In the first articles in this series of three about NHS Tayside’s ‘Teach and Treat’ model, Yousaf Ahmad described the background, here he outlines the development of the model.
THE clear messages from Prescription for Excellence mean that pharmacists in the NHS should be recognised as clinicians responsible for providing pharmaceutical care. They should be accredited as clinical pharmacist independent prescribers, and more importantly secondary care and primary care colleagues should be working together in a more integrated approach with patients, and have closer relationships with individual patients to ensure greater continuity and consistency of care.
I believe that in order to create pharmacists that can deliver on these goals and outcomes, it is paramount to give colleagues the right skills, training and confidence, coupled with appropriate peer support and mentoring in order to create the next generation of pharmacists that are just as invaluable as some of our other healthcare colleagues, such as GPs.
One of the key things taken forward in a pilot within NHS Tayside is creating this skilled workforce, with specific questions being raised around competency, knowledge, training and skills required by this future proof pharmacy workforce.
Questions in my mind at the time focused on 2 main themes:
- What mechanism model do we use to re-ignite pharmacists, in particular pharmacist prescribers at delivering something more for patients?
- What do we need to do to train and empower this cohort of pharmacist?
Potential model – ‘Teach and Treat’
Teach and treat is a system which allows less experienced pharmacist prescribers to practice and develop their clinical, assessment and consultation skills in a safe environment under the supervision of experienced pharmacist practitioners.
NHS Education for Scotland (NES) proposed this as an excellent model to help support qualified pharmacist prescribers to become established prescribers and to train future pharmacist prescribers. To date, approximately 950 pharmacists across Scotland have been trained as either independent prescribers (IP) or supplementary prescribers (SP).
However, only about half of those trained are using their skills in practice to improve patient care. In my opinion, some of the key objectives and opportunities of a model like this are to:
- Mobilize inactive pharmacist prescribers to deliver services for a caseload of patients as part of an integrated model of person-centered care.
- Improve the clinical contribution that pharmacist prescribers can make to reduce risks associated with medicines for patients with chronic pain patients many of whom have polypharmacy, in line with National Guidance.
- Develop and implement an education and training programme ,and associated competency framework for these prescribers.
- Develop specialist knowledge and skills in relation to the management of medicine related risks with appropriate consultation and clinical assessment skills associated with these patients.
Within NHS Tayside this was an accepted methodology to help upskill inexperienced and interested pharmacist professionals working in primary care. The area of specialised pain management was chosen as a potential test site to pilot such an innovative model.
Chronic pain is common in the community, affecting up to half of the population with wide ranging impact on general physical, psychological, social health and ability to work. Recovery from chronic pain is rare. Its management is generally unsatisfactory and it has been identified as a national priority for clinical research.
Primary care is where the majority of individuals with chronic pain present, and is a key point of delivery of interventions to tackle the condition. Pharmacists working in general practices and community pharmacies are well placed to improve the pharmacological interventions in pain, not only because of the expertise in therapeutics but also understanding the polypharmacy regimens frequently used in chronic pain.
What we do know is that a great majority of people with pain use analgesics regularly both prescribed and over-the-counter. Thus, ensuring the safe and appropriate use of medication is an important part of the management of chronic pain.
Clinical experience suggests that analgesics are often prescribed sub-optimally, repeat prescriptions are often monitored imperfectly, and concurrent use of over-the-counter analgesia often occurs without reference to prescribed medications.
Research conducted in Tayside shows the proportion of people currently dispensed analgesics increased in 2010 compared to 10 years ago in 1995. This increase was not equal across drug classes with paracetamol, strong opiates and gabapentinoids prescribed more than others.
I believe pharmacists working in primary care are a resource that can be used to help chronic pain patients, but how best do we do this?
Yousaf Ahmad is Lead Pharmacist at NHS Tayside
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Evidence based research on pharmacist interventions in pain management
 Bruhn H, Bond CM, Elliott AM et al. Pharmacist-led management of chronic pain in primary care: results from a randomised controlled exploratory trial. BMJ Open 2013;3 (An exploratory randomised controlled trial- PIPPC Study)
 McDermott ME, Smith BH, Elliott AM et al. The use of medication for chronic pain in primary care, and the potential for intervention by a practice-based pharmacist. Family Practice 2006; 23: 46–52
 UCL- LESS Pain Toolkit; The results of a community pharmacy pilot pain service evaluation (The LESS PAIN toolkit was designed to facilitate well informed semi-structured discussions between community pharmacists and service users with pain related problems
(N.B As a profession we need to start creating more of this evidence based relating to Pharmacist interventions in clinical conditions, so that we can prove the benefits for a pharmacist at managing patient’s clinical care)