Pharmacy In Practice Podcast Pharmacy in Practice

Ian Strachan is a community pharmacy owner contractor. He owns a number of pharmacies in England. He was the Chair of the National Pharmacy Association (NPA) between 2014 to 2018.



I have wanted to chat with Ian for a while now. He really has operated at the top of UK pharmacy politics for quite some time and has led the way with many innovative initiatives through his community pharmacies.



We had a wide-ranging and fascinating conversation about many aspects of community pharmacy.



Community pharmacy politics in England is a complicated and often turbulent arena. This came out in the chat but we offset these challenges with some positivity as we looked to the future. A fulfilling and attractive career pathway for pharmacists working in community pharmacy was important to both of us.



Ian is passionate about the profession and in particular, he cares deeply about the professionalisation of community pharmacy. We discussed what he thought the vision for the future of community pharmacy should be in the coming years and delved into some notable long-standing community pharmacy topics like free deliveries for example.



Ian is as enthusiastic an advocate for community pharmacy that I have spoken to for a while so it was fascinating to get his insight.

Failure to identify high-risk medication errors in patients with complex needs can have a fatal outcome, a recently published report warned.



The report, published by Healthcare Safety Investigation Branch (HSIB), sets out a case where a medication error with warfarin contributed to the death of a 79-year-old man.



The patient had suffered a fall at home and had been admitted to hospital. An error on his chart whilst he was on the ward led to him receiving three or four doses of warfarin, which he did not normally take before the error was spotted by a ward-based clinical pharmacist. The patient developed internal bleeding and deteriorated (due to several health reasons) and died 21 days after his first admission.



In the case HSIB examined, the patient was on 12 different medications and supplements at the time of admission. By day nine of his hospital stay, this had increased to 16.



HSIB’s national investigation focused on the role of ward-based pharmacy services and how they work within the multidisciplinary teams (MDT’s) that administer care to patients. Ward-based pharmacists are crucial in enhancing the team’s ability to spot errors, especially in high-risk situations. However, the investigation findings emphasised that there is variance in the way the services are staffed and organised.



They also found that other staff within the MDT’s could better understand the role pharmacists have in between admission and discharge of the patient. HSIB also found that more work needs to be done to assess the resilience of pharmacy services to operational pressures and the additional challenges associated with caring for older people.



As a result of the national investigation, HSIB has made three recommendations to facilitate a better understanding of the role of the ward-based pharmacist and to encourage best practice and resilience when identifying and developing models of pharmacy provision.



In this podcast, we were fortunate to be joined by Lead Investigator Deinniol Owens. We discuss some of the pertinent points in the investigation and explore some of the wider questions about pharmacy. In particular, we discuss how this investigation makes the case for the integration of pharmaceutical care led by pharmacists into every multidisciplinary team in the country.



You can read the full report here.

Graham Parsons is the Chief Pharmacist at Turning Point. He is a pharmacist with a wide range of experience in many aspects of pharmacy.



As a specialist in Substance Misuse he has worked at both local, regional and national level (through the Advisory Council on the Misuse of Drugs, National Institute of Health and Care Excellence and Turning Point) to deliver a wide range of initiatives and policies which have impacted on both substance misuse services and the lives of individuals affected by substance use disorders. This has included over six years as a prescriber within the Plymouth Specialist Addiction Service. During this time he has also developed an interest in Mental Health and Pain and the management of these conditions in this cohort of patients.



He has also delivered a number of training sessions covering a diverse range of topics from substance misuse to Controlled Drug legislation for a number of institutes including the University of Bath and the Royal College of General Practitioners and developed Post Graduate addiction courses for Medway University. I am an experienced public speaker who has presented at many events including the College of Mental Health Pharmacy International Conference and on local BBC radio. In the written media I have produced a number of articles on substance misuse and its treatment for the Pharmaceutical Journal.



We had a wide-ranging discussion about the issues of the day in the area of substance misuse.




There has been a move towards the use of Buvidal slow-release injection. Have you got any thoughts on this move especially in light of the current pandemic?
What is the future of substance misuse services delivered through community pharmacy?
What is the role of naloxone in community pharmacy?
How can community pharmacy support alcohol brief interventions?
Why are drug deaths still so high?
How is polypharmacy relevant to the area of polypharmacy?
Has nudge theory got a role in tackling the alcohol crisis in this country?

I have never met a pharmacist or pharmacy technician that does not dread the letter of complaint from the GPhC dropping through the letterbox.



Unfortunately in the context of overall rising numbers of complaints being made by fellow health professionals and also by the general public, I felt it important to touch base with our colleagues at Hempsons to get their views on what you can do if you find yourself in this terrible situation.



In a very interesting chat, we covered the fitness to practise process and how to navigate it if you need to. We also discussed some of the reasons behind rising numbers of GPhC complaints and also the variation in where complaints come from between different professions. There were some key pieces of advice so hopefully, you find these useful.



Tania Francis



Tania Francis is a solicitor and partner at Hempsons. Tania advises doctors, dentists and other healthcare professionals with all sorts of issues to do with registration and regulatory issues, specialist registration or specialist lists, litigation, associate disputes, CQC registration, difficulties with NHS England and more. Tania is a qualified doctor and works in a team which also includes a qualified dentist, and they, therefore, offer a unique approach to our clients’ problems. The team regularly contributes to Independent Practitioner Today and Dentistry magazine and offers training and seminars to our clients. Tania is also on the council of the Medico-Legal Society.



Thorrun Govind



Thorrun is a trainee solicitor at Hempsons. Thorrun studied Pharmacy at King’s College London, completing her pharmacy pre-registration training in community pharmacy. As a practising community pharmacist, she has been a strong advocate for healthcare and healthcare professionals across traditional and social media. Thorrun studied for her Graduate Diploma in Law, full time whilst working as a pharmacist. She subsequently studied for her Legal Practice course and MSc in Law, Business and Management, attaining a Distinction. As a qualified healthcare professional, she has first-hand experience of operating in a challenging environment whilst striving to provide excellent care to patients.



“This podcast is made available on the basis that no liability is accepted for any errors of fact or opinion it may contain. The content should not be regarded as a comprehensive statement of the law and practise in this area.  Professional advice should be obtained before applying the information to particular circumstances.”

I was very proud and grateful to get the chance to talk to the Chief Executive Officer of the General Pharmaceutical Council (GPhC) Duncan Rudkin.



Duncan was very generous with his time and we discussed a wide range of topics. Time was limited so we didn't get through all the topics I wanted to but we did cover lots of ground. We ran out of time and there are questions we did not get round to. Duncan has very kindly agreed toa answer these in writing so stay tuned.



Areas explored include the following:




What is the role of the GPhC and to who are they accountable?
Is the current revalidation process fit for purpose to safely regulate independent prescribers?
Is independent prescribing practice ahead of regulation?
How do the GPhC standards guard against the risk associated with unconscious incompetence?
Is the fitness to practise process in its current form fit for purpose?
Do you think the experience of registrants that have gone through the fitness to practise process good enough?
Is a person who supplies a COVID-19 rapid antibody test unfit to practise?
Will the GPhC express opinions on other matters for example homoeopathy?
Are the public at more risk now that inspections have been stopped due to the pandemic?
What was the most difficult decision the GPhC has had to make during the COVID-19 pandemic so far?

We recently had the pleasure of chatting to the founder and owner of Instant Dentist Aalok Shukla. Instant dentist is an innovative collaborative business that will help community pharmacies extend their digital impact but also deliver much earlier preventative dental care to people as they visit.



Aalok commented:



"Through easy and affordable access to private dental care, Instant Dentist is the first dental wellness platform that allows you to manage your dental health in a way you’ve never thought was possible. Prevention and diagnosis from an experienced digital dentist is just a click away."



We hope this podcast might give pharmacy owners across the country inspiration to extend into digital dental services if they have not already done so.