The Carter 2 review found that ‘no two NHS community healthcare trusts deliver the same set of services’. This heterogeneity partially explains the wide variations in the perception and understanding of our services and the role of pharmacists within this vital, yet understated, part of the NHS. This account therefore may not be fully representative of other service delivery models elsewhere in the UK.
As per all NHS organisations we have business continuity plans. This meant that, as unprepared as the world was for this pandemic, we had a starting point for swiftly prioritising, scaling up and stepping down each service and team. For the pharmacy and medicines team this meant prioritising medicines supply, our inpatient wards and medicines safety, whilst stepping down policy and protocol reviews, audits and provision of training. Implementation was rapid and with few problems.
The fundamental function for the trust pharmacy team: to support patients, doctors and nurses to choose, prescribe and monitor clinical outcomes of medicines to drive optimal use hasn’t changed, however we have increased the proportion of pharmacist time for patient-focussed services on the wards. This has been very well received and valued by the ward staff and pharmacists alike.
Our rehab and neuro-rehab wards would normally treat relatively medically stable patients. This changed as we received patients with Covid-19. Patients would develop new symptoms or rapidly deteriorate. Supporting staff with the skills and knowledge to confidently and accurately use relatively unusual medicines, including palliative care meds and intravenous antibiotics has further raised the profile of pharmacists in supporting patient care. Moving to 7-day working was essential initially, however this has been scaled back more recently as needs have changed.
We support our patients across a double interface – with secondary care on one side and general practice, community pharmacy and our community teams on the other. Regular contact with the other pharmacists across the Integrated Care System (ICS) has been hugely helpful, to help manage this smooth transfer of patients and information across interfaces, in such a busy and rapidly changing healthcare system. Existing relationships have been strengthened, as traditional boundaries have blurred.
We also have good examples outside of the wards. To reduce patient risk of exposure to the coronavirus, we have worked with our nurses to develop a service whereby patients with ulcerative colitis and Crohn’s disease now receive monoclonal antibody intravenous infusions at a community clinic setting instead of attending hospital outpatients.
As part of the local response to provide greater support for care home residents, our pharmacists have been rapidly deployed along with other pharmacy colleagues to provide system-wide support, drawing on the wide breadth of expertise across sectors. This integration heralds a positive legacy that needs to be nurtured further, so that it continues long after Covid-19.