Pharmacy Strategy - FOI Response Register

Please can I request your organisations current "Pharmacy strategy" document - This may also be titled Medicines Management Strategy, Pharmacy, Prescribing and medicines strategy or similar and should identify your organisations strategic plans to develop and evolve your hospital pharmacy to ensure safe and effective use of medicines.  In Scotland it may be incorporated into a wider Health Board strategy, and, if so, please can you identify that this is the case and share this document.

RESPONSE

The below provides the framework that pharmacy strategic focuses are drawn from in Shetland

Overarching Strategic Documents – Scotland level - Achieving Excellence, CMO Annual Reports on Realistic Medicine, Value Based Health and Care including broader health strategies available from Scottish Government websites

• NHS Shetland Clinical Strategy
• Shetland IJB and CHSCP Strategic Commissioning plan

Main local pharmacy:

Pharmacy Strategic Priorities and Focuses:

Strategic Priorities and Ambitions for Pharmacy in Shetland

Role and Function Development – Advanced Clinical Pharmacists, Advanced Pharmacist Practitioners

Significant changes in postgraduate education and learning for pharmacist, together with significant service pressures and patient needs will continue to drive local need to develop staff to meet needs of patients and deliver future service models.

Working regionally, we will continue to develop the role of the pharmacist as a clinician, focusing more during 2023-2025 on the development of Advanced Pharmacist competencies and skills within the hospital pharmacy team, and be ready for 2026 graduates who are prescribing ready.

This work and ambition will be underpinned by the due to be released Scottish Government paper on Transforming Hospital Pharmacy and Transforming Primary Care Pharmacy – outlining the need for developed pharmacist roles, enabled by the development of the hospital pharmacy technician.

Throughout this work to transform roles and workforces, medicines supply will remain central to the function of a pharmacy department and service. The supply of medicines, and the processes and governance that supports it, will be prioritised. Effective skill mix and role development will allow for traditional pharmacist “work” to be completed effectively by pharmacy technicians.

Pharmacy is an essential stakeholder within service redesign for future integrated planned and integrated unscheduled care models going forward.

Technician Led Medicines Supply and Management

The Pharmacy services across all sectors depends on the successful development of the technician role, requiring both pharmacist and technician leadership to implement.

The broadened role of the pharmacy technician is the key enabler for pharmacists to be released to be deliverers of direct patient care, outlined in the below. It is also essential for technicians to realise the potential of their role and the value their work adds to the delivery of care across all settings in Shetland. Technicians will be more present in clinical areas and be capable of carrying out direct patient interactions to support improved medicines management, through application of their technical expertise and skill.

During 2023/24 and 2024/25 it is expected that we will benefit from an established ward based technician service, providing medicines reconciliation, one stop dispensing, and discharge medicines reconciliation to improve transitions of care and medicines related work associated with discharge.

The technician role in general practice will be essential for the delivery of Pharmacotherapy level 1 services. Engaged pharmacists and technicians within the team will be supporting the incoming trainee technician.

resource that will be focused on the development of hospital pharmacists over the coming years.

Pharmacists across Scotland have been developing their clinical skills and clinical offering, providing direct patient facing clinics from outpatient setting for specialist prescribing areas. These pharmacists are supporting consultant led models of care in specialties and improving access to care for patients and importantly access to effective treatment options. Pharmacist Led Clinics

Minimising the need for travel, and establishing consistent local services is key for NHS Shetland’s strategic aims. Developing the role of the clinical pharmacist is a key objective within Scotland and a key element of delivering on Shetland’s clinical strategy aims of creating multidisciplinary teams to support communities with good access to health and care for their long term conditions, whilst keeping that care delivery as close to home as possible. Within the Highlands and Islands, there are more accredited Advanced Clinical Pharmacists than in any other area in Scotland, evidence of success of regional leadership in education and training – leadership

Newly developed and fit for purpose curricula for post-registration pharmacists to develop advanced skills are now available and supported regionally for pharmacists to undertake so they can develop into clinicians with competence, capability and confidence to deliver advanced scope roles.

Priority areas for involvement include 1) mental health, 2) medicines requiring effective shared care (i.e. rheumatology, dermatology, gastroenterology), 3) and cardiovascular disease including diabetes, 4) chronic pain, 5) general practice.

Underpinning NHS Shetland’s local ability to move to a model which provides multidisciplinary care with a pharmacist in the outpatient setting, is the successful implementation of the pharmacy technician role at ward level in hospital pharmacy, and recruitment to and development of additional technician resource within general practice pharmacy. The positive outcome of pharmacist delivered clinical care are only possible with full utilisation of the pharmacy technician role.

Digital Prescribing Benefits Realisation

NHS Shetland have successfully implemented the HEPMA and PSC system within the acute site and will be in a position during 2023/24 to begin realising the benefits of these system. The benefits will be realised across, but not limited to:

• Improving patient care by reducing risk i.e. missed dose reduction, allergy alerting, medication accuracy at setting transition (in to and out from hospital) – getting it right first time, each time.
• Improved systems learning through available intelligence of medicines use at the patient level in hospital pharmacy – demographic linked prescribing, comparative prescribing analysis with other boards in the region.
• Greater workflow optimisation for clinical pharmacists – allowing for a more effective use of time resource to implement risk management approaches and prioritisation to the delivery of pharmaceutical care.
• Improved workflow for other clinicians working from outpatients, A&E and inpatient ward areas.
• Implementing intelligence led services, leveraging data and analytics to assure, improve and prioritise medicines resource use including professional resource use.

Realisation will be made possible due to NHS Shetland’s organisational capability in its Lead Pharmacist for HEPMA who is engaged fully with the regional team and has competence and experience to support the organisation lead on the next elements of the work. The work will also involve further rollout of the HEPMA system to other clinical areas across the Gilbert Bain Hospital, including A&E and eventually outpatient prescribing.

During the coming year 2023/24, work will also be prioritised to appraise and improve organisational readiness for transition to new GPIT systems. This will include the Lead Pharmacist for Primary Care working collaboratively with community health professionals, Primary Care leadership and eHealth leadership to plan and support implementation of the new systems and ensure safe transitions of prescribing and processes for dispensing practices into the new system.

There is an emerging need to form a clinician user group for digital clinical systems as more changes take place in the next 1-3 years – spanning acute and community services.

Additional work and resource has to be identified during 2023/24 to begin approaching a solution for effectively hosting clinical guidance, pathways and policies for clinicians to use in Shetland. This is to explore the replacement of the use of the intranet, or public facing website, with professional appropriate space for guidance, and allow the curation and maintenance of local resources effectively – reducing risk of misuse of out of date guidance.

Accountable Sustainability of Medicines Use

Through improved reporting and sharing of performance, the Pharmacy Team will aim to provide regular updates throughout the year, through the Area Drug and Therapeutics Committee and other groups on the use of medicines.

This will take the form of reporting on:

• Antimicrobial use across acute and primary care (development completed, first reports available)
• Controlled drug use through the Local Intelligence Network with NHS Grampian (ongoing)
• National Therapeutic Indicator performance at both board and practice level to influence change (development completed, first reports to be prioritised)
• Financial progress of medicines resource use and effectiveness of cost saving, avoidance and mitigation strategies (development ongoing)
• Service performance measures including discharge turnarounds, pharmacotherapy service availability (development completed, requires operationalising)
• Community Pharmacy service utilisation for both board and contractor audiences (development ongoing, requires engagement with contractors)
• Medicines risk reporting across health and social care settings (development completed, requires operationalising)
• Environmental impact of medicines through medical gas use reporting and NTI data on use of pressurised metered dose inhalers. (development ongoing, led by Scottish Government).

This will give sight across the organisation of the progress in prescribing, contribution pharmacy services are making, and improve the visibility of services to other teams, which may encourage more effective collaboration on prescribing topics.

Activity will also focus on reducing waste meds through engaging with community pharmacies, focusing on future models of supply for non-medicines such as catheters, dressings and nutritional supplements, and working with social care services to review medicines management systems.

Supporting Community Pharmacy Capacity and Increased Service Utilisation

Throughout 2023/24, we will engage with the community pharmacy contractors to understand their needs and develop their role further within the delivery of care within NHS Shetland.

This work will be led by the Principal Pharmacist and Lead Pharmacist for Primary Care, through engagement and negotiation with the Pharmacy Contractors Committee and is dependent on the Principal Pharmacist resource being available for use and not to cover clinical pharmacist cover in the hospital.

This will include developing services that respond to:

• the growing medicine management needs of individuals in the community, i.e. Multicompartment compliance aids and resourcing this service delivery
• developing a local travel health service, delivered by community pharmacy on behalf of NHS Shetland
• developing unscheduled care treatment pathways to make best use of pharmacy first resource, and support the development of independent prescribing and Pharmacy First Plus in Shetland
• work with contractors to understand volume and capacity concerns and utilise serial prescribing to its fullest potential, as well as 56 day prescribing throughout Shetland
• exploring the delivery of core pharmacy services to remote communities serviced by community pharmacies for their medicines supply needs – the Isles Network of Care practice registrants.

In addition to this, we will look to listen to the public’s needs and ambitions from what they require from their community pharmacy services. We will do this in collaboration with contractors and staff, and ensure we engage with the public to develop locally appropriate services.

Deeply Integrated Interisland and Regional Working

The Pharmacy Department, with other Pharmacy Teams in regional territorial boards, will continue to broaden and deepen their collaborations and work more effectively together to share work and achieve outcomes for local populations.

We’ll achieve this through effective engagement with national pharmacy networks and structures, and through opportunity in Direction setting for the Functional Directors of Pharmacy Group, to raise local isles and remote and rural issues on national pharmacy agendas. This will also require local lean in to existing structures in other boards, and a mixture of informal and formal collaboration between key governance groups and representatives of these groups.

Education and Training for Pharmacy staff will be achieved through regional working, delivered locally and developed to meet local needs. Shetland, along with Orkney and the Western Isles, will work closely with NHS Highland in the Highlands and Islands Pharmacy Education and Research Structure to achieve learning outcomes in both pharmacists and pharmacy technicians. This work is already yielding results for the Highlands and Islands, with staff supporting interboard for Advanced Pharmacist development, and in the research being carried out by NHS Orkney’s Lead Pharmacist for General Practice through their Scottish Academic Fellowship – researching the tolerance of ambiguity in the pharmacy profession and furthering the development of effective education and learning to grow the capabilities of pharmacists as clinicians.

Work will continue between Shetland and Orkney in developing the local prescribing advice tool – ScriptSwitch. This will provide passive support for prescribing cost mitigation, as well as using it’s now extended capabilities in improving medicines safety and reducing risk to patients from prescribers.

Throughout 2023/24 and beyond, technical expertise in data analysis of medicines use will be shared between both boards – with the development of a pharmacy technician in Shetland, providing crucial analytical resource for both isles. Subsequent develop of the hospital pharmacy procurement teams and improving functional relationships across boards will allow Shetland to support Shetland with the expertise developed in the Shetland Pharmacy Procurement team.

Formulary work, led by the Principal Pharmacist, will continue with Shetland, Orkney and Grampian, and will see the inclusion of both Isles boards within the Medicines Management Groups NHS Grampian operate within their pharmacy structure – allowing for improved opportunity scoping and implementation locally within Shetland where appropriate.

Further work will be undertaken to adopt available guidance form NHS Grampian, and formalise the process for using Grampian guidance in Shetland.

National Recognition of Remote and Rural Needs

The Pharmacy Leadership Team will continue to develop in its organisational effectiveness, presence and contributions to national pharmacy structures and leadership groups, continuing to include the specific needs of rural systems in broader NHS Scotland service discussions. This work will create the necessary relationships for future opportunities and key strategic partnerships.

NHS Shetland Pharmacy Service will continue to share its excellent example of delivery with a wide audience, sharing of outcomes of the work of the teams and engaging in research collaboration with Robert Gordon University and Highlands and Islands Pharmacy Education and Research.

NHS Shetland will continue to lead on implementation of digital systems across hospital and primary care by working collaboratively locally, and regionally.

The Director of Pharmacy in the role as Chair of North of Scotland Directors of Pharmacy (DoP) regional group and DoP executive will continue to work and deepen relationships with senior strategic leaders across all NHS Scotland, exploring opportunities for improving outcomes for people and staff. The DoP will work as part of the Scottish Government group on Sustainability and Value, developing strategic approaches and influencing future policy to improve cost-effectiveness of prescribing across Scotland.

Supporting the Clinical Strategy

Pharmacy must be a strong voice and key stakeholder for developing and implementing strategic plans for achieving the ambitions of the clinical strategy. Provision of Pharmaceutical care

Pharmacy are a key provider in:

• effective care for multimorbidity,
• specialist conditions requiring medical treatment,
• development of the non-medical workforce
• systems improvements i.e. digital system transition, prescribing system effectiveness

The Pharmacy Leadership team will be a consistent presence at service transformation discussions and decision-making functions of the organisation, given the services role across all areas of care and an essential component of the future multidisciplinary models of care.

Key elements of supporting delivery of the clinical strategy will include ensuring that Pharmaceutical Care is available to all patients prescribed medicines in Shetland.

In general practice, this will be achieved through the implementation of an effective Pharmacotherapy Service through the evolved model of delivery – hub delivered – and ensuring that all patients who are prescribed medicines receive adequate pharmaceutical care and a medication review each year from the pharmacy team. These medication reviews will form the basis of delivery of pharmaceutical care and be a key measure of access to pharmaceutical care in Shetland. This activity will underpin the success in improving treatment quality, patient outcomes, reducing risk and improving cost effective use of medicines.

Within hospital pharmacy, it will take the form of clinical decisions relating to medicines including the advice of pharmacy professionals. This will increasingly be seen in the outpatient setting with the above objectives, as well as in the traditional inpatient setting where access to pharmaceutical care is already well established.

• Pharmacy IJB Directions

Additional: NHS Scotland Directors of Pharmacy Strategic Framework and draft Hospital Pharmacy Transformation Framework which are not available to be shared at this point.

Additional: Royal Pharmaceutical Society 2030 vision and Standards for Hospital Pharmacy (ongoing local assessment against standards) which are available through the RPS website: