My proudest NHS moment

We are the heart and hands of the NHS in our neighbourhoods.

“A patient had nominated our pharmacy team as we had supported her mental health alongside our excellent clinical role caring for her physical ailment.

As a result of her condition,  she had lost her job , was getting  increasingly socially isolated with the risk of further deterioration in her mental wellbeing.

We had acted proactively, contacting her regularly ,  supporting  her to be  more resilient and socially engaged.

We were really genuinely surprised to be informed of our award.

No less so than because we only did what many other community pharmacies likewise do daily.

Community pharmacy is the most accessible NHS outpost, a place where physical , mental and social challenges affecting the health and wellbeing of our communities gets resolved.

We perform this role because of the brilliant vision that created the NHS , of which we are an integral part not an adjunct .

The challenges faced today are multifaceted , the impact of social care and mental health  on physical health focusing attention on why parity of attention and resources across all three is essential.

As our patients and many others across the country can attest, community pharmacy offers so much.

We are the heart and hands of the NHS in our neighbourhoods.”

Ade Williams, Superintendent Pharmacist at Bedminster Pharmacy in Bristol.

Additional reading:

“I’m part of the NHS, not just an accessory to it” -read Ade Williams’ feature from earlier this year

My proudest NHS moment

"Patients are often surprised when they find out that I can prescribe and that they don’t always have to wait to see a GP - surprised and often very relieved."

“I’ve had patients come to me in quite a lot of pain and discomfort and I can often see them, there and then, without the need for an appointment.

Technically there are only three drugs in the BNF that I cannot prescribe but the reality is I only prescribe in my areas of competence for acute uncomplicated conditions. It’s like an extension of the minor ailment service so it’s for things like impetigo, gout, UTIs, ear infections, eczema and dermatitis.

I had to do six months’ training, alongside work, which was funded by the CCG just as the prescribing budget itself is. The CCG examined the health profile in Barrow in Furness and the difficulty in recruiting GPs and funded me in a bid to improve access to prescribers.

It works, we get quite a lot of referrals from surgeries and other pharmacies as well as by word of mouth. Patients still have to be registered with a local GP so I can access their records on the shared care viewer, which is more detailed than a summary care record.

It means we can help share more of the burden on the NHS system and take pressure off GPs and A&E but it is also often far more convenient for the patients themselves.”

Paul Blake, Pharmacist in community centre on Walney Island in Barrow-in-Furness, Cumbria

My proudest NHS moment

We want to do what's right and actually add value to our community and make sure we're helping people rather than just what some people might perceive as a retail transaction.

 

“We dispense about 12,000 items a month but we know everyone on an individual basis.”

One of the more serious issues the pharmacy has to deal with is substance misuse.

“We dispense a lot of methadone and a lot of Buprenorphine and patients feel very comfortable coming to us and that’s why we have such a high volume,” says Talha.

“We do our best to provide them with an experience where we are there to help them and not judge.”

“Once we realised one of the patients looked unwell. We questioned them little bit and found out they were getting sepsis and had a cyst on their joint. We had to convince them and organise a GP appointment for some urgent care so they can get antibiotics. That really stood out for me because if it didn’t get treated and had we had not questioned anything they would have been in position whether they could have lost their joint.”

“We want to do what’s right and actually add value to our community and make sure we’re helping people rather than just what some people might perceive as a retail transaction.”

 Talha Choudry, Pharmacy Manager at West Street Pharmacy in Crewe, Cheshire

Photo caption: From left to right: Katie Marsh, Lynda Sanderson, Talha Choudhry, Kat Edleston, Marie Fisher.

Rest of the team include: Shannon Hamilton, Heather Lloyd, Magdalena Slupska and Deb Pohlmann 

My proudest NHS moment

One of my proudest moments was helping a whole family give up smoking.

 

 

It started with a lady coming in for cough medication and then we had a chat which led to conversation around smoking cessation. Being a Healthy Living Pharmacy, it is easy for us to bring up healthy lifestyle advice with patients. This lady felt it was going to be impossible for her to stop smoking. However, four weeks down the line she had given it up. Then in came her parents, and then her aunt followed by her two sisters. Her mother actually told me she was going to paste their smoke-free certificate on the wall of their staircase at home! She said that every time any of them are climbing the stairs they will remember their achievement, which will motivate them not to smoke again. Another person I helped to give up smoking said: “If the stop smoking service had not been available in this pharmacy I would still be smoking today, or dead.” My pharmacy was the first Healthy Living Pharmacy in Dudley and that was a proud moment in its own right. Seeing positive changes in the lives of my patients due to interventions they accessed in the pharmacy always makes me proud of my career.  The joy of knowing they have achieved what they thought was impossible is priceless and it gives me enormous pleasure to help someone make such a positive lifestyle change. The Priory Community pharmacy is in a very deprived neighbourhood and we see many patients that smoke. Some are unaware of the long-term effects of smoking (and passive smoking) on them and their families, and other patients see smoking as a costly habit. We provide non-judgemental advice and information about our services and a person is ready to quit then we support and tailor our service for that particular patient. We even provide money boxes to patients so that they can save the money they would have otherwise spent on cigarettes. Seeing patients come back to show me what they have done with the money they saved over time is amazing. One patient came to show me their car and another one their lovely bicycle. I believe that smoking cessation is an invaluable public health service which should be easily available and accessible.

Author: Olutayo M Arikawe, Superintendent Pharmacist, The Priory Community Pharmacy, Dudley, West Midlands.

 

I’m part of the NHS, not just an accessory to it

This year will see 70 years since the so-called ‘Appointed Day’, designated by the National Health Act of 1946. The National Health Service’s first day of operation. I find myself invited to take part in a local expert panel convened to discuss this momentous day and deliberate on the future of this great national institution.

My preparatory ruminating, invariably leading me to reflect on the present state of the NHS and the future of community pharmacy. The Beveridge report published in 1942 formed the basis for the creation of the National Health Service. It was a time of great political Statesmanship and conviction politics. Churchill, Attlee, Bevan, Wilson, Morrison and et al not to forget the indomitable Ellen Wilkinson. The political sparring and wrangling, deal-making, discontent, inpatient clamour and general public discussion around this in my opinion not matched by anything since.

The transformation the NHS brought, enabling everyone to access free healthcare with pharmaceutical services included. The pharmacy premises of that day are certainly a world removed from today but importantly people could access their local service and the expertise it offered. The narrative of community pharmacies evolution since the ‘Appointed day’ I would simply put as delivering efficiently what has always been asked of us.

Whilst like every other part of the healthcare system we have areas we can improve on, community pharmacy certainly delivers a great service. Our responsiveness, innovation and adaptability is nowhere more evident than in the independent pharmacy sector.

The story of the NHS even in those infancy days involves battling with the financial pressures and fighting to remain true to its core values. There were pragmatic decisions in the face of financial pressures as rebuilding during the post-war years demanded. Addressing competing societal needs and challenges meant rethinking how to do things but importantly embracing the ideas that enabled things to be done better. Community pharmacy has some ideas that will enable things to be done better and more cost-effectively.

I believe that the NHS in England should face up to its present challenges and look to address them without losing sight of what community pharmacy offers. There is no need to trawl through the financial and staffing pressures the NHS faces today.  Community pharmacy has accepted and delivered on the agenda set for us in time past. I am proud to see the approach the NPA is now taking, building on the campaign to save the community pharmacy network; it is now fighting to save the NHS by advocating for empowering community pharmacy to do more. It is ready to shape the agenda for good.

Community pharmacy is part of the NHS. We are not some adjunct service but a core stakeholder. . The vision unveiled in the Community Pharmacy Forward View shows that we have answers and ideas that can work. More importantly for a little bit of trust and confidence, we can demonstrate our ability to deliver. Our communities need us now more than ever. Many of themfeel forgotten and left behind, in what  some would call a wellbeing crisis.

Bedminster Pharmacy sits in a geographical position that helps me illustrate this point. We sit within line of sight which could also be viewed as a point of intersection for East Street, West Street and North Street locally. Yet within this close proximity, the populations in the three areas have very distinctive profiles and with some exception can present social, economic, health and lifestyle behavioural profiles that make generalisation possible. All these needs and challenges find a meeting point in our pharmacy like many others around the country. It is convoluted yet the unique expertise offered by only community pharmacy brings resolution.

Community pharmacy has always been the place where physical and mental health, social care, public health education and interventions, lifestyle and behavioural support, self-care promotion, medicines optimisation, minor ailments treatment, emergency health managing and signposting amongst many other things happen daily.

We must share our ideas broadly,  to our patients and local stakeholders.  Whilst also supporting the national efforts to influence policy. I support an integrated agenda with a start point of making use of  the expertise and unique abilities already now available and on offer in community pharmacy. We want to help write the prescription to treat our ailing health service. Let no one forget, we are part of the NHS and will work to make it  better for our patients.

Author: Ade Williams

The NPA in party conference season

Building on the success of last year’s conference activity, the NPA will have a stand at each of the major political party’s conferences in the coming weeks.

Pharmacy has a vital role to play as an essential part of primary care. That’s why we will be at every major UK-wide party conference, standing up for our members and demonstrating our vital role in the ongoing fight to save the NHS.

Our aim is not only to demonstrate the fantastic work we do but to educate and inform policymakers on the opportunities that a fully engaged community pharmacy sector can deliver on. To this end, we’ll be creating debate by running fringe events at each of the conferences attended by MPs, peers and activists, to showcase exactly how community pharmacy is so valuable.

At our stall, we’ll also be running blood pressure tests with CardioClinic for MPs and conference attendees, to showcase a new service that the NPA is developing, about to be trialled in Essex and Gloucester – another way in which pharmacies can help relieve the mounting pressure being heaped on our GPs and hospitals.

We’ll be updating you with all of our activity, including photos of the events and video updates, via social media and on our website – you’ll be able to find it all, updated live at www.npa.co.uk/conferences

Cyber Virus brings down your NHS (and how to avoid that in community pharmacy)

Are you doing enough to safeguard your cyber security?

You can’t fail to have noticed the May 12 WannaCry cyber-attack. It wasn’t pretty.  The IT systems of 17 NHS Trusts and a number of GP surgeries were affected. The health service relies heavily on IT, and without IT it’s only limping along.

BBC News stressed the NHS aspect, but many other organisations around the world were infected. The virus didn’t target the NHS. The virus was indiscriminate, not that that helped the NHS. Operations were delayed. Departments were closed. Patients were adversely affected.

So what happened? Did you see Horizon on the BBC? Dr Kevin Fong explained it well.

It appears that the NSA developed a virus called a worm that is not only able to infect a computer, but then goes on to infect other computers on the local network. Microsoft became aware of the worm and wrote a Windows update that protected computers from this virus. However, not every user applied the update so many computers remained vulnerable.

Hackers combined that virus with another crypto-virus, that when it infects a computer, encrypts files on the computer and demands a ransom to unencrypt them. The result was the WannaCry virus.  For those that felt the least bad option was to pay up, the bad news was that WannaCry wasn’t even an ‘honest virus’; a number of people paid and still didn’t get their data back!

Community pharmacies don’t appear to have been infected by the WannaCry virus. Did that help the NHS? Well, it meant that medicines could be dispensed and labelled, if the prescriptions could be received.  Around 55% of prescriptions are sent electronically from GPs to community pharmacy, with almost all the rest being printed from the GP computer system, and a handful being handwritten.  In some cases GP systems were down due to either the virus, or from people trying to avoid the virus by turning off their computers. This caused real disruption.

How to keep PCs safe in your community pharmacy

Consider your assets and business processes you need to protect. e.g. your patient medicine record (PMR) system, dispensing, stock ordering, taking payments.

Think about the risks to them – e.g. loss of data (bad), or data theft (a disaster – think of having to inform patients).

Then consider how to manage those risks, detect virus/attacks, and also how to clean-up/restore normal service if affected.

So how to manage those risks

To counter virus like WannaCry (and already there are variants out there):

Use a supported operating system on the NHS Digital warrantied environment specification. Update Windows and programs, and have up to date anti-virus protection. It is important to know who manages these. For larger pharmacy chains, it’s probably your IT department. For independent pharmacies your dispensing system supplier may manage some or all of these but you really need to check. This may be what saved community pharmacy from being infected.

Be careful not to deploy a second anti-virus product onto the same PC. They may not get-along!

Also ensure your network firewall is correctly configured.  This is normally provided and configured by system suppliers as part of your secure N3 connection.

While we’re talking about security, here are some other general security measures to consider:

Physical protection /access control to stop PCs being removed

Protecting data on PCs by disk encryption

Each user needs their own PC logon (a non-admin one)

Train users to be security savvy; to be cautious of email links and attachments. Consider adding email filtering. Don’t allow personal email on work PCs.

Setup an internet browser whitelist to reduce risk

Do backups, ensuring that they are offsite, in England, and inaccessible to any virus on your pc!

Consider adding PC endpoint protection to secure those USB ports etc

Do you have other network devices on the network that might pose a risk? Eg networked TV, vending machine, check-in kiosk, photo printing PC, EPOS till, or personal phones/tablets on Wi-fi.

Follow 10 steps to cyber security, sign up for security bulletins from CareCERT, and for larger organisations consider hiring a security consultant.

Cost

Sweating your PC/PMR assets for more than a few years might seem like the cheap option but it might cost you in the long run.

What should you do?

If you want to keep serving patients, prepare now. There will be another virus along real soon.

On Tuesday, 27 June 2017, the virus dubbed GoldenEye was detected. The initial source of infection may have been Ukrainian tax system software, but it has now spread around the world.

It looks like WannaCry in that it encrypts files then demands a ransom (but don’t pay as you’re extremely unlikely to get your files back).

Based on early descriptions from Kaspersky Labs and The Register: The infection can start by email with a malware attachment that may use a faked Microsoft digital signature. If a domain administrator is duped into running the malware, all computers on the network are infected. It can also spread to non-updated computers (using EternalBlue and EternalRomance exploits).

So remember- keep your IT up to date, and in so doing, keep the lights on for your patients. Time also to revisit the NHS IG toolkit and check you’ve got it all covered.

 

Author: John Palmer is Pharmacy IT Lead at the National Pharmacy Association (NPA) @johnlspalmer

NPA takes the long view on pharmacy policy

In my role as Policy Manager at the NPA, I take issues of concern to independent pharmacists and develop policy recommendations in consultation with members, NPA staff and the Board. The ultimate aim is to shape public policy and influence the approach of the NHS and other stakeholders impacting our sector.

The key is listening, observing, gathering views and remaining neutral and open to all opinions about the emerging threats and opportunities for the sector and how to respond to them. Before joining the NPA, l was a practising community pharmacist for 20 years, so of course I have strong opinions of my own about what’s needed on the pharmacy front line – but as Policy Manager I balance this against many other opinions and, of course, the hard evidence.

At the NPA, we are concerned not only with current policy developments, but about the long term position too. A vital task in my job is horizon scanning and looking at the impact that government proposals have not only currently, but also will have in the future- perhaps in 5 years, 10 years, or 15. Changes that may seem superficially attractive to the sector now might, on close inspection, be dangerous in the medium or long term. I look at trends and the history of the independent pharmacy sector, as then it is more possible to predict where the future may be leading.

The NPA looks after independent community pharmacies across England, Northern Ireland, Scotland and Wales, and it is essential to recognise how viewpoints can differ between countries. The policy challenges themselves usually concern government legislation, but the differences between countries also lie in how the law is applied in practice. For example, looking at the current consultation on registered technicians and education standards; this is something that is set up by the GPhC, however Northern Ireland has its own regulator- the PSNI. In addition, technicians in NI are not regulated, therefore this consultation would not apply to Northern Ireland. In contrast, the hub and spoke consultation (May 2016) is relevant to pharmacies right across the UK.

I work very closely with the NPA country managers. The way that community pharmacy operates and how it is perceived differs noticeably from country to country, but there is also cross-fertilisation. Some of the models used in England have been developed from those used in Scotland, and vice versa. The systems used by Health Education England are now being applied similarly in Wales, and these are just some examples of how UK countries are learning from one another.

It is vital that the NPA is able to listen and react to the needs of the sector and its members, taking into account that each has its own priority depending on where the pharmacy is on its journey, and what it needs in order to progress.

 

Author: Helga Mangion

Go on David, Surprise Us!

Pharmacies are a hugely under-utilised resource within the NHS. To change this, there must be more ambition amongst policy makers, commissioners of services, and government ministers. Their attitudes show that pharmacy has been misplaced in the healthcare scheme; there are so many ways that we could help further

We can save the government money on various fronts if they were to use our full pharmaceutical skills.  If we actually had the pharmaceutical care management of the individual, including access to their records, then we could take care of them fully which would eventually save the NHS money when it comes to drugs usage. Pharmacies support better compliance, for example with asthma treatment to make sure that patients use their inhalers correctly. This has a knock-on effect and could save that patient from having to visit a hospital further down the line, which then relieves further pressure on that NHS service.

Services like this may seem small, but allowing pharmacy to take on that responsibility would have a positive impact which has not yet been acknowledged by the powers-that-be. We must be trusted and invested in to deliver more of the clinical services that pharmacists are capable of.

We should be more integrated with our healthcare colleagues so that we can contribute towards the care of the patient in a holistic way. There has been a lot of fuss recently about how social care is the other side of the coin to healthcare. Actually, community pharmacies are part of that same ecosystem of care, which also encompasses GPs, hospitals, district nursing and allied health professionals.

As well as being a board member at the NPA, I am also on the board at the Pharmaceutical Services Negotiating Committee. It is in this role in which I had a rude awakening that the government really doesn’t understand community pharmacy and wants to lead us down the wrong path. At PSNC we presented to them some very practical steps the sector could take to achieve cost-effectiveness and indeed cost savings. They were not ready to listen.

The cuts could have a devastating effect on local communities in the longer term. Pharmacies could be forced to reduce services, cut opening hours, stop home deliveries and minimise staff teams- all to the detriment of the efficient and valuable services that we are delivering at the moment.

In some cases they will lead to closures, not even just the low volume pharmacies, it could affect established pharmacies that supply other pharmacies and have big bank loans. The cuts will lead to all kinds of scenarios, a Pandora’s box that the government have opened up and even they do not know what the outcome will be. Their own impact analysis shows that they don’t know what’s going to happen and it can’t be predicted. Perhaps these pharmacies won’t close in Year 1, but who knows what will happen by Year 3 or 4 if the government doesn’t reverse its stance and work with the sector to improve integrated care.

At the end of last year we were pleased to welcome some of the recommendations of the Murray review and David Mowat, Pharmacy Minister, should grasp this opportunity to change tack. It’s a new year and things do not have to go on in the same vein that they have been up until now. So go on David, surprise us by getting around the table with frontline pharmacists to discuss a radically different approach.

The responsibility that the NPA has to help independent pharmacies is absolutely critical. We are the Head Office of the independent sector and we see it as our duty to lead independent community pharmacies on a journey of change and improvement whilst retaining the very best of the historic values of our sector.

I think members value the amount of hard work we are doing on their behalf to highlight what community pharmacy is capable of- particularly in times of crisis like this one. I was among those who delivered the 2 million #LoveMyPharmacy signatures to Downing Street and I can see the value that members see in that, seeing that there is a body standing up for their core concerns and taking it to the highest level.  Rest assured that we will continue to do that and try to make the government see sense in allowing pharmacy to maximise our contribution to patient care.

 

Author:  Bharat Patel

How community pharmacy can better support the NHS

In my role as chief pharmacist at the NPA I meet a lot of dedicated pharmacists all over the country. The last few months, with government cuts hanging over us in England, have been difficult for everyone but something it has highlighted is the irreplaceable role that pharmacies play for the public.

Unfortunately, the Department of Health has not understood what pharmacies can actually deliver, and neither have they understood what patients need or want. It’s obvious that they don’t see the impact that some of these proposals will have on patient care. A lot of patients who are housebound and are dependent on the deliveries and services provided by community pharmacy will have to find care elsewhere. This is very concerning for many, particularly elderly patients, who will find it harder to access care. This will put even more strain on our NHS too.

It seems to me that the government needs to know what pharmacists are achieving at the moment and what potential pharmacy has, and that rather than trying to diminish the role of the pharmacist through cutting their services they should embrace and develop them further. Research has demonstrated that pharmacists could take a huge burden off the shoulders of the NHS, but the government does not yet seem to have taken this on board.
The NHS is changing, as it has to, with the requirements of the moment such as long-term conditions, population growth and increased life expectancy, there are various different challenges health-wise that now need to be scrutinised. There is huge potential for pharmacy to enter new arenas and provide a new set of healthcare services.

Pharmacists are embracing the needs of their local patients and providing different sorts of services; be it getting involved in mole testing to delivering flu vaccination services. It is becoming a more service orientated profession, and with that comes the need to acquire different skills. And if with more skills come more responsibility then pharmacy will be ready to take that responsibility on.

The NHS needs us, as pharmacists, to be working more collaboratively with other healthcare professionals in local areas, identifying local needs and stepping in to manage any risks in that particular area.

Pharmacies will always have a central role in safe supply of medicines. This is a function that a lot of our members do very well, and a lot of patients do appreciate the ease of going to a healthcare professional, getting the relevant services and being supplied medicines without having to book an appointment. But we can still go much further to help take pressure off GPs and A&E all over the country. I see the future of pharmacy very much developing to provide more services to benefit patients and local communities, including the care of long-term conditions such as diabetes and asthma.

We all hear about the burdens on the NHS and an increased pressure on GPs. Pharmacy can stand out as a service that helps relieve that burden; one that the public can use without having to book an appointment at a GPs or unnecessarily visiting A&E. We want to establish pharmacy even more firmly as a first point of contact for the public.

The NPA will continue to support our members and continue to highlight the importance of pharmacy to the government, the NHS and the general public too. Together, we can ensure that the NHS truly benefits from the skills of pharmacists.

 

Author:  Leyla Hannbeck