Foster and support excellence in the practice of clinical pharmacy


Islam Elkonaissi and Zahra Laftah of UKCPA explore UK model of supporting excellence in clinical pharmacy practice

In the UK, there is growing evidence that pharmacists can deliver better clinical outcomes and more effective, consistent and sustainable services for patients. In this article, key themes are discussed to show the importance of empowering pharmacists and fostering leadership in clinical pharmacy practice.

The context

The National Health Service (NHS) (FYFV) 5-Year Forward Vision (1) vision is for a sustainable NHS that continues to be tax-funded, free at the point of use and fully equipped for meet ever-changing needs. of its patients, today and tomorrow.

To achieve this vision, pharmacists are supporting efficiencies in the NHS and improving patient care by undertaking reviews of person-centered medicine in a variety of care settings and as part of care pathways and teams. multidisciplinary.

Medication optimization

Amid an NHS grappling with an aging population, extended life expectancy, large numbers of patients managing co-morbidities and polypharmacy, the National Institute for Health and Clinical Excellence (NICE) has released an optimization guideline drugs (2).

NICE’s main recommendations include effective medication-related communication in different care settings, medication reconciliation in addition to medication reviews. Pharmacists across the country have carried out projects under these recommendations. This includes antimicrobial stewardship, diabetes reference tools, and polypharmacy stopping and starting tools.

clinical pharmacy practice

The four guiding principles (3) (figure 1) described by the professional pharmacy body, the Royal Pharmaceutical Society of Great Britain (RPS) in 2013, describe the optimization of medicines in practice and the results that it is supposed to have an impact. These principles can be used by pharmacists as well as other healthcare professionals and it just shows the level of influence pharmacists have across their professional body.

Medication optimization and profitability

Lord Carter’s review of effectiveness (4), which highlighted significant variation between NHS pharmacy services, was fundamental in paving the way for pharmacists to lead new models of care in a way financially viable. The Carter review pointed out that an unwarranted variation in the use and management of drugs has cost the NHS at least £ 0.8bn, which could be reinvested.

Among other recommendations, Lord Carter recommended a hospital pharmacy transformation program to ensure hospital pharmacies meet their goals such as increasing the number of prescribing pharmacists, electronic prescribing and administration, accurate cost coding. drugs and stock consolidation. The main objective of these activities is to ensure that pharmacists and pharmacy technicians devote more time to medication optimization activities for patients.

The Commissioning for Quality and Innovation (CQUIN) program (5) contributes to this vision by incentivizing NHS organizations that achieve specific goals. Of particular importance to pharmacists is the CQUIN drug optimization program. The aim of this program is to optimize the use of expensive drugs, to combat variation and to reduce waste.

The program highlights ways to achieve this through:

  • Adoption of biosimilars and generic switches.
  • Improving the quality of drug data.
  • Using the most economical distribution channels.
  • Compliance with policies / guidelines to reduce variation and waste.

The future of what is known as Carter is envisioned through the “Top Ten Drugs” list identifying other productivity opportunities, as recommended by Lord Carter, opening up more roles for pharmacists. The list itself was developed in collaboration with a small group of chief pharmacists working in NHS organizations, using a tool known as ‘Define’. The savings targets for the individual trusts are based on a time frame and represent either a simple reduction in expenses or the adoption of a less expensive alternative medicine. The following example demonstrates the enormous role pharmacists play in developing and achieving economic efficiencies.

Learn from Cancer Vanguard (6) in UK

At the heart of the FYFV strategy is the development of new or avant-garde models of care. It recognizes that there are universal levels of caregiving that require some degree of compliance. He therefore proposed many new models of care which are being explored and implemented through the avant-garde.

The Cancer Vanguard (6), through a collaboration led by The Christie, The Royal Marsden and University College London Hospitals, provided a platform for a pharmacy to develop new models of cancer care that are reproducible and transformational, which would ultimately serve as models. for the NHS nationwide. For example, a process timeline for biosimilar uptake has been developed with guidance, resources and accompanying template documents to improve biosimilar uptake in the NHS.

The reproducibility of both the process and the new models developed means that the national impact is substantial. With the support of the pharmaceutical industry, other examples include the monitoring of adverse events in patients receiving immunotherapy, the development of models of care for home delivery of chemotherapy, the delivery of Denosumab outside of hospitals and the use of applications for patients in metastatic colorectal care pathways. Future opportunities are increasingly focused on prevention and early diagnosis with hospital-community pharmacy collaborations.

The Cancer Vanguard has therefore provided an example of collaborative and systemic leadership in terms of the speed with which results are produced as well as their reproducibility. Openings for further joint work with industry and participation in early diagnosis are key learning outcomes.

Initiatives for a resilient and competent pharmacy workforce:

To ensure leadership in practice, there is a certain need for resilience and competence of the workforce which is necessary to improve parity between different sectors of care. The following explores two examples of such efforts.

National training programs

The Royal Pharmaceutical Society, along with the United Kingdom Clinical Pharmacy Association (UKCPA) and other affiliate partners, are in the final stages of developing national pharmacist education programs for all levels and sectors. This will support pharmacists, meeting clinical training needs in pharmacy up to consultant level. It includes elements adapted to the scope and level of practice of each pharmacist.

Each program component will be mapped to the professional study programs and the advanced pharmacy framework of RPS6. With an assessment within each module, pharmacists could receive a certificate of completion to prove their training to employers, commissioners, patients, the General Pharmaceutical Council and the faculty program (6) by the RPS.

Pharmacy scholarship programs

Established in 2015, the Chief Pharmaceutical Officer Fellowship programs offer early-career pharmacists a unique opportunity to spend a year working with senior pharmaceutical executives in national healthcare organizations. It enables fellows to lead key projects that contribute to national health priorities relating to patient safety, drug optimization, care handover, digitization and the training of pharmaceutical staff. Host organizations for this program include, among others, the Care Quality Commission (CQC), NICE, NHS England, Public Health England, NHS Digital, and the Center for Pharmacy Postgraduate Education (CPPE).

Take away message

This article summarizes some examples that demonstrate the central role of pharmacists in new models of healthcare in the UK. Empowering pharmacists and providing them with the necessary training yields exceptional results. The way forward is to foster community involvement in prevention strategies. The essence of clinical leadership can ultimately be summed up in the vision provided by Jatinder Harchowal, the chief pharmacist at the Royal Marsden Hospital in London, as he puts it: “Leadership is when it’s easier to do nothing. “. Therefore, leadership is not just a title, but simply an action.

The references

(1) Quality of Care Commission, Public Health England, National Health Service (2014). Prospective vision over five years. England: NHS, pp. 22-23. [Accessed 3 Oct. 2017].

(2) NICE NG5 Guidelines (2015), Medication Optimization: The Safe and Effective Use of Medications for the Best Possible Outcomes, London (UK): National Institute for Health and Care Excellence (NICE). [Accessed 3 Oct. 2017].

(3) The Royal Pharmaceutical Society (2013). Optimization of medicines: the evidence in practice. [online] Available at pharmacy-pdfs / mo — proof-in-practice.pdf [Accessed 3 Oct. 2017].

(4) Carter (2015), Review of Operational Productivity in NHS Providers (interim report), London, [online] Available at [Accessed 3 Oct. 2017].

(5) NHS (2016). Commissioning for Quality and Innovation (CQUIN) Guidance for 2017/19. [online] Available at: [Accessed 2 Oct. 2017].

(6) The Cancer Vanguard website. (2017). The vanguard of cancer. [online] Available at: [Accessed 3 Oct. 2017].

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