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IN THIS ISSUE:● Impact Of An Integrated Medicines
Management Service (IMMS) OnPreventable Medicines-relatedReadmission To Hospital: A Pilot ParallelCohort Study
● Competency-Based Learning NeedsAnalysis Of Pharmacists At WesternHealth And Social Care Trust
● A Retired Industrial Pharmacist’s Tale:What I Wish I Had Known Before
● Home Oxygen Service Review (HOS-R)Pharmacist
● Will The Elastic Break?
● How To Be A Success At Failure
17JulyVolume Thirtythree
Number Three
FACULTY
ROYA
L PH
ARMACEUTICAL SOC
IETY
ACCREDITED TRAININGPROVIDER
ISSN 2052-6415 (Online)ISSN 1354-0912 (Print)
Journal of Pharmacy Management
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FACULTY
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ARMACEUTICAL SOC
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Journal of Pharmacy Management Volume 33 Issue 3 July 2017
Impact Of An Integrated Medicines Management Service (IMMS)
On Preventable Medicines-related Readmission To Hospital:
A Pilot Parallel Cohort Study
Professor Nina Barnett, Krupa Dave, Devinder Athwal, Paresh Parmar,
Sunaina Kahe and Christine Ward
Competency-Based Learning Needs Analysis Of Pharmacists
At Western Health And Social Care Trust
Kathryn S. King and Dr. Alison J. Gifford
CLARION CALLA Retired Industrial Pharmacist’s Tale: What I Wish I Had Known Before
Dr Malcolm E Brown
FACE2FACEHome Oxygen Service Review (HOS-R) Pharmacist
Ameet Vaghela
MANAGEMENT CONUNDRUMWill The Elastic Break?
LEADERSHIP How To Be A Success At Failure
77
90
101
108
111
114
CONTENTS
BEST PRACTICE IN PHARMACY MANAGEMENT
73
Journal of Pharmacy Management Volume 33 Issue 3 July 201774
Medicines are known to contribute to
approximately 10% of hospital admissions
and up to half of these may be
preventable. A paper in this edition
compares the rate of preventable
medicines-related readmissions in a
hospital where an Integrated Medicines
Management Service (IMMS) had been
developed in comparison to a traditional
service at another hospital within the same
organisation. The IMMS was found to
reduce the rate of preventable medicines-
related readmissions with a saving of £3
for every £1 spent on an IMMS
pharmacist. Hospital pharmacy managers
will find this to be a useful resource when
making a case to develop pharmacy
services to improve patient care.
A review of learning needs for
pharmacists has shown that they need to
improve their personal effectiveness and
develop their emotional intelligence. It is
suggested that proactive communication
and networking must be encouraged
using formal methods. Ttraining on
preparing workshops and educational
materials should be provided and
mentoring should be more widely
established. Methods discussed to
promote management and leadership
skills include learning from role models,
delegation and managing projects. It is
clearly important to identify staff learning
needs and make appropriate provision in
training if services are to be developed to
the highest possible standard. The work
reported here will provide a most useful
template for those who wish to conduct
a local needs analysis.
Clarion CallThere comes a time in every pharmacist’s
life when they need to consider
retirement. Leaving it until it is upon you
is too late. Consideration needs to be
given ahead of time to a raft of issues.
Finance is important but, as the article in
this section shows, there are many other
aspects that need some thought.
Will you wish to continue registration
with the General Pharmaceutical Council
or member/fellowship of the Royal
Pharmaceutical Society? Do you need to
attend a course relevant your outside
interests or hone some interpersonal
skills? How will you keep fit and healthy?
Will you want to do occasional work?
Will you need to build new networks?
These aspects, and more, are answered in
an article that will be of much interest not
only to those within striking distance of
retirement but to those who have some
years to go but need to start planning for
it now.
Management ConundrumThe issue of 7 day working is a topical
one that will be presenting challenges for
many, particularly when there is an
expectation that longer working hours
should be provided without additional
investment. The Management Conundrum,
which explores some thoughts about
how to handle such a situation, will prove
helpful to those in similar situations.
Face2FaceThis describes the role and duties of a
Home Oxygen Service Review Pharmacist.
Is that a role that would be helpful in your
organisation?
Leadership sectionSomeone once said to me “Show me
someone who has never failed and I’ll
show you someone who has never
achieved anything”. It’s a fact of life that
failure will happen at some point –
particularly for those who are developing
and ‘pushing the boat out’. How, then,
should you deal with failure or prevent a
fear of failure from becoming
overwhelming in the first place? The
article in this section will tell you!
EDITORIAL
Journal of Pharmacy Management Volume 33 Issue 3 July 2017
www.pharman.co.uk
75
ADVANCE NOTICE
Autumn series of Pharmacy Management Academy Meetings
Make sure you save the date in your diary for your nearest meeting!
Further details and the topic will follow on the Pharmacy Management website atwww.pharman.co.uk .
Thursday 5th October North London
Thursday 12th October Cardiff
Thursday 19th October Manchester
Wednesday 1st November Stirling
Tuesday 7th November Gateshead
Thursday 16th November Birmingham
Tuesday 28th November Gatwick
Wednesday 29th November Leicester
Tuesday 5th December Bristol
Thursday 7th December South London
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Journal of Pharmacy Management Volume 33 Issue 3 July 201776
WOULD YOU LIKE TO PUBLISHYOUR WORK IN THE JoPM?
The JoPM aims to disseminate good practice about service developments andprocesses involved in the management of medicines to senior pharmacists
in primary and secondary care.
Guidance for authors is available at:https://www.pharman.co.uk/uploads/imagelib/pdfs/PM%20Journals%20Guidance_for_Authors.pdf .
All material should be sent electronically to the Editor-in-Chief (alex.bower@pharman.co.uk).
Journal of Pharmacy Management
Journal of Medicines Optimisation
Journal of Pharmacy Management Volume 33 Issue 3 July 2017
www.pharman.co.uk
77
BEST PRACTICE IN PHARMACY MANAGEMENT
Impact Of An Integrated Medicines Management Service(IMMS) On Preventable Medicines-related Readmission To Hospital: A Pilot Parallel Cohort Study Professor Nina Barnett,1 Krupa Dave,2 Devinder Athwal,2 Paresh Parmar,2 Sunaina Kaher,2 Christine Ward.2
1 Consultant Pharmacist, Care of Older People, Northwick Park Hospital, London North West Healthcare NHS
Trust & NHS Specialist Pharmacy Service; Honorary Reader, School of Pharmacy, University College London;
Visiting Professor, Institute of Pharmaceutical Science, Kings College, London.
2 London North West Healthcare NHS Trust
Correspondence to: nina.barnett@nhs.net.
Introduction
About £12.5 billion was spent in England
between 2012-2013 due to emergency
admissions.1 This is an important quality
outcome measure2 for hospitals in
England who may compare their
emergency admission with the national
figure, which is 5.3% for emergency
admissions (2012/2013). In addition,
hospitals are liable for penalty payments
when patients are readmitted as an
emergency within 30 days of being
discharged so local readmission rates are
also important. Data from the local Trust
indicates a readmission rate of 6.4%.3
Approximately 10% of all hospital
admissions and readmissions can be linked
to medication with up to half being
considered preventable.4,5 While there are
many reasons for preventable medicines-
related admissions and readmissions,
common causes include non-adherence,
taking specific high risk medicines, poor
communication between care settings at
care transitions and lack of monitoring.6-9
Abstract
Title Impact Of An integrated Medicines Management Service (IMMS)On Preventable Medicines-related Readmission To Hospital:A Pilot Parallel Cohort Study.
Author ListBarnett NL, Dave K, Athwal D, Parmar P, Kaher S, Ward C.
BackgroundMedicines are known to contribute to approximately 10% ofhospital admissions and up to half of these may bepreventable. A service, known as the Integrated MedicinesManagement Service (IMMS), was developed at a largegeneral hospital (A) to identify and manage patients at risk ofpreventable medicines-related readmission (PMRR) in order toreduce the risk of PMRR.
Objectives This study investigates the effect of the pharmacy IMMS atHospital A on the rate of PMRR in comparison to a traditionalUK hospital pharmacy service at Hospital B within in thesame organisation.
Method Hospital A: Between October 2008 - October 2014, 744patients were identified using the PREVENT© tool. IMMSpharmacists managed patients at risk of PMRR throughmedication reconciliation, review, consultation and, whereappropriate, undertook post-discharge follow-up.
Hospital B: From February until October 2014, 92 patientswere identified as at risk of PMRR who were then managed
Abstractwith a traditional pharmacy service.
Results Hospital A: 119/744 patients were readmitted within 30 daysof discharge. 2/119 patients (0.3%) were assessed as havinga PMMR.
Hospital B: Of 92 patients identified 17 (18%) were readmittedwithin 30 days of discharge of whom 4/17 had a PMMR(4.4%). The difference was statistically significant.
Discussion The IMMS pharmacists provided interventions to improvesafety and efficacy of medicines use, identifying and resolvingkey concerns which can lead to medicines-related problemspost discharge. This is supported by published literature.Consultations included using a coaching approach to supportmedicines adherence. Cross-sector, multidisciplinarycommunication with patients, carers and health/social careprofessionals supported safe transfer of care.
Conclusion IMMS statistically reduces the rate of PMRR, representing asaving of £3 for every £1 spent on an IMMS pharmacist. Widerprovision of this service has the potential to improve safetyand reduce cost for the organisation.
Keywords: medicine support, medicine safety, medicinesoptimisation, pharmacy interventions, medicines-relatedreadmissions.
Nina Barnett
Journal of Pharmacy Management Volume 33 Issue 3 July 201778
Figure 1: PREVENT© - current version at the time of publication
PREVENT© CHECKLISTRefer patients with unmanaged complex medicines issues, modifiable through pharmaceutical care.
Patient Name: Name of Referrer:
NHS Number: Designation:
DOB: Contact no:
Address/Ward, Bed no Date of Referral: Site: NPH/ CMH /Ealing /E-CCG
Managed by:
If appropriate For Pharmacy Integrated Care Service (PICS) use only:
Date of Admission: Referral Accepted: Yes
Date of Discharge: No Reason ____________________________________________
Please circle relevant risk factors
Physical impairment
FRailty
adhErence issues/compliance support
cognitiVe impairment
nEwdiagnosis/exacerbation ofdisease
MediciNes relatedadmission/risk from specific medicines
culTural/social
Patient has difficulties with swallowing, impaired dexterity, poor vision, hard of hearing orpoor mobility which will impact on them taking medication.
Patient is identified as frail using validated methods e.g. Clinical Frailty Index (1 = very fit, 2 = well, 3 = managing well, 4 = vulnerable, 5 = mildly frail, 6 = moderately frail, 7 = severely frail, 8 = very severely frail, 9 = terminally ill).
Patient has not been taking their medicines e.g. various dispensing dates on medicines, norecent dispensing of medication, newly started on all medicines or cannot give names ofmedicines they are taking.
Patient has decided to stop taking all or some of their medicines which has led, or will lead,to worsening of their clinical condition.
Refer all new requests for compliance support.
Patient has a temporary or long-term condition which affects their mental capacity to safelytake medicines (including memory loss) e.g. confusion, delirium, dementia.
Admission is related to poor management of medication for a long-term clinical conditionor deterioration of organ system function e.g. renal, cardiac, epilepsy, diabetes.
Previous admission or A&E attendance within 30 days.
Depression, high level of stress, other mental health, alcohol or drug abuse.
Falls - include disease and medication related (exclude mechanical/alcohol related falls).
Patient is taking a high risk medicine: anticoagulants/antiplatelets, insulin/oralhypoglycaemics, NSAIDs, benzodiazepines, antihypertensives, diuretics, beta blockers,opioids, methotrexate, injectable medicines or drugs requiring therapeutic drug monitoringespecially with no monitoring which the patient is unable to manage.
Patient has a complex of medicine regimen, recent stop, start or change in medicines.
Polypharmacy or patient is unable to manage.
Patient cannot manage daily activities independently or has carers to help with dailyactivities but not medicines.
Patient has cultural beliefs around illness and treatment impacting on medication adherence.
Patient has social issues such as no fixed abode, unkempt, etc which impacts on themtaking medication.
Smoker.
Journal of Pharmacy Management Volume 33 Issue 3 July 2017
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79
A local referral tool was created from the
literature and informed by pharmacy
practice, known as the PREVENT© tool (see
Figure 1, current version at the time of
publication. For the version used in the
study, please contact the author). This tool
has been designed and was developed over
time to identify risk factors for preventable
medicine related readmissions (PMRR)4-9
and, while the literature offers a number of
methods to target patients at high risk of
readmission, there is no nationally accepted
or validated method.10,11,12
The literature describes integrated
medicines management (IMM) services in
the USA, Northern Ireland and Sweden
which reduce preventable medicines-
related readmissions.13-16 In 2008, an IMM
service was introduced to Hospital A, a
658 bedded district general hospital with
one whole time equivalent (WTE)
experienced pharmacist (provided by two
half time pharmacists) during weekday
and working hours. The service was
managed and supervised by a Consultant
Pharmacist for Older People and key
components of the service, which has
been described in the literature,17 are
described in Box 1.
Objective
To pilot a comparison of the effect of a
traditional United Kingdom (UK) Clinical
Pharmacy Service with IMMS on reduction
in preventable medicines-related hospital
readmissions within 30 days of the first
discharge across two hospital sites.
Method
In Hospital A (active site, Northwick Park
Hospital), patients meeting the referral
criteria for a PMRR from any ward were
referred to and managed by the IMMS
team using the method outlined in Box 1.
This constituted the active group. Patients
who had risks not modifiable by pharmacy
were referred to the appropriate service.
In Hospital B (control site, Central
Middlesex Hospital), an approximately
200 bedded hospital within the same
Trust without IMMS, patients who met
the PREVENT© criteria for referral were
identified during a specified time period
and managed as per the standard clinical
pharmacy service. This constituted the
control group.
Pharmacy staff involved in the pilot
were trained to use the PREVENT© tool
(both sites).
Data collection
In order to achieve statistical significance
for the comparison, retrospective data
was collected on the 744 patients
referred to IMMS in Hospital A between
October 2008 and October 2014. Full
year data was available from October
2008 - March 2010 but information
technology challenges meant that only
samples of data were available thereafter.
Data was compared with Hospital B
where a statistician was consulted and it
was calculated that 92 patients from
Hospital B were required to compare to
the 744 in Hospital A. The data from
Hospital B was collected between
February and October 2014.
Box 1: Key components of the IMMS
• Medicines reconciliation on admission.
• Medicine optimisation e.g. stopping or starting medicines, titrating medicines to clinically effective doses.
• Patient-centred medicines consultations, including discussion of newly prescribed, stopped and changed medicines.
All members of the team received formal training in health coaching during 2014.
• Full documentation of medicines changes and monitoring required on the discharge notification sent to GPs and/or
pharmacies.
• Medicines-related discharge planning with patients, carers, health and social care teams in primary and secondary
care, including medicines compliance aid assessment where appropriate and medication counselling.
• Pre-discharge referral to primary care health and social care professionals as well as carers where necessary,
including referrals to community pharmacists for the New Medicines Service (NMS) or discharge Medicines Use
Review (MUR) where appropriate.
• Post discharge telephone follow-up with patient and/or carers to support medicines-related care.
“Approximately 10% of all hospital admissions and readmissionscan be linked to medication with up to
half being considered preventable.”
Journal of Pharmacy Management Volume 33 Issue 3 July 201780
Readmission review
Using the Trust Hospital Admissions data,
information on readmissions at 30 days
was obtained for both Hospital A and B
for the periods studied. Data were
reviewed from the electronic discharge
summary for patients readmitted as an
emergency (excluding A&E visits only) by
two IMMS senior member pharmacists
and the reason for readmission was
classified according to clinical, social and
medicines-related. The readmission was
also classified as preventable or non-
preventable. Note that some patients had
more than one classification (see Box 2).
A Consultant Geriatrician, blinded to
the cause of readmission and hospital site,
peer reviewed all readmissions including
cause of readmission as preventable or
non-preventable and clinical, social or
medicine-related classification.
In addition, the Consultant Geriatrician
reviewed a random sample (1 in 10), of all
patients readmitted from both hospitals
and classified according to the same criteria.
A flow chart to illustrate Hospital A
and Hospital B data collection is
presented in Figures 2 and 3.
Statistics
A statistician was engaged to review the
data. Fisher’s exact test was used to
compare the data from Hospital B and
Hospital A as this data was binary and
readmissions were uncommon. In
addition, 95% confidence intervals and
risk ratio were calculated for both sites.
Box 2: Readmission classification examples and details for preventable medicines-related readmissions
Readmission classification
Readmissions can either be preventable (e.g. patient not taking their regular medicines as they are unable to obtain them) or
non-preventable (e.g. patient had a new diagnosis of depression).
The preventable readmission can be modifiable (e.g. arrange repeat dispensing and delivery of medicines through pharmacy
intervention) or unmodifiable (e.g. patient is homeless). While the IMMS team can contribute to reducing a preventable
medicines-related readmission through pharmacy interventions, other readmissions can only be influenced where there is a
medicines-related aspect to that readmission.
Readmissions can be classified according to clinical, medicines-related or social reasons. Clinical reasons may include patients who
are readmitted due to an exacerbation of a long term medical condition such as Parkinson’s disease, diabetes, heart failure, asthma
and chronic obstructive pulmonary disease, as well as chronic alcohol use and recurrent falls. Social readmission relates to, for
example, patients who have no fixed abode or GP, show signs of self-neglect, social isolation, housebound and patients unable to
manage tasks of daily living independently. These patients may require support with daily tasks through carers (informal or formal.
Medicines-related reasons include patients who have poor adherence and those prescribed a high risk medication but due to a
physical or cognitive impairment may not be able to take their medication safely. There are many medicines that can increase the
risk of a readmission if not taken as prescribed; examples include insulin, warfarin, antiplatelets, diuretics, oral hypoglycaemics,
antihypertensives and opiates. Poor communication on medicine changes between care settings may also lead to a readmission.9
Preventable medicines-related readmission data from Hospital A and Hospital B
• Patient was readmitted one day following discharge with diarrhoea secondary to laxatives use that were not reviewed on the
previous admission (Hospital B).
• Patient was readmitted with unresolved vomiting secondary to use of anti-tuberculosis medication (Hospital B).
• Patient with dementia readmitted with seizures secondary to non-compliance with anti-epileptic medication as patient had
carers but they would not support with medication unless in a compliance aid (Hospital B).
• Patient on warfarin for deep vein thrombosis (DVT), insulin and oral anti-diabetic medicines for diabetes was readmitted with
reduced mobility and treatment of DVT. On his readmission it was noted that he was non-compliant with medication due to
longstanding cognitive impairment, therefore his warfarin was stopped and arrangements were made to start LMWH for
treatment and for support with his other medicines, including district nurses to administer insulin ( Hospital B).
• Patient medication changes were not actioned by GP on discharge and patient readmitted as ran out of medication following
discharge (Hospital A).
• Patient was started on dexamethasone prior to admission for a tumour. However, the patient was intentionally non-complaint
due to fear of adverse effects from steroid therapy. Readmitted due to exacerbation of clinical condition that could have been
prevented with dexamethasone. Potential for prevention of readmission if the patient’s health beliefs had been explored more
during admission (Hospital A).
Journal of Pharmacy Management Volume 33 Issue 3 July 2017
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81
92 patients identified at risk ofpreventable medicines-related
readmission at Hospital B(One in ten patients were
peer reviewed)
17 patients readmitted within30 days of discharge
NB: patients may have hadmore than one reason
for readmission
5 Medicines-relatedAdmissions
12 Non-PreventableClinical Admissions
3 Non-Preventable Social Admissions
4 preventablemedicines-related admissions
1 non-preventablemedicines-related admission
Note: Some patients have more than one reason for readmission so total readmission reasons exceed total Figure 3: Flow chart for patient numbers at Hospital B
119 patients readmitted within30 days of discharge
NB: patients may have hadmore than one reason
for readmission
744 patients identified atrisk of preventable medicines-related
readmission at Hospital A
13 Social Admissions
1preventable
12 non-preventable
116 Clinical Admissions
1preventable
115 non-preventable
10 Medicines-related Admissions
2preventable
8 non-preventable
Note: Some patients have more than one reason for readmission so total readmission reasons exceed total readmission. The majority of all cause readmissions identified were non-preventable.
Figure 2: Flow chart for patient numbers at Hospital A
Journal of Pharmacy Management Volume 33 Issue 3 July 201782
Governance
The study was assessed by the Trust
Governance Committee and was deemed
to be a service improvement and did not
need ethical approval.
Results
ReadmissionsThe IMM team saw 744 patients for which
data was available in the pilot study period
of whom 119 (16%) were re-admitted to
Hospital A within 30 days of discharge,
with two (0.3%) of the readmissions being
identified as a PMRR (Chart 1).
92 patients were identified at Hospital
B of which 17 (18%) were re-admitted
within 30 days of discharge, 4 (4.4%) of
these patients were re-admitted for a
PMRR (Chart 2).
The difference between PMRR rates at
the two sites was statistically significant
(P<0.002, Fisher’s exact test) with a risk
ratio of 16.2 and 95% confidence
intervals of 3.0, 87.1.
ReferralsAt Hospital A, the most common reason
for referral to the service was to assess the
need for commencing a compliance aid.
At Hospital B, however, the main reason
for referral was cognitive impairment, non-
adherence to medication and risk from
specific medicines followed by compliance
aid support (Chart 3).
Interventions
Most interventions identified ongoing
medication problems for patients,
interventions made during the inpatient
stay and follow-up recommendations
post discharge (including community
pharmacist). Specifically, more than three
quarters of interventions (84%) involved
patient consultations. Half (50%)
included discussion with the patient’s
community pharmacist and one third
(32%) with their GP surgery (Chart 4).
CostAn IMMS patient episode was estimated at
4 hours per patient during the pilot. This
equates to 1 WTE (given 46 weeks/year
with 6 weeks leave) reviewing 460 patients
each year. Data from this pilot suggests
Preventable
Non-Preventable
140
120
100
80
60
40
20
01 1 2
115
128
Clinical Social Medical
Reason for Readmission
Nu
mb
er o
f Pa
tien
ts
Note: There may have been more than one reason for readmission. The majority of all cause readmissions identified were non-preventable.
Chart 1: Bar Chart showing the reasons for readmission within 30 days of dischargefor 119 patients at the Hospital A site.
Journal of Pharmacy Management Volume 33 Issue 3 July 2017
www.pharman.co.uk
83
that, if 460 patients are seen, only one
patient would be re-admitted with a PMRR
compared to 20 when the service was not
provided. This suggests that 19 PMMRs
per year per pharmacist per site could be
avoided if the service had been provided
in Hospital B. Provision of the service at
Hospital A cost £49,974 per annum.
With over 95% of patients seen by
IMM pharmacists being older people, the
length of stay was estimated from Care
of Older People wards. This is nineteen
days at a cost of £444 per day (non-
elective emergency admission) and the
estimate of cost for one PMRR is £444 x
19 days = £8436 which, for 19 patients,
is £160,284. With a pharmacist cost of
£49,794, there is an opportunity cost of
£110,490. Our pilot suggests this equates
to a saving of over £3 for every £1 spent
on pharmacist or an return on investment
(ROI) of >2.
Discussion
With approximately 10% of hospital
admissions being medicines-related and
half being considered to be preventable,
our study showed that at Hospital A had
less readmissions than expected. From
local readmission data we would expect
6.3% of patients to be readmitted within
30 days. For the number of patients seen
in the study, this means 47 patients would
be readmitted with a PMRR at Hospital A.
By providing IMMS, this number was
reduced to 2. In comparison to Hospital B,
where 4 of 92 (4.4%) patients were
readmitted, there were only 2 of 744
(0.3%) readmissions, the difference being
statistically significant (p<0.002).
Scullin et al demonstrated that one
readmission was prevented for every 12
patients receiving an IMMS.14 Similar
services in other countries have
demonstrated benefits.15,16 The pilot study
data from Hospital A alone have been
published17 and the full data given here
concurs with findings from other centres.
While it is recognised that the data
presented here are pilot results, these
data suggest that provision of the service
could benefit the health care economy
with a return of over £3 per £1 invested.
Preventable
Non-Preventable
14
12
10
8
6
4
2
00 0
4
12
3
1
Clinical Social Medical
Reason for Readmission
Nu
mb
er o
f Pa
tien
ts
Note: There may have been more than one reason for readmission. The majority of all cause readmissions identified were non-preventable.
Chart 2: Bar Chart showing the reasons for readmission within 30 days of discharge for 17 patients at the Hospital B site.
Journal of Pharmacy Management Volume 33 Issue 3 July 201784 Chart 4: Interventions by IMMS pharmacy staff at Hospital A.
90
80
70
60
50
40
30
20
10
0
Perc
enta
ge
of
pat
ien
ts
84
Patie
nt consu
ltatio
n
22
32
50
2319
45
5
53
36 36
24
10 71
53
Med
icins O
ptimisa
tion
Discussi
on: GP
Discussi
on: Com
m Ph
arm
Discussi
on: Socia
l Car
e
Discussi
on: Dist
rict n
urse
Discussi
on: Hosp
ital c
linici
an
Arrange N
MS/M
UR
Info
rmal
care
support
Form
al ca
re su
pport
Med
icaca
tion co
mplia
nce ai
d
Med
icines
rem
inder
char
t
Post
disch d
iscussi
on care
r
Post
disch ca
ll to p
t.
Sign Po
sting
Dischar
ge note
annota
ted
Chart 4: Interventions by IMMS pharmacy staff at Hospital A.
30
25
20
15
10
5
0
Nu
mb
er o
f Pa
tien
ts
Hospital A
Hospital B
1210.4
5
10.8
17
19.7
26
13
21
17.8 17.815
3
10
Socia
l
Phys
ical
Cognitive
Impair
men
t
Med
icines
Com
pliance
aid
Adheran
ce is
sues
Spec
ific m
edici
nes ri
sk
New co
ndition/Ex
erbat
ion
Reasons for referral
Note: some patients had more than one reason for referral.
Chart 3: A bar chart to compare the reason for referrals via the PREVENT© checklist to the IMMS team between Hospital A and Hospital B site.
Journal of Pharmacy Management Volume 33 Issue 3 July 2017
www.pharman.co.uk
85
This finding is in line, but with a lower
ROI, with data reported from other IMMS
sites where savings calculated including
opportunity costs suggested a return of
between £5 and £8 per every £1 spent on
service provision.18 Reasons may be that
other studies included costs associated
with admission and outside hospital costs
rather than cost of staff alone and
assessing readmissions over a longer time
frame.
Other benefits suggested by this
pilot include support for medicines
optimisation, including reducing
inappropriate polypharmacy and
improving transfer of care, which have
been highlighted nationally.19 The IMMS
team at Hospital A provided patient-
centred consultations using a coaching
approach and following NICE
recommendations7 prior to discharge, and
at discharge, documented medication
changes to improve safety at transfer of
care as part of medicines optimisation.20
This included discussion of perceptual and
practical issues around medicine taking as
well as education of patient and/or carer
regarding indications, adverse effects,
follow-up and ongoing monitoring.
Many of the interventions included
facilitating information transfer between
the patient, community pharmacist and
GP. Studies have shown that risk around
medicines can be minimised with good
communication8,9,21 and referral to
community pharmacists can reduce
length of stay by 50%.22 The IMM service
commonly liaised with social care as
patients needing help with activities of
daily living may also require assistance
with medicines.9,23,24,25
It is interesting to note that 36% of
patients had medication compliance aids
(MCAs) initiated at Hospital A whereas
Hospital B does not provide a hospital-
based compliance aid filling service for new
patients. This is likely to account for the
difference in interventions in this category.
However, interventions including MCAs at
Hospital A often resulted in alternative
medicines support being put into place.
This has been described recently in a study
of a hospital and primary care service
published by Lai et al24 who identify that
patients referred for compliance aids often
need individualised medicines support.
In terms of cross-sector working, there
are a number of published studies which
describe post discharge follow-up and its
contribution to improving care through
patient satisfaction24,26 as well as
reducing hospital utilisation and
admission.27-30 In a review of drug-related
problems in older people after hospital
discharge, the most effective
interventions in reducing drug-related
problems were considered as including
both discharge planning and home
“In a review of drug-related problems in older people after hospitaldischarge, the most effective interventions in reducingdrug-related problems were considered as including
both discharge planning and home follow-up.”
iStock.com/jorgeantonio
Inappropriate polypharmacy needs to be reduced
Journal of Pharmacy Management Volume 33 Issue 3 July 201786
follow-up. The IMM team worked across
the interface, undertaking agreed post
discharge telephone calls to patients/
carers to support post discharge
medicines management integrated with
the multidisciplinary health and social
care team. Studies have shown that
post discharge follow-up helps promote
patient satisfaction24,26 and reduce
admission and hospital utilisation.27-30 In
this study the community pharmacist was
contacted to support adherence and
provide community pharmacy medication
services as appropriate.
As stated, studies suggest that causes
of readmission are multi-factorial and
that multidisciplinary team working
supports reducing overall readmissions to
hospital. A number of IMM services
similar to this pilot have also
demonstrated benefits of this type of
support,14,15,16,24,25 which begs the question
regarding rollout of IMM services. In
order to do this, a collection of
prospective data will be needed,
preferably including a number of sites
in primary and secondary care. An
exploration of other measurable outcomes,
which could include patient satisfaction,
will also be needed.
Bias and limitations
This study is a pilot to explore what is
possible in terms of data collection within
a hospital Trust. Several limitations to this
study are acknowledged including:
● lack of published data to guide the
study around methods of reducing
PMMRs
● discontinuous data collection from
Hospital A
● convenience sampling over a
different time period in Hospital B
● lack of detailed demographic data
● unmatched cohorts
● lack of standardisation of service
across the time period due to
evolving practice. Standard procedure
and forms minimised variation but
individualised care possibly limits
standardisation.
● readmissions collected over 30 days (a
longer period may have revealed more)
● PREVENT© checklist not formally
validated (although developed from a
literature review, has been peer
reviewed and aligns with other UK
tools).
While some pharmacists at Hospital B
knew about IMMS, Hospital B did not
provide the opportunity to undertake IMMS.
When Hospital B pharmacists identified
‘at risk’ patients and then managed them
as per usual ward management, they also
had an ethical duty to ensure that any
medication issues that they identified
were highlighted or addressed during the
admission if possible or on the electronic
discharge note so it could be actioned in
the next care setting or by the primary
physician. This may have led to GPs/social
care, etc acting upon issues highlighted
by the pharmacists that would not
previously have been identified and thus
prevented a medicines-related admission.
A different culture and availability of
pharmacy services at Hospital B
compared to Hospital A may have led to
different actions for the same problem.
Ongoing developments
The team has been renamed ‘Pharmacy
Integrated Care Service’ (PICS) to reflect
that services from the other sites will be
merged and that work will be across
disciplines and sectors of care.
The following is in progress:
● The service on all three sites is in the
process of being merged, with staff
in place on each site to undertake
identification and management of
patients in the risk group in
secondary care and, on one site,
primary care too.
● The data collection tool is being
updated to improve robustness of
data gathering and to add exclusion
criteria for the service to PREVENT© to
ensure that services are being
appropriately prioritised.
● PICS was launched on 6th June 2017.
Conclusion
Some medicines-related admissions and
readmissions to hospital are avoidable.
Reducing readmissions is better for
patients and for the health system. This
pilot study focussed on the provision of an
IMMS to deliver holistic pharmaceutical
care, identifying and managing high-risk
patients to reduce preventable medicines-
related readmissions. Results of this work
suggest that an IMMS team is a cost-
effective method to reduce PMMR.
Further work, such as a case control
prospective study, is required to confirm
or refute these findings.
Declaration of interests
The authors have nothing to disclose.
Acknowledgements
We would like thank Dr Joseph Devine for
peer reviewing the cases, Mr Paul Bassett
for statistical analysis and Professor
Michael Scott for his comments on the
paper.
“. . . an IMMS team is a cost-effective method to reducepreventable medicines-related readmissions.”
Journal of Pharmacy Management Volume 33 Issue 3 July 2017
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87
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5. Leendertse AJ, Visser D, Egberts ACG, van den Bemt PMLA. The relationshipbetween study characteristics and the prevalence of medication-relatedhospitalizations: a literature review and novel analysis. Drug Safety. 2010;33(3):233-244. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20158287[Accessed 14 November 2016]
6. Howard RL, Avery AJ, Slavenburg S, Royal S, Pipe G, Lucassen P, PirmohamedM. Which drugs cause preventable admissions to hospital? A systematicreview. British Journal of Pharmacology. 2007;63(2):136-147. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2000562/ [Accessed 14November 2016]
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8. Witherington EMA, Pirzada O, Avery AJ. Communication gaps andreadmissions to hospital for patients aged 75 years and older: observationalstudy. QualitySafety Health Care. 2008;17:71–5. Available from:https://www.ncbi.nlm.nih.gov/pubmed/18245223 [Accessed 14 November2016]
9. Royal Pharmaceutical Society. Keeping patients safe when they transferbetween care providers – getting the medicines right. 2013. Available at:http://www.rpharms.com/previous-projects/getting-the-medicines-right.asp? [Accessed 14 November 2016]
10. Morrissey EFR, McElnay JC, Scott M, McConnell BJ. Influence of Drugs,Demographics and Medical History on Hospital Readmission of ElderlyPatients. Clin Drug Invest. 2003;23(2). Available from:http://link.springer.com/article/10.2165/00044011-200323020-00005[Accessed 14 November 2016]
11. El Hajji FW, Scullin C, Scott MG, McElnay JC. Enhanced clinical pharmacyservice targeting tools: risk-predictive algorithms. J Eval Clin Pract.2015;Apr;21(2):187-97. doi: 10.1111/jep.12276. Epub 2014 Dec 15.Available from: https://www.ncbi.nlm.nih.gov/pubmed/25496483[Accessed 14 November 2016]
12. Barnett N, Athwal D and Rosenbloom K. Medicines-related admissions: Youcan identify patients to stop that happening. The Pharmaceutical Journal. 1April 2011. Available at: http://www.pharmaceutical-journal.com/learning/learning-article/medicines-related-admissions-you-can-identify-patients-to-stop-that-happening/11073473.article?adfesuccess=1[Accessed 14 November 2016]
13. Schnipper JL1, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E,Kachalia A, Horng M, Roy CL, McKean SC, Bates DW. Role of pharmacistcounseling in preventing adverse drug events after hospitalization. ArchIntern Med. 2006 Mar 13;166(5):565-71. Available from:https://www.ncbi.nlm.nih.gov/pubmed/16534045 [Accessed 14 November2016]
14. Scullin C, Scott MG, Hogg A, McElnay JC. An innovative approach tointegrated medicines management. J Eval Clin Pract 2007 Oct;13(5):781-8.Available from: https://www.ncbi.nlm.nih.gov/pubmed/17824872[Accessed 14 November 2016]
15. Gillespie U, Alassaad A, Henrohn D, Garmo H, Hammarlund-Udenaes M, TossH, Kettis-Lindblad A, Melhus H, Mörlin C. A comprehensive pharmacistintervention to reduce morbidity in patients 80 years or older: a randomizedcontrolled trial. Arch Intern Med. 2009 May 11;169(9):894-900. doi:10.1001/archinternmed.2009.71. Available from:https://www.ncbi.nlm.nih.gov/pubmed/19433702 [Accessed 14 November2016]
16. Hellström LM1, Bondesson A, Höglund P, Midlöv P, Holmdahl L, Rickhag E,Eriksson T Impact of the Lund Integrated Medicines Management (LIMM)model on medication appropriateness and drug-related hospital revisits. .Eur JClin Pharmacol. 2011 Jul;67(7):741-52. doi: 10.1007/s00228-010-0982-3.Epub 2011 Feb 12. Available from:https://www.ncbi.nlm.nih.gov/pubmed/21318595 [Accessed 14 November2016]
17. Barnett NL, Dave K. Athwal D, Parmar P, Kaher S, and Ward C. Impact of anintegrated medicines management (IMM) service on preventable medicines-related readmission (PMRR) to hospital: A descriptive study. European Journalof Hospital Pharmacy. Available from:http://ejhp.bmj.com/content/early/2016/11/01/ejhpharm-2016-000984[Accessed 14 November 2016]
18. Scott MG, Scullin C, Hogg A, Fleming GF, McElnay JC. Integrated medicinesmanagement to medicines optimisation in Northern Ireland (2000–2014): areview. Eur J Hosp Pharm 2015;22:222-228. Available from:http://ejhp.bmj.com/content/early/2015/04/13/ejhpharm-2014-000512[Accessed 14 November 2016]
19. Royal Pharmaceutical Society. Medicines Optimisation: Helping patients tomake the most of medicines. 2013.
20. Garcia-Caballos M, Ramos-Diaz F, Jimenez-Moleon F, Bueno-Cavanillas A.Drug-related problems in older people after hospital discharge andinterventions to reduce them. Age and Ageing 2010; 39:430–438. Availableat: http://ageing.oxfordjournals.org/content/39/4/430.1.abstract[Accessed 14 November 2016]
21. National Institute for Health and Care Excellence. NICE pathways MedicinesOptimisation. Available at:http://pathways.nice.org.uk/pathways/medicines-optimisation [Accessed14 November 2016]
22. Personal communication, Rachel Howard. Isle of Wight Medicinesoptimisation in vulnerable patients project, Jan 2015.
23. Moving patients,Moving Medicines, Moving Safely. Guidance on Dischargeand Transfer Planning. 2005. Available at: http://psnc.org.uk/wp-content/uploads/2013/07/Moving20Medicines20new1.pdf [Accessed 14November 2016]
24. Lai K, Howes K, Butterworth C, Salter M. Lewisham Integrated MedicinesOptimisation Service: delivering a system-wide coordinated care model tosupport patients in the management of medicines to retain independence intheir own home. Eur J Hosp Pharm 2015;22:98-101. Available from:http://ejhp.bmj.com/content/early/2014/11/03/ejhpharm-2014-000565[Accessed 14 November 2016]
25. Blagburn J, Kelly-Fatemi B, Akhter N, Husband A. Person-centredpharmaceutical care reduces emergency readmissions. European Journal ofHospital Pharmacy August 2015. Available at:http://ejhp.bmj.com/content/early/2015/10/01/ejhpharm-2015-000736
[Accessed 14 November 2016]
26. Dudas V, Bookwalter T, Kerr KM, Pantilat SZ. The impact of follow uptelephone calls to patients after hospitalization. The American journal ofmedicines 2001;111(9B)26s-30s. Available from:https://www.ncbi.nlm.nih.gov/pubmed/11790365 [Accessed 14 November2016]
27. Wright PN, Tan G, Iliffe S, Lee D. The impact of a new emergency admissionavoidance system for older people on length of stay and same-daydischarges. Age Ageing. 2014 Jan;43(1):116-21. Available from:https://www.ncbi.nlm.nih.gov/pubmed/23907007 [Accessed 14 November2016]
28. Talsma J. Post-discharge pharmacist follow-up as important as pre-dischargemed review. April 28, 2014. Available at:http://formularyjournal.modernmedicine.com/formulary-journal/content/tags/american-pharmacists-association/post-discharge-pharmacist-follow-imp?page=full [Accessed 14 November 2016]
29. Jack BW, Chetty VK, Anthony D, Greenwald JL et al. A ReengineeredHospital Discharge Program to Decrease Rehospitalization. A RandomizedTrial. Ann Intern Med. 2009 Feb 3;150(3):178–187. Available from:https://www.ncbi.nlm.nih.gov/pubmed/19189907 [Accessed 14 November2016]
30. Novak CJ, Hastanan S, Moradi M, Terry DF. Reducing unnecessary hospitalreadmissions: the pharmacist's role in care transitions. Consult Pharm. 2012Mar;27(3):174-9. Available from:https://www.ncbi.nlm.nih.gov/pubmed/22421517 [Accessed 14 November2016]
Journal of Pharmacy Management Volume 33 Issue 3 July 201788
Pharmacy in Practice
Pharmacy in Practice is an online publication for pharmacists. The ultimate aim is to provide
information, advice and insights that will improve the practice of pharmacy.
Unusually in today’s pharmacy press, Pharmacy in Practice is edited by practising pharmacists
Johnathan Laird and Ross Ferguson, who are based in Scotland and between them have decades
of experience in pharmacy and publishing.
Moreover, while site content is useful for pharmacists throughout the UK and beyond, Pharmacy
in Practice only focusses on pharmacy news in Scotland, as despite the significant changes in
pharmacy compared to the rest of the UK, it is largely ignored by the pharmacy press. As an
online publication, we are responsive, relevant and reliable.
Pharmacy in Practice provides a collaborative platform for pharmacists to share their knowledge,
voice an opinion and inform their colleagues. Uniquely, we encourage our audience to be part of
the site through an open invitation to submit articles, and we engage daily with them on social
media and in person at events and conferences.
Our weekly CPD quizzes are very popular, as is our weekly dilemma which encourages reflection
on practice when faced with a difficult situation. Our weekly e-mail digest keeps people up to
date with the latest content.
We are delighted to form a professional partnership with Pharmacy Management as our ethos is
the same: to create confident clinical pharmacy professionals that can positively contribute to
improving the health of the nation.
We are incredibly excited about the future and have some great joint plans to support
pharmacists in their work and careers and to celebrate and promote their successes. We want you
to be part of that journey.
Journal of Pharmacy Management Volume 33 Issue 3 July 2017
www.pharman.co.uk
89
We are delighted to announce that Pharmacy in Practice has teamed up with Pharmacy Management in a
professional partnership, with the aim of creating, supporting and delivering a number of pharmacy
projects that will benefit pharmacists and their teams.
As the official media partner for Pharmacy Management in Scotland, we are proud to be supporting PM
events this year, including the:
• Pharmacy Management Academy on April 26.
• Clinical Leadership in Pharmacy – Certificates Award Ceremony in Edinburgh on June 8 (Certificates
to be presented by Scotland’s Chief Pharmaceutical Officer, Professor Rose Marie Parr).
• Pharmacy Management National forum for Scotland on August 30, in Dunblane.
• Pharmacy Management Academy – Autumn Series.
Pharmacy in Practice’s Ross Ferguson said: “We have the same ethos: to help create confident clinical
pharmacy professionals that can positively contribute to improving the health of the nation.
Ted and his team have a range of skills and experience that fit nicely with ours and we look forward to
working with them on a number of projects.
We are incredibly excited about the future for the site and this collaboration, and have some great joint
plans to support pharmacists in their work and careers as well as to celebrate and promote their successes.”
Johnathan Laird said: "This professional partnership is something we are extremely proud of at Pharmacy in
Practice. We have many shared values so it feels like a perfect fit.
Like Pharmacy Management we aim to use the partnership to help pharmacists increase their competence,
but possibly as important to us is to help pharmacists increase their confidence too.
We have exciting plans and very much look forward to the journey together."
Ted Butler, Chairman of Pharmacy Management, said: “Scotland has long been a key focus for Pharmacy
Management and we introduced our ground breaking programme Clinical Leadership in Pharmacy there
before going to other countries in the UK.
We have some exciting plans for the future to support the profession and believe that Pharmacy in Practice
is the ideal partner
Journal of Pharmacy Management Volume 33 Issue 3 July 201790
Competency-Based Learning Needs Analysis Of PharmacistsAt Western Health And Social Care TrustKathryn S. King, Teacher Practitioner Pharmacist, Altnagelvin Hospital, Londonderry and School of
Pharmacy, Queen’s University, Belfast; Dr. Alison J. Gifford, Postgraduate Programme Manager,
School of Pharmacy, Keele University.
Correspondence to: kathryn.king@westerntrust.hscni.net.
Abstract
Title Competency-Based Learning Needs Analysis Of PharmacistsAt Western Health And Social Care Trust.
Author ListKing KS, Gifford AJ.
SummaryThis project aimed to identify the learning needs ofpharmacists employed within the Western Health and SocialCare Trust through learning needs analysis (LNA) to informtraining decisions. An evidence-based, contemporary,competency model approach to LNA was selected for use.Mixed methods were used with an online survey as theprimary, quantitative method and face-to-face, semi-structured interviews as the secondary, supporting method.Quantitative data was processed using descriptive statistical
Abstractanalysis and the interview data using thematic analysis. Theresponse rate to the questionnaire was 62 percent and all fiveinvited senior pharmacy managers (SPMs) agreed toparticipate in the interviews. The results showed thatpharmacists need to improve their personal effectiveness anddevelop their emotional intelligence. Proactive communicationand networking must be encouraged using formal methods.Training on preparing workshops and educational materialsshould be provided and mentoring should be more widelyestablished. Methods discussed to promote managementand leadership skills include learning from role models,through delegation and by managing projects.
Keywords: learning needs, LNA, competency, survey,interview.
Kathryn S. King
Introduction
An important method of establishing the
learning and development needs of
healthcare staff is through learning needs
analysis (LNA). Generally, a learning need
exists when there is a gap between what
is required of a member of staff to
perform their duties competently and
what they know and do.1 LNA will
identify the new knowledge, skills and
behaviours required to close this gap.
In 2015, senior managers within the
Western Health and Social Care Trust
(WHSCT) pharmacy department approved
a strategy for pharmacy staffs’ learning,
education and development (LED),
informed by a regional review of
development needs,2 observations,
workshops, and benchmarking. LNA was
proposed at this time to help identify
prevalent and appropriate learning and
development needs. Identification of the
same learning needs by a number of
individual pharmacists would facilitate a
departmental LNA3 and could inform a
LED action plan. The goal was to have a
workforce that has the right skills,
behaviours and training to support the
delivery of excellent healthcare and
health improvement.4
Literature review
A published search of the nursing and
healthcare literature between 1985 and
2003 identified 266 papers concerned
with LNA.5 The authors note that most of
these consist of ‘recipe book’ accounts of
how to undertake LNA. We searched the
electronic databases ProQuest and
EBSCO, and individual journals (pharmacy,
medical, nursing and health education)
for peer-reviewed publications in the
English language from 2005-2015 using
keywords ‘learning needs’, ‘learning
needs analysis’ and ‘training needs
analysis’. These searches produced 228
papers and, of these, 23 papers reported
identified learning needs.
Six papers explored learning and
development needs using competency
frameworks as the method, or the basis
to design the method, of data collection.
Researchers employed varying approaches
and methods to LNA in healthcare: seven
papers6-12 used qualitative methodology
to identify learning needs including
interviews, focus groups and participant
observation. Eleven papers13-23 used
quantitative methodology issuing either
postal or internet survey questionnaires
and five studies24-28 used mixed qualitative
and quantitative methods. Where
competency models were not employed,
authors designed questionnaires and
interview schedules using various methods
(for example, focus group findings,
literature reviews, reviews of existing
courses, theories and surveys), or used a
validated instrument appropriate to the
topic. These published studies tended to
focus on learning needs within a specific
subject, often seeking to gauge needs
across different professions or different
job roles in the same profession.
Overlapping learning needs within topics
and professions in these studies include
research activity, legal issues, clinical
practice and skills, communication/
interpersonal skills, health promotion,
evidence-based medicine, teaching and
learning from others.
Justification of approach
We opted for an evidence-based,
competency model approach for our LNA.
Competency models allow for a highly
targeted LNA as their design reflects the
knowledge, skills, behaviour and attributes
required by staff working at different levels
of practice. An NHS wide competency
framework, the NHS Knowledge and Skills
Framework (KSF) was introduced in
2004.29 It applies to all staff who are
employed under Agenda for Change (AfC)
terms and conditions, including hospital
pharmacists. Evidence indicates that the
KSF has recently been used, or considered
for use, by healthcare professionals to
conduct learning needs analyses.30-32 The
KSF is also capable of linking with other
nationally developed competencies that
have been externally quality assured and/
or approved.29 Two such pharmacy practice
competency frameworks are available, the
Foundation Pharmacy Framework (FPF)33
and the Advanced Practice Framework
(APF),34 endorsed by the Royal
Pharmaceutical Society (RPS) in Great
Britain through its Faculty.
Within this LNA, where the intention
was to inform training decisions, it was
important to identify other factors,
such as learning methods and learner
characteristics, which may have an impact
on individuals’ commitment to learning
and development.35 We therefore
introduced a career concept model,36,37
Schein’s Career Anchors (Box 1),38 into our
LNA. Schein’s model describes a broad
view of what is important to an individual
by combining talents, motives and values.
Where Schein’s theory has been tested in
pharmacists, career aspirations have been
reported to be influenced by life and age.39
Objectives
• To gather the views of the WHSCT
pharmacists regarding their learning
needs within key dimensions of the
simplified NHS KSF, which have been
mapped to professional competency
frameworks.
“. . . a learning need exists when there is a gap between what is
required of a member of staff to perform their dutiescompetently and what they know and do.”
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A learning needs analysis will identify what needs to be done to ensure staff perform their duties competently
iStock.com/vaeenma
Journal of Pharmacy Management Volume 33 Issue 3 July 201792
• To determine how these pharmacists
would prefer to address their
identified learning needs.
• To ascertain career aspirations and
motivators for these pharmacists.
Method
The primary, quantitative method was
survey research, which facilitated inclusive
and anonymous coverage. Qualitative,
semi-structured interviews with senior
pharmacy managers to whom these
individuals report were used to provide
further insight into their learning needs
from a manager’s perspective and help
formulate a holistic, departmental view of
learning and development needs. The
face-to-face interviews were completed
during August 2015, and the online
questionnaire was launched in September
2015. The survey remained available for
completion for five weeks.
Questionnaire design
Competencies required in key KSF
dimensions (Communication, Personal
and People Development, Health, Safety
and Security (HSS), Service Improvement,
Quality, and Management and Leadership)
were mapped to recognised professional
frameworks (FPF and APF) at the
standards expected for AfC bands 6, 7,
8a/b and 8c/d, and to example job
descriptions to enhance the relevance
and depth of questioning appropriate to
pharmacists. Such mapping is not a new
occurrence having been performed by
other groups for pre-registration
pharmacists,40 for band 6 pharmacists41
and by other professions such as
physiotherapy and psychology.42,43
Survey questions were then
constructed using the mapped
competency model documents. We
designed an online questionnaire using
software powered by SoGoSurvey®
(www.sogosurvey.com). A range of
question types were used in the design
including open-ended questions, lists
from which participants selected
preferred responses, five-point Likert
scales, visual analogue scales and ranking
scales. Questions were also included to
ascertain which methods of learning are
Box 1: Definitions of the eight generally acknowledged Career Anchors
Schein’s Career Anchor
Technical/ Functional
General Managerial
Autonomy/ Independence
Security/ Stability
Entrepreneurial Creativity
Service/ Dedication to a Cause
Pure Challenge
Lifestyle
Definition
Primarily excited by the content of the work itself; prefers advancement only in his/her
technical or functional area of competence; generally disdains and fears general
management as too political.
Primarily excited by the opportunity to analyse and solve problems under conditions
of incomplete information and uncertainty; likes harnessing people together to
achieve common goals; stimulated (rather than exhausted) by crisis situations.
Primarily motivated to seek work situations which are maximally free of organisational
constraints; wants to set own schedule and pace of work; is willing to trade off
opportunities for promotion to have more freedom.
Primarily motivated by job security and long-term attachment to an organisation;
willing to conform and to be fully socialised into an organisation’s values and norms;
tends to dislike travel and relocation.
Primarily motivated by the need to build or create something that is entirely their own
project; easily bored and likes to move from project to project; more interested in
initiating new enterprises than in managing established ones.
Primarily motivated to improve the world in some fashion; wants to align work
activities with personal values about helping society; more concerned with finding
jobs which meet their values than their skills.
Primarily motivated to overcome major obstacles, solve almost unsolvable problems,
or win out over extremely tough opponents; define their careers in terms of daily
combat or competition in which winning is everything; very single minded and
intolerant of those without comparable success.
Primarily motivated to balance career with lifestyle; highly concerned with such issues
as paternity/maternity leave, child care options, etc. Looks for organisations that have
strong pro family values and programmes.
Journal of Pharmacy Management Volume 33 Issue 3 July 2017
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93
preferred by pharmacists and to identify
their Career Anchor.38
We piloted the questionnaire with ten
pharmacists from other Health and Social
Care Trusts in Northern Ireland and one
NHS Trust in England to assess response
burden and identify any components of
the questionnaire that were difficult to
complete. Feedback indicated that the
survey was lengthy and subsequently a
number of questions were removed.
Semi-structured interviewdesign
A semi-structured interview schedule was
developed to facilitate the face-to-face
interviews with individual senior pharmacy
managers (SPMs). Topics were identified a
priori, allowing the mapped competency
model approach to continue in this part of
the LNA. The interviews were held in the
individual SPMs’ office at their convenience.
Each interview was voice-recorded using
the Voice Memos app on iOS.
Ethical approval
The Director for Research and
Development at the WHSCT designated
this project a service evaluation therefore
research governance approval was not
required. The project proposal was
approved by the Keele University School
of Pharmacy Research Ethics and
Governance Committee. All participants
provided overt, informed consent.
Data analysis
Quantitative data from the questionnaire
was entered into SPSS® for descriptive
statistical analysis. Reliability analyses
were performed and Cronbach’s α values
exceeded 0.7 for all subscales within the
questionnaire indicating good internal
consistency. The non-parametric Kruskal-
Wallis test was used to identify the effect
of AfC band on response to some Likert-
scale questions. Thematic analysis was
used to process the qualitative data,
following a six-step process described by
Braun et al (2006).44
Results
Questionnaire results
The survey was issued to 55 pharmacists
and the response rate was 62 percent
(34/55). Respondents were mostly
female (n=29, 85%), accurately reflecting
the female: male ratio of pharmacists in
the department. Other respondents’
demographics are given in Table 1.
Communication
Communication skills most commonly
identified by pharmacists for development
were persuading or influencing, and
negotiating (n=26, 76.5% of cases). Two
further skills, motivating (n=20, 58.8% of
cases) and writing professional
documents (n=19, 55.9% of cases), were
also frequently selected.
Graph 1 is a boxplot showing the
distribution of perceived competence in
building working relationships amongst
respondents.The median (midpoint of the
ratings) for accepting feedback, knowing
when to ask for help, supporting
colleagues, being a role model and
having the respect of others was ‘usually’
with a positive dispersion i.e. the overall
pattern of response was between usually
and consistently. The median for giving
feedback was also ‘usually’ but with a
negative dispersion. There was a high
level of consistency for the statement
around accountability where the median
was ‘consistently’ competent. The range
of views was wide for some statements
as indicated by the long whispers.
Respondents largely felt able to share
and engage their thinking with others but
were less able to manage conflict (n=9,
26.4%), present work or research
externally to the Trust (n=9, 26.4%) or be
assertive (n=16, 47.1%) and were less
aware of others’ team roles (n=27,
79.4%). Band 8 pharmacists (n=22) were
asked additional advanced practice
questions around effective working
relationships. Participants predominantly
disagreed that they network and
influence the service at a national level, or
are a champion for a service or patient
group. They did, however, ‘agree’ that
they approach Trust colleagues from
other professions and people working at
other Trusts to offer support and ideas.
Personal and people development (PPD)
Respondents generally felt able to
consider their own development and
Characteristic n Percentage
Age (years) - -
18 to 24 0 0
25 to 34 13 38.2
35 to 44 15 44.1
45 to 54 6 17.6
55 to 64 0 0
65 or older 0 0
Agenda for Change (AfC) band - -
Band 6 2 5.9
Band 7 10 29.4
Band 8a/b 18 52.9
Band 8c/d 4 11.8
Table 1: Demographics of respondents (N=34)
Journal of Pharmacy Management Volume 33 Issue 3 July 201794
contribute to the development of others.
They reported feeling less able to make
presentations externally to the Trust,
prepare educational materials and
solve problems. Band 8 respondents
indicated that they had learning needs
around managing performance, research
supervision and creating learning
opportunities for others. This group felt
they were consulted externally for advice
within their area of practice although a
wide variety of views was demonstrated.
Professional practice
Figure 1 shows the level of practice at which
respondents felt they were currently
working and the number of pharmacists
selecting this level of practice at each AfC
band. Most participants categorised their
level of practice as commensurate with
their grade. Participants were also asked
to list one way in which they could be
supported at work to develop. Three
themes were uncovered:
• Formal education including managing
budgets, attending courses and
conferences.
• Resources such as protected time for
LED, more staff and improved skill mix.
• Learning from others; for example,
consultant ward rounds, work
shadowing and discussions.
Participants appeared confident in
identifying problems in their area of
practice (Graph 2) but felt less able to
take action based on their own
interpretation of information. The widest
spread was seen with ability to solve
problems, which was affected by AfC
band (H (3) = 13.243, p = .004).
Quality
Pharmacists indicated a high level of
agreement in ‘consistently’ working in a
way that complies with legislation and
Trust policies. The median rating of
competence for managing resources,
supporting colleagues around medicines
governance, implementing guidelines or
policies and contributing to risk
management discussions was also
‘consistently’ but the range of responses
3 4
11
16
Foundation (band 6: n=2,band 7: n=2)
Advanced Stage I (band 7: n=5, band 8a/b: n=8)
Advanced Stage II (band 7: n=3, band 8a/b: n=11, band8c/d n=2)
Fig 1: Level of practice in area of work (N=34)
4
3
2
1I give
feedback tocolleagues
I acceptfeedback from
colleagues
I know whento ask
for help
I am a rolemodel for
others
I identifywhen a
colleagueneeds supportand provide it
I acceptresponsibility
for myown actions
I have therespect of
teams accrossthe department
Vertical axiskey:
1 = rarely
2 = sometimes
3 = usually
4 = consistently
Graph 1: Distribution of perceived competance in building effective relationships
Journal of Pharmacy Management Volume 33 Issue 3 July 2017
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95
was greater. Recording their contributions
and influencing the governance agenda
showed a lower median of ‘usually’.
Service development, management
and leadership
Participants generally felt that they did
contribute to service development. Graph
3 indicates that managing a process of
change and managing performance
were prioritised for development by
participants whereas research methodology
was regarded as the least necessary by
many.
Preferred methods of learning
Graph 4 shows that participants prefer to
learn by attending workshops or seminars,
by doing and in discussion with peers.
Peer review, teaching, research and
mentoring are less favoured methods.
Career values and motivators
As displayed in Graph 5, respondents
selected the Technical/ Functional Career
Anchor most often, indicating that they
are primarily motivated by the content of
the work itself in their careers.
Pharmacists were also asked how they
envisaged their careers would have
progressed five years from now. Five
themes were evidenced:
Graph 3: Dot plot showing how respondents rank skills they need to develop to improve the service (band 7 and 8 pharmacists only)
Graph 2: Dot plot showing how respondents rate their ability for skills required in professional practice
• In the same job but continuing to
develop in that role.
• Achieve enhanced professional
recognition.
• Become an expert practitioner.
• Exert a strategic influence.
• Achieve a degree-credit qualification.
Semi-structured interview findings
All five senior pharmacy managers (SPMs)
agreed to be interviewed. Four major
themes were identified and confirmed
through data analysis.
1) The influence of behaviour on LED
Desirable behaviours included being
passionate, enthusiastic, assertive,
accountable, confident, resilient and
honest. Taking initiative and seizing
opportunities, adopting a questioning
approach, influencing others and
making decisions were also identified.
Commonly discussed was the need for
pharmacists to understand behaviour
better, reflecting on their own
behaviour, and identifying and
supporting the behaviour of others.
SPMs talked about the need for staff to
know others’ strengths and weaknesses
and have patience and tolerance.
Factors that they considered influence
behaviour towards LED include career
commitment and culture.
2) Ability as a primary requisite for LED
SPMs identified key abilities as having
vision, insight, the respect of others
and self-belief. They want pharmacists
to be reflective practitioners, self-
starters, able to hold their own in a
discussion, aware of their own
limitations and able to articulate
Journal of Pharmacy Management Volume 33 Issue 3 July 201796
Graph 5: Histogram showing respondents’ Career Anchors by age
Graph 4: Histogram showing how respondents prefer to learn and develop
Journal of Pharmacy Management Volume 33 Issue 3 July 2017
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97
concerns, and work effectively in a
team. SPMs described the relative
ease of recruiting into posts without
managerial responsibilities but the
difficulty into posts that have.
Methods for providing management
and development opportunities such
as identifying projects and delegating
tasks with managers’ support were
considered.
3) Formal mechanisms as a major
enabler of LED
A significant theme across all KSF
dimensions related to the effectiveness
of formal mechanisms and methods in
achieving objectives. SPMs described
degree-credit qualifications, appraisal and
continuing professional development
(CPD) as drivers for LED. Mentoring
and coaching were frequently alluded
to and peer review, as a development
rather than managerial tool, was
specifically mentioned by some.
Quality improvement methodology
was commonly discussed with the
observation that this has taken root
and projects are helping to develop
staff. The need to create opportunities
for pharmacists to learn from role
models and colleagues in a supportive
way resonated from SPMs. Being
research active, attending conferences
and skill mix review were discussed as
other ways to facilitate LED. Key to
the success of formal mechanisms
around LED was ‘timetabling these in’.
4) Barriers to developing advanced
practitioners
SPMs talked about perceived
communication silos, both within the
pharmacy department and the region
generally. They commented that
pharmacists can lack understanding of
their position and its importance, and
how they portray themselves and
are viewed by others. Certain SPMs
expressed a view that advancing
practice pharmacists were often
developed by other senior healthcare
professionals (such as designated
medical practitioners) rather than by
mastery level pharmacists in certain
practice areas. Time, money,
opportunities and priorities were also
discussed.
Discussion
Identified learning needs
This project has identified key learning
needs of pharmacists employed within the
WHSCT through LNA. Communication
weaknesses relate to individuals’ personal
effectiveness i.e. their ability to persuade,
negotiate, motivate and influence and
their emotional intelligence, which
encompasses handling emotions, self-
management, empathy and social skills.45
Pharmacists need to develop these soft
skills as evidenced by feeling less able to
manage conflict, make presentations or
be assertive and in situations where SPMs
have observed difficulties in human
relations e.g. understanding personalities
and personal styles. Similar learning needs
around interpersonal skills and recognising
the value of team members have
previously been highlighted by Rutter et al
(2012)7 and Hicks et al (2005)18 in their
needs assessment studies of healthcare
practitioners.
The finding that survey participants
considered they usually approach
colleagues offering advice and support or
are themselves approached for their
expertise contrasts with the perception of
SPMs around communication silos, and a
lack of networking and links with the
wider pharmacy community. Austin et al
(2005)9 and Power et al (2011)16 both
describe the important role of peers and
learning from others in their studies of
pharmacists’ attitudes to CPD.
Around personal and people
development, participants favoured
discussions and workshops as methods of
learning but have little experience of
preparing and delivering workshops, or
educational material (lower AfC grades)
that commonly facilitate discussion.
Respondents in a study of pharmacist
preceptors’ learning needs by Troung et
al (2012)25 indicated that being familiar
with small group teaching strategies
would be beneficial in developing others.
The SPMs’ view that mentoring and
coaching could be more widely established
is reflected in the questionnaire results.
Pharmacists are not consistently research
active and interestingly research was
rarely mentioned in the SPM interviews.
A majority of pharmacists felt they
were working at the Advanced Stage II
level of professional practice (defined as
an expert in an area of practice,
experienced; routinely manages complex
situations and a recognised leader locally/
regionally). SPMs would generally
support the view that pharmacists’
adroitness in their pharmacy practice
areas is good but not that abilities are
advanced in all other non-practice areas.
Observed difficulty in transitioning from
band 7 to 8a posts has previously been
reported in the pharmaceutical press.46
The existing momentum surrounding
quality improvement methodology and
its observed impact on developing
pharmacists may explain why quality and
risk management was not identified by
participants as a priority learning need.
SPMs identified managing and leading
“. . . participants favoured discussions and workshopsas methods of learning but have little experienceof preparing and delivering workshops . . .”
Journal of Pharmacy Management Volume 33 Issue 3 July 201798
as a development need and responses to
the questionnaire statements addressing
man management, such as holding others
to account or managing performance,
confirm this development need.
Learning preferences, and career
motivators and values
This study provides evidence of
pharmacists’ preferred methods of
learning to managers commissioning or
selecting, and trainers providing or
facilitating, internal and external education.
Schein’s Technical/Functional Career
Anchor was most frequently selected as
describing what primarily motivates and
inspires pharmacists in their career and
this fits the ‘role culture’ seen within
hospital pharmacy departments.47 The
ability to work accurately has been
described by Ortiz et al (1992)48 as an
important characteristic for pharmacists’
job satisfaction.
Limitations of the study
Limitations to the study relate to its design
and objectivity. The use of competency
frameworks to design a broad LNA for
hospital pharmacists means that it will not
be all things to all people. It was not
possible to drill down to precise learning
needs for specific service areas or subjects.
Survey respondents were asked to self-
select their primary Career Anchor after
reading a brief description of Schein’s
eight Career Anchors. A more robust
measure may have been the career
orientations inventory, a 48-item
questionnaire. One of the researchers
practices alongside all participants in the
study and although steps were taken to
promote reflexivity, a researcher’s
background and prior knowledge will
have had an unavoidable influence.
Conclusion
Pharmacists need to improve their
personal effectiveness and develop their
emotional intelligence to enhance
communication, promote personal and
people development and enable effective
leadership. Proactive communication and
networking must be encouraged using
formal methods and learning shared with
the wider group. Establishing links with
the wider pharmacy community will also
reap benefits to individuals’ personal
development and their management and
leadership skills. Training on preparing
workshops and educational materials
should be provided to all pharmacists to
help facilitate communication and
discussion. Mentoring should be more
widely established to support personal
growth but also to help develop leaders
and ultimately with succession planning.
Methods discussed to promote
management and leadership skills include
learning from role models, through
delegation and by managing projects.
The design of this LNA is transferable to
other pharmacy staff groups using
recognised, practice-based competencies
and/or job descriptions, which can be
mapped to the KSF. The online survey has
already been adapted to gather the views
of the WHSCT pharmacy technicians,
support workers and administrative staff.
Acknowledgements
We would like to acknowledge Ms Anne
Friel, Head of Pharmacy and Medicines
Management at WHSCT for her
encouragement and support.
Declaration of interests
This project was submitted by Mrs King in
partial fulfilment of the requirements for
the degree of Professional MSc at the
School of Pharmacy, Keele University.
iStock/com/Halfpoint iStock.com/vaeenma
Pharmacists need to develop their emotional intelligence
Journal of Pharmacy Management Volume 33 Issue 3 July 2017
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99
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“Pharmacists need to improve their personal effectiveness and develop
their emotional intelligence to enhance communication, promote
personal and people development and enable effective leadership.”
Journal of Pharmacy Management Volume 33 Issue 3 July 2017100
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35. Hanson AL, Bruskiewitz RH and DeMuth JE. Pharmacists’ Perceptions ofFacilitators and Barriers to Lifelong Learning. Am J Pharm Educ 2007;71(4):1-9. Available at:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1959207/pdf/ajpe67.pdf[Accessed: 150317]
36. Derven M. Lessons Learned: Using Competency Models to Target TrainingNeeds. T+D 2008:68-73.
37. London Pharmacy Education and Training (LPET). Inspiration and Motivationand the links with Goal Setting and Personal Development Plans. 2008.Available from: http://www.lpet.nhs.uk [Accessed 301115]
38. Schein EH. Career dynamics: matching individual and organizational needs.London: Addison Wesley; 1978.
39. Rodrigues R and Guest D. Career anchors of professional pharmacists: testingSchein’s theory. Paper presented at 16th Congress of the EuropeanAssociation of Work and Organizational Psychology (EAWOP): Imagine thefuture world: How do we want to work tomorrow?; Germany; 2013 May 22-25.
40. London Pharmacy Education and Training (LPET). Guidance on Producing KSFOutlines for Pre-registration Trainee Pharmacists. 2010. Available from:http://www.lpet.nhs.uk [Accessed 301115]
41. Competency Development & Guideline Group and Cambridge UniversityHospitals NHS Foundation Trust. NHS Trust Band 6 Pharmacists KSF Outline:Operational Guidance on using General Level Framework (editions 1 & 2).2007. Available at:http://www.codeg.org/fileadmin/codeg/pdf/glf/KSF_full_Outline_Band_6_PharmacistswithGLFguidance.pdf [Accessed 301115]
42. Chartered Society of Physiotherapy. The KSF and the CSP Core and ServiceStandards of Physiotherapy Practice: Mapping Links. Available from:http://www.csp.org.uk [Accessed 301115]
43. British Psychological Society. Accreditation through partnership: additionalguidance for clinical psychology training programmes: the NHS Knowledgeand Skills Framework (KSF) and clinical psychology training. Available at:http://www.bps.org.uk/system/files/documents/pact_knowledge_and_skills_framework.pdf [Accessed 301115]
44. Braun V and Clarke V. Using thematic analysis in psychology. Qual ResPsychol 2006;3(2):77-101. Available from:http://eprints.uwe.ac.uk/21155/3/Teaching%20thematic%20analysis%20Research%20Repository%20version.pdf [Accessed 150317]
45. Goleman D. Working with Emotional Intelligence (Kindle edition). New York:Bloomsbury; 1999.
46. How NHS pharmacists can secure a promotion (online). Clinical Pharmacist2014;6(10). Available at:file:///C:/Users/Kathryn/Downloads/pharmaceutical-journal.com-How%20NHS%20pharmacists%20can%20secure%20a%20promotion.pdf[Accessed 150317]
47. Handy C. On the Cultures of Organizations. In: Understanding Organizations.4th ed. London: Penguin Books; 1993:185-200.
48. Ortiz M, Walker W-L and Thomas R. Job Satisfaction Dimensions ofAustralian Community Pharmacists. J Soc Adm Pharm 1992;9(4):149-158.
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CLARION CALLA section for passionate calls for action to further develop the contribution that
pharmacy can make to healthcare
A Retired Industrial Pharmacist’s Tale: What I Wish I Had Known Before Dr Malcolm E Brown, Sociologist and retired pharmacy manager, Beccles, Suffolk, UK.
Correspondence to: mebrown@meb-qp.co.uk.
Abstract
Title A Retired Industrial Pharmacist’sTale: What I Wish I HadKnown Before.
Author ListBrown ME.
SummaryPharmacy managers who plan and act could enhance theiremotional fulfillment and financial security on retirement. Thispaper offers opinion on the next stage of a career i.e.retirement. Sociologists Bourdieu and Weber inform it.Retirement is a rite of passage. You should plan and act for itmeticulously. Consider whether you wish to continueregistration with the General Pharmaceutical Council ormember/fellowship of the Royal Pharmaceutical Society. Evenif you leave both you will retain the mindset of a pharmaceutical
Abstract
scientist. You will no longer have patients whose interests youare bound to serve. However, people will still ask your opinionabout medicines. Practical advice includes attending coursespertinent to your outside interests and honing interpersonalskills. They will remain important. Refine the tale that you tellabout yourself to maximise your self-esteem. Maximise yourNHS pension; public service, compared with private, pensionschemes are a better investment for you. Start to spend onlarge or long term purchases such as a car, house or holidaybefore retirement. Remember the possibility of continuingoccasional practice. Stress should reduce. Work at keepingfit. Develop new social contacts.
Keywords: retirement, sociology, pension, interpersonal skills,keeping fit, Bourdieu, Weber.
Introduction
The common reaction of a Briton to a
colleague who has announced that he
or she is to retire is, “What are you
going to do?”
However, the reaction of the typical
Italian is, “Bravo! Is your hammock
comfortable? Is your cellar sufficient?”
“The relief! It felt as if a great weight
had fallen from my shoulders!” said one
retired pharmacist.
Some pharmacists retire with glee;
others, such as I, did not. I retired with
mixed feelings. Relaxation beckoned.
However, my career had rewarded me
with fulfilment and variety in community,
hospital and industrial pharmacy
including senior management roles.
I am now able to reflect upon what I
lost on retirement and what, with
hindsight, I should have done differently.
Human beings can plan; other animals
cannot. Famously, failure to plan is
planning to fail. It would be presumptuous
to suggest that my take on practice might
influence those still practising. One reason
is that what is ‘right’ for one generation
may be ‘wrong’ for the next. However, my
experience and, maybe, the odd
recommendation might be worth bearing
in mind especially for younger pharmacy
managers. For example, some time after
‘retirement’, I undertook two weeks
consultancy after which I returned to
retirement. “What’s the problem?” gushed
the recruiter levering me from retirement.
“Lots of people pop out of retirement and
pop back. Look at the judges!”
So I experienced the double shock of
again entering and leaving practice. The
Dr Malcolm E Brown
“. . .failure to plan is planning to fail.”
Journal of Pharmacy Management Volume 33 Issue 3 July 2017102
shock of the ‘strange’ is the stock in trade
of those, such as I, who write about
people - so I noted behaviours and fitted
into an explanatory framework.
Bordieu’s habitus formula
Learn from luminaries. I have borrowed
the qualitative ‘formula’ of the often-
cited, well-respected sociologist Bourdieu
(1930 – 2002).1 I show it in Figure 1.
Practice
You know what pharmaceutical
‘practice’ is.
Habitas
The ‘habitus’ is your disposition: your
lasting, acquired schemes of perception,
thought and action. It is how you are
socialised to perceive things as a
pharmacy manager. It is looking after
people (your patients) who have to trust
you and cannot look after themselves,
your drive to follow NHS guidelines and
so on.
Capital
‘Capital’ is your material (e.g. pension,
property, salary) and intellectual wealth.
The latter includes scientific knowledge,
your up-to-the-minute savvy about the
‘lie of the land’ in connection with top
management, attitude of clinical
consultants, inspections from all sorts of
authorities and so on. It could also
include the contents of a course on
planning for retirement; many are
available. If your NHS management will
not pay, it is well worth funding one
yourself. It is an investment in your
future. It seems unbalanced to be
saturated with training for working life
(say forty years) but benefit from none
whatsoever for retirement (say twenty-
five years). Ensure that your course does
not only cover financial aspects;
obviously, any financial opinion within it
should be independent.
Field
‘Field’ is structured social space with its
own rules, schemes of domination,
legitimate opinions and so on. One field
is pharmacy management. There, you
are responsible for overseeing
professional pharmaceutical aspects,
management, including personnel,
finance and staff pastoral care and
generally trying to juggle all the
crockery simultaneously.
Practice changes on retirement: a rite
of passage. The practice of pharmacy
metamorphoses into the practice of
retirement. Your practice might become,
for example, minding grandchildren. You
become the happily exhausted locum
responsible person. Your habitus loses
only its pharmaceutical professional and
practitioner dimensions. Your financial
capital may reduce. Your intellectual
capital may reduce or appear to do so in
the eyes of others.
Consider retaining registration as a
pharmacist. You would retain a
pharmacist’s title and prestige. You have
lived with that privilege for decades and
may not realise how much you would
miss it. However, remaining registered is
expensive and demands continuing
continual professional development
(CPD) and, if practising, insurance. You
might after a year or two perceive CPD as
a time-consuming chore that you simply
no longer want. CPD had just become
more paper or electronic labour that you
thought you had escaped. Things that are
more important crowd it out. Be aware
that, if you remain registered, community
pharmacist managers may ask you to do
community locums. Doing them may be a
shock. At the very least some supervised
training, probably unpaid, would be
prudent. I will delve into why people do
things later.
You might want to stay with the Royal
Pharmaceutical Society (RPS). You would
keep your post-nominal MRPharmS or
FRPharmS if you can bear to pay the £71
a year, if paid by bank debit. I still would
not feel ‘whole’ without them.
One retired chemist volunteered, “I
couldn’t bear not to be a member of the
Royal Society of Chemistry. It’s what I am.
It was so hard to get it. I’d be nothing
without it.”
Moreover, the RPS continue on
request to provide you with high quality
up-to-date focused information on
clinical or other queries. That is valuable
as friends may well ask you about taking
medicines, efficacy and so on.
Intellectual capital may increase;
retirement offers time to do what you
really want to do. Examples include
annihilating monsters within ‘EverQuest’,
cross-stitch, drawing, flicking through
YouTube, gardening, reading ‘free’ on-
line newspapers, relaxing with coffee and
newspaper, stargazing, travelling, and
tweaking your collection of digital
photographs using image-processing
software - or even reading Bourdieu.
His formula suggests that you can
remove the pharmacist from the retired
pharmacist by removal from the General
Pharmaceutical Council’s register but
you cannot remove the pharmaceutical
scientist. More specifically, the pharmacist
is socialised to be a practitioner,
professional, scientist and scholar. The
pharmacist stops being a practitioner
on ceasing to practise. The retired
pharmacist stops being a professional
when ceasing to be paid. Professionals
are, by definition, paid for their work,
otherwise it is ‘merely’ a hobby. However,
you do not lose all your pharmaceutical
knowledge. You retain, for example,
some understanding of the scientific
method absorbed during degree studies:
you remain a natural scientist. You also
remain a scholar. You remain learned onFigure 1: Bourdieu’s habitus formula
Practice = (habitus X capital) + field
topics
such as
pharmaceut i ca l
history, the aspirations of
behavioural science and CPD.
All manner of people will still ask you
about their, mainly clinical, concerns.
Topics such as mortgages, job insecurity,
Scouts/Guides, holidays, who is with
whom and university fees have waned.
The hot topic becomes ‘pills’– and you
remain comparatively expert. If you feel
that you still know enough, it is fine to
venture an opinion so long as you say
that you are retired.
What you lose is the privilege of trust,
when many people presented their
problems to you and you could help.
Practising pharmacists may become so
used to that situation that they are no
longer conscious of their prestige. You
should perhaps reflect upon that trust
and just how privileged you are.
Weber
The luminary sociologist Weber (1864 –
1920) is useful here.2 He said that there
were just four reasons for human
behaviour.
EgotismThe main one is egotism (self-interest).
You act because it is in your interest.
TraditionThe second is tradition, the great flywheel
of society. You act that way because of
habit.
AltruismThe third, far less common, is altruism. All
your professional life as a pharmacist you
are socialised, and bound by your code of
ethics, to put your patients first, before
yourself. Some sociologists argue,
perhaps over-cynically, that is merely a
generic marketing ploy by professions to
gain market share. Note that altruism only
counts if it is anonymous. If others know,
for example, that you have given to
charity that does not count: it is egotism
because
you increase
your prestige.
Such pontifications
may not make you feel
any better while you are
called into the hospital to dispense
an urgent medicine on a Christmas
morning when your children are opening
their presents.
AffectivityThe final reason, Weber only added for
completeness. It is affectively. You act
because you just like it such as putting a
sweetener in your coffee because you
have a sweet tooth.
Figure 2’s word cloud illustrates the
above points.
What changes in retirement is that you
no longer have patients so you can be
unashamedly egotistical. You can maximise
your income. At last, you should be able to
do what you want to do. So, perhaps,
Journal of Pharmacy Management Volume 33 Issue 3 July 2017
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103
Figure 2: Weber’s reasons for behaviour
egotismtradition
altruismaffectivity
iStock.com/monkeybusinessimages
Journal of Pharmacy Management Volume 33 Issue 3 July 2017104
savour that fine malt with the newspaper
moaning about the winter NHS bed crisis
while sporting your favorite purple pullover.
Three practical tips
Three more practical suggestions for
practising pharmacists emerged from my
interpretation of Bourdieu’s formula.
Transferable skillsFirst, accumulate transferable skills. Seize
any courses at work connected, even
tenuously, with your hobbies or any
activity that you would like to develop.
For example, I love writing and speaking,
so report writing and public speaking
courses suited me. An MBA or similar
would be excellent. I know of no one
possessing an MBA who is poor during
retirement. I lack one. However, I knew
sufficient, having been a pharmacy
manager and starting my own business,
to help younger people develop theirs as
a volunteer with a retiree organisation
organised by the business school of the
University of East Anglia and as a mentor
for undergraduates. You can learn from
them and they help to keep you ‘young’.
I was asked to talk to science PhD
students about the real world of work
outside academia; it was a privilege.
Assisting individual pupils in a local
primary school with English or
mathematics is another possibility.
Your interpersonal skills are presently
high. Seize any mentoring or similar
opportunity to polish further. They are
perhaps the most valuable skills that you
can transfer to retirement. People will ask
you to take assorted roles. Be careful. Do
not take on so much to satisfy other
peoples’ needs that you lack time to fulfil
your own dreams. Interpersonal skills will
help you make new friends to replace
some work colleagues. Despite close
collegiate relationships, after a few years,
contact with them tends to diminish. So
join, now, clubs and local societies
unconnected with work.
MemoriesSecondly, you will possess many
memories. The most vivid are when you
were emotionally involved. For example,
one trauma was in 1994 when the NHS
made me redundant. I was furious. How
dare lay individuals make a pharmacist
manager redundant? My naivety was
extreme. Actually, they did me a favour
by opening a plethora of opportunities,
especially in pharmaceutical consultancy.
However, my redefinition of that tale
from tragedy to heroic saga demanded
continuing exertion: work. My heart goes
out to those pharmacists and others
presently being made redundant for the
pain that they will suffer. However, the
sooner they perceive those threats as
opportunities the better. During your
work, you will have had some really good
times. For example, you may have
travelled. You may have met some top
people. You will have seen how some
organisational wheels rotate within
wheels and how people work, or jostle
together, in groups. Your practice has
become slicker. You have been trusted to
write countless references. Occasionally,
you may have been thanked.
After retirement, you may feel
perceived as a seldom-visible subordinate,
iStock/com/Halfpoint iStock/com/Halfpoint
Keeping fit and healthy is important
Journal of Pharmacy Management Volume 33 Issue 3 July 2017
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105
a grey-haired bed-blocker, no longer
contributing anything to the economy
and only taking. However, you have been
privileged to have held a high visibility
post wielding position and expert power.
You should gather those joys together
and shamelessly refine the tale that you
tell to yourself about yourself: your
memories.
LifestyleThirdly, plan and act to maintain your
favoured lifestyle on retirement. Ensure
that your NHS pension is the maximum
possible. My hunch is that if any ‘new’
government scheme attempts, hard, to
sell you any modified pension or similar
scheme, they do so to save government
money and that means taking it from
you. Your long-established scheme is
probably better. Private pension and
similar schemes are, in my lay experience,
inferior to government-backed schemes.
These are complex matters. At least take
advice from your trade union and
consider hiring an independent financial
advisor. Money is that important.
Dickens, in ‘David Copperfield’
(1850), shared Mr Micawber's recipe for
happiness, "Annual income twenty
pounds, annual expenditure nineteen
[pounds] nineteen [shillings] and six
[pence], result happiness. Annual income
twenty pounds, annual expenditure
twenty pounds ought and six, result
misery.”
That still applies. Presently, your
prospects seem sound. However, they
merit continued scrutiny to ensure they
are not raided.
Decide who your reference (peer)
group are with whom you compare
yourself. If they seem at your level yet
after retirement seem to be doing better
than you are, your reaction may well be a
violent sense of misfortune. The
philosopher de Botton (1969- ) informs
that perspective.3 Medical practitioners
will comfortably trump your pension.
Make big-ticket purchases now,
before retirement. They will require more
agonising afterwards, when your income
is smaller and fixed. So buy that newer
car and reflect that, for example, a S̆koda
may be more affordable, longer term,
than a BMW. Travelling and telephone
expenses will no longer contribute to
your domestic budget. Winter fuel
allowance, subsidised travel and film
screenings (with ‘free’ tea and biscuits in
a grey ghetto) may not compensate. You
may have promised yourself that once-in-
a-lifetime six-week trip to Australia and
New Zealand or around-the-world cruise.
Book it now, before you retire. Generally,
you get a better deal the further ahead
you book. Relish those long-haul holidays
sooner rather than later. You will be fitter
to savour them. Famously, world-cruise
ships reserve extra refrigeration space for
customers who do not survive to get their
full money’s worth. Consider photovoltaic
solar panels and that big monitor. Ask IT
contacts what home computer they
recommend for you (not them!).
If moving posts (with funded costs) for
house purchase, bear retirement needs in
mind when choosing. A bungalow or
ground floor flat is better for long-term
motility. Ensure it is on a public transport
route. Check that the bus signs have not
been sawn off at ground level. Ensure
that a well-regarded GP surgery and the
accident and emergency department of
your local hospital is near enough — and
remaining open.
To reduce the chance of that cardio-
vascular or other accident, keep fit. That
matters. Sweat at the gym, or similar
exercise, now. Eat healthily, stop
smoking, be vaccinated against influenza,
and reduce stress. You know the public
health messages. You have trumpeted
them all your professional life. Pharmacy
manager, follow them yourself .
I was fortunate in being a fit retiree
until, in 2015, influenza turned to
pleurisy, double pneumonia, 13 lung
abscesses that required two emergency
operations, ITU and six weeks in hospital.
I remember little, except a physiotherapist
saying, “Cough! Spit! Cough or you will
die!” I was not expected to live. Being
here to tell you my tale, I put down to the
strength of being, initially, fit.
Gender has a substantial impact on
your life expectancy. Are you female? If
so, congratulations. In 2013 - 2015 a
man in the UK aged 65 had an average
further 18.5 years of life remaining and a
woman 20.9 years. The most common
age at death in the UK for men was
85 and for women it was 89. As a
pharmacy student in the 1960s, I knew
well four male and four female students.
Even before I had retired, 50% (two) of
the males were dead but 0% of the
females. I am not suggesting a sex
change operation if you are male. I am
suggesting both genders should take full
account of demography in pre-retirement
planning.
Overview
Plan now. Do not assume that you will
have plenty of time after you retire. You
will have less.
Reflect on Bourdieu’s formula and
Weber’s reasons to help you understand
“Make big-ticket purchases now, before retirement. They will requiremore agonising afterwards, when your income is smaller and fixed.”
Journal of Pharmacy Management Volume 33 Issue 3 July 2017106
your life during and after pharmacy
management. Nurture your habitus and
capital so that when retired you can relish
a variety of pursuits without having to
strive to excel. Maximise retirement
income. Refine your biography so that it
offers more meaning to your career and
income potential afterwards.
Do your bit: fight for pharmacy and
the NHS according to your circumstances,
as generations have before you. Look
forward to observing the jostling of the
pharmaceutical service from the sidelines
as it is no longer your direct concern – but
root for it nevertheless.
Declaration of interests
I am a paid columnist in Industrial
Pharmacy and European Industrial
Pharmacy journals.
REFERENCES
1. Sayer A. Habitus, work and contributive justice. Sociology 2011;45(1):7-8.Available from:http://journals.sagepub.com/doi/abs/10.1177/0038038510387188 .
2. Weber. M. 1956 (translated from original German 1922) Wirtschaft undGesellschaft 4th ed. Tubingen 1,1-14.
3. de Botton A. Status Anxiety. 2014. London:Penguin
4. Office for National Statistics. National life tables, UK: 2013 - 2015. 29thSeptember 2016. Main points. Available at:https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/bulletins/nationallifetablesunitedkingdom/20132015 .
“Look forward to observing the jostling of the
pharmaceutical service from the sidelines as it
is no longer your direct concern . . .”
iStock/com/Halfpoint iStock.com.shutteratakan
COMING TO A TOWN NEAR YOU IN 2017 - APHARMACY MANAGEMENT EVENT FOR MEDICINES
PM National Forum for Scotland 30 August 2017, Dunblane
JoMO-UKCPA National Cardiovascular Workshop 19 September 2017, Leicester
National Homecare Conference 28 September 2017, London
National Forum for Northern Ireland October 2017 (day and venue to be confirmed)
JoMO-UKCPA National Diabetes Workshop 10 October 2017, London
Pharmacy Management National Forum Workshop 10 November 2017, London
Pharmacy Management Academy See details for the next programme elsewhere in the Journal.
Details from jenny.thompson@pharman.co.uk or jgriffiths@pmmarketaccess.com
75c High Street, Great Dunmow, Essex CM6 1AE
Tel: 01371 874478
Homepage: www.pharman.co.uk
Email: pharm@pharman.co.uk
Further information relating to these events will be added onto the PharmacyManagement website events page which
can be found using the QR code.
Question:
What is your job title?
Answer:
Lead Respiratory and Home Oxygen
Service Review (HOS-R) Pharmacist
What are your main
responsibilities/duties?
● Providing a clinical pharmacy service for
respiratory inpatients at Whittington
Hospital.
● Identifying adults in Islington who
have oxygen at home and reviewing
their oxygen prescriptions so that they
are appropriate and safe.
● Identifying high risk patients (smokers,
misusers of oxygen) and reducing
harm to them from smoking, fire and
oxygen toxicity.
● Managing oxygen use (wastage,
misuse) and improving the patient
experience of having oxygen at home
and thereby increase the value of
oxygen as a treatment in a safe,
clinically effective, patient-centric
manner.
● Keeping patients safe by setting up
Patient Specific Protocols together
with London Ambulance Services for
those patients who are at risk of
developing hypercapnic respiratory
failure from oxygen toxicity.
● Being a key component of the
Multidisciplinary Community Respiratory
Team providing pharmacy input on
individual patients.
● As part of the Responsible Respiratory
Prescribing Group, working towards
improving respiratory care for patients
within the Camden, Haringey and
Islington boroughs of London.
● Delivering education and training for
the pharmacy and respiratory teams
as well as patients in the Islington
community.
To whom do you report and where
does the post fit in the management
structure?
I work within a Pharmacy Medicine Team
as well as within the wider Respiratory
Multidisciplinary Team. So, in the pharmacy,
I have a Medicine Lead and I also have a
Respiratory Consultant I work under for
the HOS-R service.
How is the post funded? Is the post
funded on a non-recurring or
recurring basis?
Islington Clinical Commissioning Group
commissioned the HOS-R service. The
HOS-R Team is made up of 1 day a week
of a Specialist Respiratory Pharmacist’s time,
2.5 days a week of a Specialist Respiratory
Physiotherapist and 2 hours a week of a
Respiratory Consultant.
The remaining 4 days of my week are
funded by Pharmacy.
When was the post first established?
The post was initially a fixed-term 2-year
pilot and was subsequently made into a
permanent post in 2015.
Are you the first post holder? If not,
how long have you been in post?
I was not successful at interview during
the initial stage of the pilot. My
predecessor left the post in early 2015.
The job went out for advert and I was
successful the second time round. I
started at the Whittington in September
2015.
What were the main drivers for the
establishment of the post and how
did it come about?
A Respiratory Consultant was the
visionary and main driver for setting up
the Islington HOS-R.
Oxygen is a drug and should always
be planned, prescribed and reviewed by
staff trained in oxygen prescription and
Journal of Pharmacy Management Volume 33 Issue 3 July 2017108
FACE2FACEHome Oxygen Service Review (HOS-R) Pharmacist Ameet Vaghela, Lead Respiratory Pharmacist, Whittington Health, London
Correspondence to: ameet.vaghela@nhs.net
Ameet Vaghela
“Oxygen is a drug and should always be planned, prescribed and
reviewed by staff trained in oxygen prescription and use.”
Journal of Pharmacy Management Volume 33 Issue 3 July 2017
www.pharman.co.uk
109
use. It only made sense that, as
pharmacists are experts of medicines, one
was recruited into a HOS-R team.
What have been the main difficulties
in establishing/developing the post
to its current level?
Securing funding for the service meant
proving to the commissioners that there
is worth in having a pharmacist within
the team.
So that I can understand the
intricacies of oxygen prescribing, I needed
to upskill my respiratory and oxygen
knowledge.
What has been really important is
working as part of a close-knit team. This
is essential so that patients are provided
with the right treatment at the right time
by the right people.
What have been the main
achievements/successes of the post?
The first task I had was to manage a
person who was costing the CCG in
excess of £1,500 per month on oxygen.
His neurologist prescribed his oxygen for
treating cluster headaches. He was a
high-risk smoker with excessive oxygen
orders and deliveries. Through working
closely with several clinicians involved in
his care, we were able to review his
oxygen prescription, address his tobacco
dependence, provide a safe environment
for him and his family and reduce costs
down to £450 per month.
What are the main challenges/
priorities for future development
within the post, which you currently
face?
Identifying and managing smokers on
home oxygen is an ongoing challenge.
Treating tobacco dependence is really
difficult. This is where my motivational
interviewing training and knowledge of
‘stop smoking’ medicines comes into
play. It isn’t easy.
Lots of these patients haven’t had an
oxygen review in years and tracking
down the original oxygen prescriber has
proven difficult.
Most patients have multi-comorbidities
and have complex needs due to the
nature of their illnesses. Therefore, they
require very much an individualised
approach in their care. This can only be
achieved in a way that is co-ordinated
and integrated.
What are the key competencies
required to do the post and what
options are available for training?
For me, it has been a steep learning
curve. I have always enjoyed the
respiratory aspects of medicine and it has
helped to have strong support from my
peers.
I think I have benefited from learning
from specialists. All members of the
teams are smart, forward-thinking and
like-minded individuals. That makes for
solid teams.
How does the post fit with general
career development opportunities
within the profession?
I think it is a good fit. I have met several
Respiratory Pharmacists and they are
involved in various aspects within the
field e.g. stop smoking services and
respiratory pharmacist-led clinics in
severe asthma. I don’t know any other
pharmacists currently involved in oxygen
prescribing.
How do you think the post might be
developed in the future?
I would like there to be a core group of
pharmacists interested in respiratory
medicine and in oxygen prescribing.
Celebrating and sharing success stories
only makes us work harder towards
better patient outcomes.
What messages would you give to
others who might be establishing/
developing a similar post?
Be patient. Setting up a Home Oxygen
Service requires time, tact, effort and
energy. Work closely with your
commissioners and your consultants.
Even once a service is commissioned,
know that patients can have very fixed
health beliefs and this makes it tricky in
engaging with them. It’s hard work but it
is also rewarding, particularly when
patients turn round and thank you for
your efforts.
Do you have any Declarations ofInterest to make and, if so, whatare they?
A payment for writing the article will be
made by Pharmacy Management.
“I would like there to be a core group of pharmacists interestedin respiratory medicine and in oxygen prescribing.”
Journal of Pharmacy Management Volume 33 Issue 3 July 2017
www.pharman.co.uk
111
MANAGEMENT CONUNDRUM
Will The Elastic Break?
Janet Donit, Chief Pharmacist at Metropolis NHS Trust
stared pensively out of her office window and drummed
gently with her fingers on her desk.
Clive Black, Chief Executive had just been in to say that
the demands of patient flow for unscheduled care were
increasing and had got to the level where it was
necessary to extend the hours of the pharmacy service
at weekends and weekday evenings.
Janet had said she could certainly look at that but there
would be a need for additional resources since the
pharmacy service was already struggling with
demands and extending the hours of service will add
further strains.
Clive Black had, though, taken the view that since the
service was to improve patient flow then it should be
provided as a cost-neutral project and be achieved
through the appropriate re–engineering of core services.
Janet had started to protest but Clive Black had simply
said that financial restraints were making it hard for
everyone in the NHS and he wanted to have a paper put
before the management team to show how pharmacy
would respond.
Janet was concerned that what she had been asked
could not be done without stretching staff too much
and, possibly, impairing the safety of services. Her
inclination was that she should frame a case for
investment in the service to support additional hours
but that would not meet the ‘cost-neutral’ requirement.
If you were Janet, what would you now do?
Ewan Maule, Deputy
Chief Pharmacist -
Operational Services,
Northumberland Tyne
and Wear NHS
Foundation Trust.
Email: ewan.maule @ntw.nhs.uk
Janet may be right about the risk of
overstretching the service; however, she
should view this as an opportunity to
showcase, at a high level, the services
pharmacy do and could provide. Whilst
further investment may not immediately
appear to be on offer, presenting a
compelling case backed up by data may
unlock some of this. It is also important
that Janet understands the motivation of
Clive by asking herself some questions e.g:
• does he understand and value the role
pharmacy plays?
• does he want services to be
consistent across the week?
• is it an alignment with other services
increasing their service offering or is it
simply that he is asking all department
heads to outline their offering?
Janet will undoubtedly be aware of
the impact on her staff of the
introduction of weekend working, but
the expectation of the Board will
probably be that this is an issue for her to
manage locally. Her paper should,
therefore, focus on what a pharmacy
Commentaries
“. . . point out where the skills and activity of the pharmacy team
can reduce reliance on other staff groups . . .”
Journal of Pharmacy Management Volume 33 Issue 3 July 2017112
service can do to support the aims of the
organisation, and how investment in
pharmacy services can save money
elsewhere in the system.
I would advise that she obtain accurate
figures relating to admissions, length of
stay and discharges across the week, the
availability of other services (radiology,
pathology, etc) and, from this, anticipate
how pharmacy activity would change if
pharmacy services were available at
weekends. In doing so, it will be necessary
to make clear the range of services
pharmacy offer and the impact this has on
patient flow and outcomes. This would
need to differentiate the medicines supply
service from the clinical pharmacy service.
Present a range of options which include
a varying range of investment (including
at least one low impact cost neutral
approach ). For example:
• Cost neutral option – 8 hours of
medicines supply service across the
weekend (4 hours a day).
• Minor investment – 8 hours of
medicines supply service and clinical
pharmacy service (focussed on urgent
care and high turnover areas) across
the weekend (4 hours a day).
Investment required - £x/pa
• Comprehensive service – weekend
service exactly mirroring weekday
service. Investment required - £x/pa.
In framing these cases, Janet would
be well advised to point out where the
skills and activity of the pharmacy team
can reduce reliance on other staff groups
in their existing service models, and also
take the opportunity to present ideas on
new roles they could undertake (with
adequate investment of course) to
enhance skill mix, which would support
the aims of the organisation.
Present a range of options
Christine Gilmour,
Chief Pharmacist,
NHS Lanarkshire
Correspondence to:
christine.gilmour@
lanarkshire.scot.nhs.uk
Janet needs to be very clear what it is she
has been asked to provide and what the
organisation wants/needs from the
extended service. She must also
determine if this will be a short term or an
ongoing service commitment. Whilst her
instinct is to prepare a case for additional
funding she must think through all the
implications of that not being supported.
The impact of this and the
sustainability of the pharmacy service
needs to be considered as a whole. Janet
needs to review and document how the
current service is structured and funded,
and highlight if any current services that
the organisation is reliant on are provided
via staff working overtime. Overtime
working is voluntary and staff cannot be
obliged to undertake overtime duties.
Janet must not try and meet the needs of
the organisation by designing a solution
reliant on staff goodwill. It may be,
however, that there are already services in
place that work this way - for example
existing Saturday and Sunday services, or
iStock.com/BrianAJackson
Journal of Pharmacy Management Volume 33 Issue 3 July 2017
www.pharman.co.uk
113
evening working over the winter period
to assist with bed pressures.
Janet should work with her senior
team to try and identify changes that
could make the pharmacy service more
efficient, for example earlier presentation
of discharge prescriptions from wards,
etc. The organisation is looking for
solutions and will support her, however
when all that is said and done she needs
to be prepared to consider restructuring
and even cutting existing services to
accommodate this request. Doing this
should be difficult and uncomfortable for
her, because if it’s not then that is a
whole different matter to reflect on.
Through this process she must identify
where her ‘red lines’ are and why.
Restructuring can mean changing duties
and skill mix so she needs to engage with
HR and staff side colleagues.
Declaration of interests
● Ewan Maule: Personal fee from
Pharmacy Management for writing
the commentary.
● Christine Gilmore: Member of the
Editorial Board, Journal of Pharmacy
Management (JoPM). Personal fee
from Pharmacy Management for
writing the commentary.
Janet needs to be clear about her red lines
iStock.com/sukmaraga
“Janet should work with her senior team to try and identifychanges that could make the pharmacy service more efficient . . .”
Journal of Pharmacy Management Volume 33 Issue 3 July 2017114
We live in a society where the pressure to
be successful has reached almost
pandemic levels. Whether it is our personal
or professional lives or both, we feel like
we have to ‘succeed’ at everything we do.
Ironically, this pressure is often the very
thing that hold us back from being
successful. Fear of failure is not just an
expression, for some people it is an actual
clinical condition called atychiphobia. For
many of us a fear of failure is not this
severe, but it does hold us back.
So how should we deal with failure or
prevent a fear of failure from becoming
overwhelming in the first place?
1. Know what you want to achieve
and have a plan to achieve it
There is a well-worn old adage that
says: ‘A failure to plan is a plan to fail’.
That is very true here. Nobody plans to
fail but, in not having a plan to get to
where we want to with our lives, we are
more likely to end up in a place we
don’t want to be. Having a clear
destination and a plan to get there
gives us a much greater chance of
arriving successfully. Consider this
analogy, how many times have you
gone on holiday and just turned up
at the airport, jumped on the first
available flight to wherever and then
checked-in to the nearest available
hotel when you reach your destination?
Not many of us have done this or would
do this. Ironically, most of us spend
more time every year planning our
holidays than we do planning our lives.
The other great thing about having a
plan is that we quickly realise when the
plan is not working and we can change
it. The destination remains the same,
but the journey to get there can and
does change.
2. Adopt a ‘black box’ mentality
In his best-selling book, ‘Black Box
Thinking: The Surprising Truth About
Success’,1 author Mathew Syed talks
at length about the global aviation
industry and how it learnt very quickly
from mistakes, some of which have
had catastrophic consequences.
Within days of an incident occurring
(no matter how major or minor)
aviation companies will pull together
teams of investigators and anyone
involved in the incident is fully
encouraged to disclose everything
relating to it that they can. In this way
lessons are learned and mistakes of a
repetitive nature are avoided. Key
learnings from the incident are very
quickly disseminated and acted upon.
Interestingly, Syed draws lots of
comparisons with global healthcare
where the reverse is often true.
When you make a mistake, look at
what you can learn from it and take
steps to avoid repeating the same
mistake again .
How To Be A Success At FailureBy Tom Phillips, lead trainer at Pharmacy Management, who has enjoyed 20 years of working with both theprivate and public sector, during which time he has gained extensive experience and demonstratedconsiderable success in management, sales, marketing and training. Tom is an excellent communicator andmotivator and has designed/ delivered training at all levels from trainees to directors at both a national andinternational level. Such is Tom’s love of training and development that, in his personal life, he is also aqualified fitness and diving instructor. Tom Phillips
LEADERSHIP
‘There is freedom waiting for you on the breezes of the sky, and you ask “What if I fall?” Oh but my darling, what if you fly?’
Erin Hanson, Poet
“Having a clear destination and a plan to get there gives us
a much greater chance of arriving successfully.”
Journal of Pharmacy Management Volume 33 Issue 3 July 2017
www.pharman.co.uk
115
3. To err is human
Accept that we can and do make
mistakes and when we do, rather
than beat ourselves up, we need to
accept that we are human and fallible.
Look at the situation objectively and,
with reference to point 2 above, look
at what you can learn from the
situation. Something can be learned
even from the worst mistakes. Do not
put unrealistic pressure on yourself to
be perfect. Accept from the outset
that mistakes are an everyday part of
life. In designing the lightbulb,
Thomas Edison famously ‘failed’ 999
times. He saw each failure as an
integral part of his human nature and
also saw each failure as another
learning opportunity and another step
closer to his ultimate goal.
4. Don't make it personal
Failure is human. To have failed in a
task or a pursuit does not make you, as
a person, a failure. We need to
separate the incident from who we are.
In fact, if we dust ourselves off, learn
from the experience and have another
go, by definition we are not a failure.
5. The past is a place of reference,
not a place of residence
Do not dwell on past failures. The past is
in the past and whilst we should always
be ready to learn from past experiences,
it is not healthy to keep dwelling on
them and allowing them to interfere
with our present and our future.
6. Get someone else to hold themirror for you
If you are really struggling to analyse a
failure in an objective manner, then it
is a good idea to get someone else to
help you review the situation
objectively. A professional business or
life coach can help you to do this.
They should help you to review the
event objectively and to learn from it.
7. Fail fast
As we embark upon a journey to
wherever, it is a good idea to get the
failure out of the way early on so that
we can arrive at our destination that
much faster. Procrastination (possibly
because of a fear of failure) will only
delay us from reaching our objectives
and learning along the way. You are
going to make mistakes, that is
inevitable. Surely it would be best to
get the mistakes out of the way
sooner, rather than later?
Good luck with all your failure in the
future!
Declaration of interests
Tom Phillips discloses payment for
writing the article and professional fees
from Pharmacy Management outside the
submitted work.
REFERENCES
1 . Black Box Thinking: The Surprising Truth AboutSuccess. Mathew Syed. 2015.
Learning from your mistakes will help you to avoid repeating them
iStock.com/GOSPHOTODESIGN
“. . . whilst we should always be ready to learn from pastexperiences, it is not healthy to keep dwelling on them . . .”
Journal of Pharmacy Management Volume 33 Issue 3 July 2017
www.pharman.co.uk
EDITORIAL BOARD FOR THE JOURNAL OF PHARMACY MANAGEMENT (JoPM)
Dr Tim HanlonChief Pharmacist & Clinical Director ofPharmacy and Medicines Optimisation,Guy's and St Thomas' NHS Foundation Trust;Visiting Professor of Pharmacy, School ofPharmacy, University of Readingtim.hanlon@gstt.nhs.uk
Katy JacksonHead of Prescribing and MedicinesCommissioning/ Controlled DrugsLead, Brighton and Hove ClinicalCommissioning Groupkjackson2@nhs.net
Jas KhambhPharmacy and Medicines OptimisationLead, Primary Care, NHS LondonProcurement Partnership (seconded toNHS England) jas.khambh@lpp.nhs.uk
Robbie TurnerDirector for England,Royal Pharmaceutical Societyrobbie.turner@rpharms.com
Anthony YoungLead Clinical Pharmacist,Northumberland Tyne and Wear NHS Foundation Trustanthony.young@ntw.nhs.uk
SCOTLANDChristine Gilmour Chief Pharmacist, NHS Lanarkshirechristinegilmour746@ btinternet.com
Sharon PflegerNHS Highland, Consultant inPharmaceutical Public Health/NationalClinical Lead, Area Drugs andTherapeutics Committee Collaborative,Healthcare Improvement Scotlandsharon.pfleger@nhs.net
Campbell ShimminsCommunity Pharmacist, Owner,Practitioner.c.shimmins@me.com
David Thomson Lead Pharmacist, CommunityPharmacy Development &Governance, NHS Greater Glasgowand Clydedavid.thomson@ggc.scot.nhs.uk
EditorAlex BowerDirector of Publishing,Pharmacy Management alex.bower@pharman.co.uk
ENGLANDRena AminClinical Associate, Hartland WaySurgery, Londonrena.amin@nhs.net
Graham BrackDeputy Accountable Officer forControlled Drugs, NHS South Region(South West) graham.brack@nhs.net
NORTHERN IRELANDLindsay GraceyCommunity Pharmacistlindsaygracey@googlemail.com
Dr Ruth MillerProject Manager, Medicines Optimisationin Older People & Lead ResearchPharmacist, Western Health and SocialCare Trust, Altnagelvin Area Hospitalruth.miller@westertntrust.hscni.net orr.miller@ulster.ac.uk
Professor Michael ScottHead of Pharmacy and Medicines Management.Northern Health and Social Care Trustdrmichael.scott@northerntrust.hscni.ne
WALESJohn Terry Head of Pharmacy,Neath Port Talbot Hospitaljohn.terry@wales.nhs.uk
Roger WilliamsHead of Pharmacy Acute Services,Abertawe Bro Morgannwg UniversityHealth Boardroger.williams@btopenworld.com
Published by Pharman Limited
75c High Street, Great Dunmow, Essex CM6 1AE
Tel: 01371 874478 Homepage: www.pharman.co.uk Email: pharm@pharman.co.uk
July17
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