales, where a cohort of selected participants are “prescribed” outdoor activities to support and enhance mental and physical health.

In the pilot, a clinician in a GP practice refers a participant into the Nature Wellbeing scheme. The nature wellbeing coordinator then helps them choose a nature activity that suits their interests and needs by discussing the opportunities available locally. The participant then attends these activities each week enjoying the health and wellbeing benefits of nature and being outdoors.

We hope this pilot will provide the basis for developing a wider initiative, with a strong evidence base, for ensuring green spaces in the area support and strengthen residents’ wellbeing in a mutually beneficial fashion.

Some challenges have already been identified. Interventions like our pilot have been termed ‘green prescribing’ by many but we have found this term is understood as linking to climate change, carbon footprints or physical prescriptions rather than wellbeing. As a result, we are supporting a survey from Cardiff University exploring this term with the aim of establishing a name for the scheme that is clear and recognisable to both health professionals and the public.

Interventions like our pilot are rewarding and timely. More than 3.2 million antidepressant items were prescribed by GPs in Wales in the six months after the COVID-19 pandemic started [1]. Our vision is to see pilots like ours widened to include pharmacists in all sectors as well as direct referrals from any member of the public. I would urge you to explore what’s already available locally, and if there isn’t anything in place why not explore setting something up?

A team at Cardiff University is interested in your views and experiences of green prescribing: If you are interested in taking part in a 5-minute survey please review the  Survey information and complete the Survey questions

 

Independent Prescribing: A Game Changer for Community Pharmacy

'By 2030 there will be an independent prescriber (IP) in every community pharmacy’. This is a central aim of Pharmacy: Delivering a Healthier Wales. Here, community pharmacist Jon David describes how he uses his prescribing skills and explores both challenges he has faced and the myriad of opportunities it offers the profession and our patients.

By Jon David, Community Pharmacist in Pembrokeshire

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It’s a fight; it’s relentless, and day in day out just like others working in the NHS, it doesn’t stop. COVID was the last thing we needed, but the second wave is here now and ‘cometh the hour’ we haven’t let anyone down. Like most Community Pharmacies, on a daily basis, we do between 400-600 items, probably see 200 people and with regard to independent prescribing, see another 10-15 patients a day and that is 6 days a week.

Having worked as a community pharmacist for 25 years (and before that at Charing Cross Hospital and Northwick Park Hospital, London),  I feel that Independent Prescribing (IP) has allowed me to use my skills more fully than at any other point in my career. Providing this service, from a community pharmacy, has been nothing short of a game changer in terms of patient care.

The IP service was introduced in May 2020, as part of a trial of the service on Choose Pharmacy, an IT platform for community pharmacies in Wales. It has been very popular in the pharmacy and last month (September) I saw 136 patients. I have now seen 300 patients since the trial began a few months ago. I specialise in ‘acute minor ailments’ – shingles, UTIs, ENT, rashes etc. Most of the patients were seen immediately at the pharmacy, without having to book an appointment, improving the patient journey and care whilst also making huge savings for the NHS.

Often patients presenting with seemly innocuous symptoms, are often quite serious and so consultations can be intense and complex, and nothing is ever ‘black or white. Is it a simple condition or a red flag? A pulled calf muscle or DVT? Is it within my scope of practice, or something more chronic? A simple UTI or pyelonephritis? IP is certainly a challenge but incredibly rewarding.

There have been some challenges to delivering IP services from the community pharmacy. The workflow has had to change, including the PMR system and retraining of staff to become ACTs. Delivering an independent prescribing service effectively in the community requires the support of the entire team, and that is one aspect that becomes very clear when you undertake this service.

I am a keen advocate of community pharmacy services and feel that generally they have been underutilised.  Reflecting on what we contribute to the local community with regards the Common Ailments Service, a ‘Triage and Treat’ service and now the IP service, community pharmacy has a huge potential to improve access to NHS care. That’s why I was pleased to see the RPS  pushing for all patient-facing pharmacists to be trained as independent prescribers in their recent Policy: Thefuture of pharmacy in a sustainable NHS. It is so important that we develop the infrastructure, like the Choose Pharmacy system in Wales, to support and facilitate its use.

The need for ongoing professional support is also vital. As a prescriber, I value the peer support that I get through some social media groups and would encourage any pharmacists to discuss their practice regularly. Having the infrastructure in place to support this is going to be essential as IP continues to expand in the community. Peer support and mentoring spaces, such as the RPS mentoring platform, will inevitably become more and more important in this field.

I would fully recommend implementing an IP service to any community pharmacist thinking about this. It is hard work and challenging in terms of time and capacity, plus each consultation can be a step into the unknown. It is however, deeply satisfying and renews a sense of pride in being a pharmacist. Don’t just take my word for it, go for it!

Being a perinatal mental health pharmacist

Using pharmacists’ unique set of skills and clinical knowledge so that patients can get the best out of their medicines is a core component of Pharmacy: Delivering a Healthier Wales. Here’s Alice Evans explains how she’s using her skills to empower and support patients as part of her split role in perinatal mental health.

By Alice Evans, Perinatal Pharmacist

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I work as part of a multidisciplinary perinatal mental health team three days a week, whilst the other two days are spent with the pharmacy mental health team based at Glangwili hospital, West Wales. As a perinatal pharmacist, I support women on medication during the perinatal period, which includes pre-conception and up to one year post-partum. Women are referred to me when they are considering starting a medication, for advice on current medicines or for a medication review. I also advise other healthcare professionals on the most appropriate medication to use during the perinatal period. The rest of my time is spent writing documentation/guidelines on the use of medication during this period.

Starting a new role during a pandemic

When I first began my role in August, I had no idea how prevalent perinatal mental health was and how it could affect both men and women. Around 1 in 5 women develop a mental illness during pregnancy or within the first year after birth and if left untreated, women can continue to experience symptoms, sometimes for many years after the birth of the child.

Unfortunately, some women are often reluctant to seek help during the perinatal period. There is still a stigma regarding the perception that they should be a “perfect parent” but many women that I speak to suffer with depression and/or anxiety. Recently, I’ve met a few mothers who developed post-partum psychosis after giving birth. I had never heard of this condition before starting my job, and I had no idea of how severe it is. What surprised was that it can happen to women without any previous mental health issues, which is why we need to raise more awareness on these issues.

This job is completely different to what I was used to as a ward-based pharmacist and working in perinatal mental health has been a massive learning curve for me. It took a while to get used to the ‘office style job’ and because of COVID-19, most consultations are done over the phone, so it can be difficult to build a relationship with patients. I am hoping to do more face-to-face consultations in the near future. I was grateful for the RPS guidance on remote consultations  to support this new way of working.

Dealing with new trends in mental health

The perinatal team noticed a trend of women being referred to the team with a decline in mental health after stopping their psychotropic medication. It came to light that these women were told to stop their medication by the GP because they were pregnant. They had no information on the risks versus benefits, and some stated they had no option but to stop taking their medication. Some women who were breastfeeding were told to “pump and dump” to prevent the baby receiving any drug from the breastmilk.

It quickly became clear that more needed to be done to discuss medication at pre-conception or at the early stages of pregnancy. As a result, I’ve completed a psychotropic prescribing tool that contains information on the use of antidepressants and antipsychotics during pregnancy and breastfeeding. The tool uses the format of a traffic light system with the medication with the most evidence of safety coloured in green and the medication with the least evidence of safety coloured in red. We made sure that the tool was easily accessible to all practitioners within Hywel Dda Health Board. We believe that this tool will help GPs discuss all the options with these women and show them that in some cases keeping them on an antidepressant/antipsychotic is the best option.

Going forward

My aim in this role is to continue building strong relationships with other primary care professionals, by continuing to work with prescribers on the appropriate use of medication during pregnancy and breastfeeding. I would also like to increase collaboration between my team and community pharmacists, who are ideally placed with often already have a good relationship with the patients, allowing them to identify any red flags.  By ensuring community teams know they can access our team and resources to help them counsel these women and signpost them to the most appropriate places.

 

Thinking about a move into pharmacy education?

By Helen Davies, Primary Care Team Leader for Education, Training and Workforce Development

HealthierWales3Two of the four key themes of Pharmacy: Delivering a Healthier Wales are ‘developing the pharmacy workforce’ and ‘harnessing innovation and technology’. Here, Helen Davies discusses her role in education and the development of remote methods of training that takes full advantage of new technologies.

I’ve always had a passion for pharmacy education and training, having been inspired by prominent leaders in pharmacy throughout Wales. As a result, I have embraced all opportunities to get involved in education and I’ve thoroughly enjoyed it. For anyone thinking about a new role in pharmacy education, I would strongly encourage it. The range of roles is vast and if my career is anything to go by, you can get involved very quickly in tutoring pre-registration pharmacists, diploma pharmacists and teaching independent prescribers.

My journey

My leap of faith into pharmacy education started in 2015, when I secured a secondment as acting Associate Course Director for the MSc in Clinical Pharmacy at Cardiff. This role gave me the impetus, as well as the confidence, to start as primary care strategic lead for pharmacy education and training in Cwm Taf Morgannwg University Health Board (CTM UHB) in 2019. I’m grateful to be part of such a progressive education and training team, where primary care has been included in training pathways such as foundation training for some time, as well as the delivery of multi-sector pre-registration foundation training models in collaboration with Health Education and Improvement Wales (HEIW).

Since being in the post, I organise regular peer review sessions for our advanced primary care pharmacists to provide necessary support and development. For those primary care staff in post that have not had previous training in the sector, we have been fortunate to benefit from HEIW’s ‘GP pharmacist transition programme’, led by one of our CTM UHB primary care team leaders, Kate Spittle.

Working across teams

I reserve some of my time for clinical practice, to ensure I understand the challenges faced by our team at the coalface, as this informs my strategy for maintaining and developing a highly specialised primary care pharmacy workforce. My background as a clinical lead pharmacist at Royal Glamorgan Hospital reflects my love of clinical pharmacy which I still have.

In between training, workforce planning strategy and clinical commitments, I’m the pharmacy lead for multi-disciplinary teams that has been rolled-out after a successful pilot.  Advanced primary care pharmacists and technicians are an integral part of this team and further support multidisciplinary models for patient care. To that end, we recognise the need for multidisciplinary training and interprofessional education to meet the needs of our complex population.  As part of this, we are delivering ‘medicines management’ training days to GP trainees and fortunate enough to receive input from our pain, mental health and antimicrobial lead primary care pharmacists. I fully welcome the RPS work encouraging multi-disciplinary teams working in GP practices , published this year.

I’m now excited to begin working with industry partners, AlphaTangoDelta on a role-play training app. This ‘proof of concept’ project, supported by the Bevan Commission, the Pharmacy Delivery a healthier Wales board, HEIW and the Cwm Taf Morgannwg innovation team, aims to facilitate the development of a competent primary care pharmacy workforce and to be a platform for training all NHS staff.  The pandemic has demonstrated the importance of remote methods of training for the future.

Pharmacy education and training leaders play a vital role in the future of our workforce and feel privileged to have played an instrumental role in managing and protecting our future workforce throughout this pandemic. I would encourage pharmacists to recognise the impact they can have in the education and training sector.

Prehabilitation pharmacy: Preparing patients for their cancer recovery

By Marian Jones, Prehabilitation Pharmacist, Cardiff South West cluster

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Pharmacy leadership in medicines optimisation, collaboration and innovation are central aspects of Pharmacy: Delivering a Healthier Wales. These principles are also central to a new rehabilitation service being led by pharmacist Marian Jones in the Cardiff South West Cluster. This is another great example of the advancement of pharmacists’ roles leading to improved patient safety and experience.

It’s crucially important to prepare patients for the beginning of the cancer pathway, particularly to help with their mental health and wellbeing. Patients who present any red flag symptoms are referred via the urgent suspected cancer pathway for further investigation. At this stage they are also referred for a prehabilitation review, which is where I come in.

As a prehabilitation pharmacist, I consult with patients and give them an optimisation bundle which consists of medication reviews, screening checks and any lifestyle interventions that I need to make, particularly regarding smoking cessation, alcohol detoxification and weight management. Prehabilitation encompasses both physical and holistic needs for a patient to ensure maximum benefit for their treatment and recovery.

It is always exciting to deliver a new patient service and especially within cancer services where patients are going through a very difficult period. As pharmacists, we play a key role in optimising patient therapy and by targeting high risk patients promptly, this means we can have a huge impact at increasing their health status whatever the outcome of their investigations. As with every new service, there are always challenges, the pandemic has proved to be our biggest challenge as patients are not presenting early enough with red flag symptoms.

Having moved to virtual consultations, we’ve adapted our ways of working and changed protocols to ensure we can deliver the objectives of prehabilitation. This allows us to review bloods and alter treatments as well as requesting further examinations on an individual basis. Feedback from patients has been very positive and the opportunity to have a consultation prior to their investigations addresses their concerns as well as providing support and a point of contact for future follow up once discharged back to primary care.

The cluster is already set up with an integrated care hub and therefore has a lot of established services ready for patients to be referred to. It has been a great advantage to be able to refer patients promptly for social prescribing, wellbeing services and address issues early on to improve future outcomes. Working in a proactive and pro-pharmacy cluster has been key to capturing patients at the start of their journey in order to maximise their rehabilitation status.

The prehabilitation programme is made up of a wide network of allied healthcare professionals, so it’s encouraging to see engagement from GP practices and patients as well as the organisations patients are being referred to. We have set up links to ensure patients are prioritised through these services based on the fast track approach of the cancer pathway. I am extremely fortunate to be part of this multidisciplinary team and am very excited to be part of the prehabilitation team, working alongside colleagues that are making a difference to patients going through an exceptionally difficult process.

Pharmacists are central to supporting mental health care

By Emily Laing

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An all-important principle of Pharmacy: Delivering a Healthier Wales is that the skills and knowledge of specialist pharmacists must be accessible to patients within their communities, not just in hospitals. Here, pharmacist Emily Laing discusses how she’s now using her mental health specialist knowledge within primary care. It’s a fantastic example of multidisciplinary and cross sector working leading to improved patient care that is closer to home.

After six years of the hustle and bustle in London, I decided to return home to the rolling welsh hills for an exciting new role as advanced primary care pharmacist specialising in mental health at Cwm Taff Morgannwg University health board. The welsh healthcare system was new to me, the way primary care functioned was new to me and starting a new service in the middle of a global pandemic was most certainly new to me.

During my time as a resident pharmacist at Guys and St Thomas’s NHS trust, I undertook a placement at South London and Maudsley NHS trust, where my world was opened up to mental health as a speciality. I really enjoyed the unpredictability of each day, the passion of my colleagues, as well as the new responsibility given to me to provide evidence-based treatment options. Soon after, I made the switch from general hospital to mental health, initially covering inpatient wards but then moving over to the community mental health teams.  During these years, I have been lucky enough to be supported to complete a clinical diploma, independent prescribing course and most recently an MSc in pharmacy research.

There are still so many unknowns with mental health. Guidelines for some conditions can often seem vague and a trial and error mentality when it comes to treatment. This means that pharmacists as experts in medicines have an essential role in mental health treatments.

Adherence to medicines is the main reason for re-admissions to hospital. This is another key role for mental health pharmacists to provide timely medication information, involve patients in their treatment choices and help to match medication regimens to a patient’s lifestyle and beliefs with the hope of supporting better adherence.

When you are dealing with a person suffering from an episode of mental health deterioration, you are dealing with someone at their most vulnerable. It is extremely rewarding to know that pharmacists, as experts in medicines, can use their skills and experience to support people to feel better and to be able to watch them gradually get back to feeling themselves.

During my roles over the years in secondary care, I realised the disparity of mental health services offered to people in secondary care compared to primary care. The majority of secondary care services are bursting at the seams, which means the vast majority of patients who need help are managed in primary care. GP’s, practice nurses, cluster pharmacists and community pharmacists get minimal training in mental health, yet they are dealing with the majority of the patients. So, when I saw this role in CTM advertised, I thought it was the perfect step.

Since being in post, I have spent most of my time building relationships with GP practices, primary care pharmacists and secondary care mental health services. It has taken time to understand where we are as a health board on different mental health services and where we need to be. I have been busy answering clinical queries, providing staff training, and evaluating progress of valproate in females of child bearing potential. I was also working on the discontinuation of Priadel but I am so grateful for the RPS campaign which has helped to ensure patient access to this vital medicine.

All of this has been done in a time of uncertainty due to the pandemic. There have been many challenges along the way and I expect more over the coming year but I feel each day I am progressing (slowly). Although there are challenges, the excitement and determination to develop this service to support primary care practitioners to provide better care for patients outdo the challenges. I feel very grateful to have the opportunity to shape primary care mental health services across the health board at a time when it is needed the most .

Treating patients with blood-borne viruses in the community

By Paul John, All Wales community lead pharmacist for blood-borne viruses

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Making sure health services and patients have the maximum benefit from the expert clinical knowledge and skills of community pharmacists is a core part of Pharmacy: Delivering a Healthier Wales. Here, Paul John, discusses how the sector is developing it’s role in Hepatitis C services.

I’ve always been passionate about helping those in need. Earlier in my career whilst working in community pharmacy I particularly enjoyed supporting those on substance misuse pathways. This evolved into a hepatology and blood-borne virus secondary care role with emphasis on curing hepatitis C (HCV). My current role as All Wales community lead pharmacist for blood-borne viruses – involves identifying and treating patients with blood-borne viruses (BBV) such as hepatitis and HIV in the community.

I’ve been proud to be part of the successful Hepatitis C national campaign with the team being recognised recently for a BMJ clinical leadership award. Since 2014 we have treated over 2500 patients in Wales, saving in excess of £29 million through procurement, reducing progressive liver disease and halving the need for liver transplants with hepatitis C being the primary disease.

Our target is to identify the remaining 12,000 patients in Wales required to eliminate HCV in Wales. The hepatitis C virus is very simple to detect and can be cured with an oral course of once daily antivirals. Our biggest challenge is identifying those infected individuals. Many of our patients are asymptomatic with acutely distorted liver function tests. Unless detected with specific antibody and PCR tests, many can silently progress to scarring of the liver (cirrhosis) or end stage liver disease (ESLD).

What I do

My role in this important work is varied and no two days are the same. Although I’m based in the community my role takes me to out-reach clinics, hospitals, substance misuse agencies, prisons and general practice. I also liaise with research projects and the pharmaceutical industry to simplify identification pathways with the future aim of test and treat in a single day.

Part of my role is to educate, teach and support community pharmacy staff to provide the service. I understand that this is a new clinical area for many and it’s so satisfying to see them grow in confidence as they are offering such a great service. To support our training programme, we have worked with Health Education and Improvement Wales to produce a learning module that reinforces the learning. I also always emphasise to staff we are always accessible if they need us and want to ask further questions.

The pandemic has had an impact on this work, but we have modified our approach to sustain clinics. We have offered virtual ‘attend anywhere’ clinics, allowing for discussions on blood results and to support ongoing treatment. During the consultation we can also determine if patients need surveillance for cancer and prescribe the necessary treatment for the viral infection.

Working within a multidisciplinary team has continued to be important too and I continue to learn so much from colleagues from different disciplines. I hope that I can spread this learning into community pharmacy practice in order to increase accessibility of patients and treating BBV.

Looking to the future

We now have an enhanced service for pharmacies in Wales which is a great development.  Support can be offered by both pharmacists and pharmacy technicians for patients who suspect they have been exposed to a blood borne viruses such hepatitis C, hepatitis B and HIV. The test is traditionally offered through a finger prick test, however new technology is emerging in this field.

I was pleased to see community pharmacy Hepatitis C Antibody Testing Service introduced in England as a new service. It will be interesting to monitor their progress and work together to achieve the WHO global eradication aim.

There is no doubt that community pharmacy will continue to play an increasingly important role in this work. I look forward to further opportunities for community pharmacy to help lead us to our target of eliminating HCV in Wales.

Virtual working: A shift in perspective

By Dave Edwards

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COVID-19 brought unprecedented challenges to our health service. In the face of this challenge, the response to the pandemic also created opportunities and has led to innovation across the health service. One of those is around greater use of virtual consultations and digital technology – a key aim of Pharmacy: Delivering a Healthier Wales. Here pharmacist Dave Edwards discusses how he’s adapted and is now supporting his patients via video consultations.

Since Covid-19 hit the UK early this year, health care organisations have moved services online at a dramatic pace. This has ushered in a significant change in practise, with virtual consultations taking centre stage. As a pharmacist working in primary care, I have always been an advocate of face-to-face patient consultations and a little sceptical of anything virtual where rapport with the patient and non-verbal cues could be adversely affected. Adapting to the pandemic response has, however, shifted my perspective totally.

A focus on respiratory conditions

Becoming an independent prescriber in a cluster of GP practices in South Pembrokeshire and running respiratory clinics has given me new opportunities to help patients.

Well controlled asthma is the key to better health and wellbeing. We know that a patient with a long-term condition is four times more likely to be admitted to hospital, and that almost 50% of the increase in winter hospital admissions are patients with an existing respiratory condition. Evidence shows that increasing patients’ knowledge of their condition, prescribing according to guidelines and having a management plan in case of the condition worsening are the key factors in keeping these patients well and away from unscheduled care.

In the current climate, the only way to deliver reviews for these patients was through virtual consultations, either by phone or video link app, either from the patients’ surgery or elsewhere via access to EMIS. To evaluate the service, I asked every patient to fill out a feedback form.

My learning to date

I’ve used these tools for six months now and have learnt a great deal more about patient engagement. I no longer harbour my initial concerns about working remotely and many of my patients have admitted they would happily choose virtual consultations going forward. Feedback from patients has also indicated that in the main, my virtual consultations are as effective as face to face consultations. One patient recently reported: “ This is the first review of this type that I have had and it has changed my situation substantially. I cannot overstate how much of a difference it has made having access to this service”.  Says it all really!

The impact on my practise is positive too. I feel that I can manage my time more effectively and patients are generally more relaxed and open during consultations, allowing for a more meaningful consultation.

A virtual future?

I still maintain that there is an important place for face to face consultations, perhaps the first review or when the patient is poorly controlled.  However, the pandemic has highlighted that there is a place for virtual consultations and all the advantages to the patient that they confer. I recently read the future view of pharmacy by RPS which calls for virtual consultation tools and equipment for pharmacists in all settings. This makes complete sense to me. Our future as pharmacists depends on additional flexibility, and it is important to embrace these changes.

If you are concerned about virtual consultations, please be assured it only takes a small shift in perspective. The training offered by the RPS also helps you find your feet!

Multi-sector Pre-Reg Blog

By Chloe Evans

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Wales is leading the way for Pre-Registration training in the UK. The new multi-sector model of Pre-Registration pharmacist training contributes to the building of a flexible pharmacy workforce with the skills and competence to deliver the vision of “Pharmacy: Delivering a Healthier Wales”: a workforce that can work, communicate and understand the whole patient care pathway which is essential for the efficient management of patient services.

I am currently on the multi-sector Pre-Reg programme in north Wales. The year is composed of two-month rotational placements in primary care, hospital, and community. I chose this pre-reg as I wasn’t 100% sure which area of pharmacy I wanted to go into once qualified, and so this gave me a good insight into the role of pharmacists in different sectors.

A key learning for me has been the importance of supporting patient care pathways and the key role that pharmacy teams can play by supporting integration between sectors to support patients.

One example of this was during my time in community pharmacy. Here, I observed that the team weren’t aware when patients were admitted to hospital, even vulnerable patients on weekly trays. This could have been dangerous as medicines could be changed at the hospital, but the community pharmacy wouldn’t know. This changed my practice in the hospital, when doing meds reconciliation on admission. If the patient is on blister packs, I would make sure to ring the community pharmacy to let them know that the patient is in hospital, so they can wait for the discharge to see if there are any changes before sending out/making up the blister packs.

I also noticed the patient benefit of having a discharge review of medicines with the pharmacist in primary care or as part of the community pharmacy discharge review service. I got the chance to do medicines reconciliations using the patient's discharge from hospital. If there were any queries then I contacted the hospital to discuss these, I was confident doing this as I had undertaken training in the hospital sector. The main challenge supporting patients with their discharge in the community pharmacy is knowing about it and obtaining a discharge advice letter. This was an important lesson that I was then able to share with the hospital team.

A huge benefit from my hospital and primary care placements was it improved my confidence when interacting with other healthcare professionals. It reinforced the importance of multidisciplinary working and gave me greater insight into their roles and when and how to refer and signpost. As my knowledge of community pharmacy grew, I was also able to support other healthcare professionals to refer into services such as the common ailment scheme, smoking cessation and the sore throat test and treat. This utilised community pharmacists’ skills and improves the patient care pathway.

There have been some challenges. The workload is heavy with many ways of working. Also, the pandemic has meant that a lot of shadowing opportunities and consultations with patients couldn’t happen or had to be over the telephone. This is no fault of the programme, just a challenge of the pandemic.

The programme is certainly helping me to gain a good insight into the wide range of pharmacist roles and to understand the whole patient care pathway. I have had great feedback from job interviews which have said they could tell from my answers given that I did a multi-sector pre-reg. I am pleased that I chose a multi-sector placement as it has supported me to work in a multidisciplinary way, consider patients holistically and to support more efficient patient pathways.

Do you want more information about the integrated pre-registration programme in Wales? Want to hear more from trainees? Please visit HEIW for more information here.