The new Centre for Pharmacy Innovation at Liverpool John Moores University – the first of its kind in the UK – aims to challenge preconceptions and develop pharmacists’ role. Mark Greener reports

 

“COMMUNITY pharmacists are the most underused resource in the NHS,” remarks Alison Ewing, the recently appointed professor of pharmacy innovation at Liverpool John Moores University (LJMU) and clinical director of pharmacy at Royal Liverpool and Broadgreen University Hospitals NHS Trust. “In discharge dispensing, for example, community pharmacists know far better than their hospital colleagues which patients are vulnerable and who needs more support.” Alison admits that hospital pharmacists do not always have the time or resources to optimise discharge dispensing. “Receiving prescriptions from the wards took time. We needed to deal with around 120 discharges a day and hospital pharmacists have many other competing priorities,” Alison told Pharmacy Magazine. So, in 2009, the trust contracted LloydsPharmacy to provide the hospital’s outpatient dispensing.

“The arrangement we developed in Liverpool with LloydsPharmacy could be repeated anywhere in the UK and by any group of pharmacists,” she says. “But through our collaboration we soon realised we could do a lot more by working more closely with community pharmacists.” This led to the Centre for Pharmacy Innovation (CPI) – a research collaboration between the Royal Liverpool and Broadgreen University Hospitals NHS Trust, LJMU and LloydsPharmacy. “We have come such a long way since 2009.” Alison remarks. “I feel really proud to be involved.”

Commercial and clinical opportunities

Obviously, LloydsPharmacy senses – over the medium and long-term – potential commercial opportunities arising from the insights offered by the CPI’s research. Nevertheless, Andrew Willetts, healthcare solutions director, stresses that the chain is helping to fund the CPI not solely for its own commercial interests but to “help advance the cause of pharmacy generally”. “Our involvement grew from our long-standing relationship with Liverpool and Broadgreen University Hospitals NHS Trust in delivering an outpatient dispensing service,” Andrew explains.

“We know from our experience, and that of other chains and independents, that community pharmacists can have much greater roles. Initially, we’re looking at improving discharge dispensing, which would ease the process, reduce bureaucracy and improve the patient experience, but there are numerous other potential opportunities. “However we need to look closely at care processes to see what works and to determine what elements are scalable, which is where the CPI comes in. “The research is at a very early stage and the clinical benefits and commercial opportunities are not yet clear. In general, however, innovations that are better for patients will be better for community pharmacy.” During the first project, a PhD student is studying the transfer of pharmacy care between hospitals and the community at admission and discharge. “We hope that the study will identify opportunities to improve the quality of medicines management, decrease medicines waste and maximise pharmacists’ clinical input,” Alison remarks.

Specifically, the research aims to develop an innovative hospital discharge prescribing process that provides safe, quality and effective transfer to community care. Lloyds- Pharmacy will pilot the model. “Our aim is that the research will improve future processes in all hospitals and all pharmacies across the UK, in every area and with every pharmacy company,” Alison says. The CPI also plans to run MSc projects examining other areas of pharmacy care. “We are starting to build up a research portfolio,” Alison adds. “I would like to think we can help pharmacists become more central to the management of patients with long-term conditions. Community pharmacists could, for example, work more closely with specialist diabetes nurses as well as GPs. That’s one example, but pharmacists could do a lot more in many different areas.”

In addition, the CPI promotes pharmacist education. “Some community pharmacists do not have the time or resources to gain a clinical diploma,” Alison remarks. “Our postgraduate education and training programme aims to meet this need.” Alison envisages a series of self-contained modules on specific topics – such as common ailments, diabetes and asthma – that could count towards a clinical diploma.

Glimpse of the future

Nevertheless, better education and improved processes won’t be enough to realise the benefits offered by innovation in community pharmacies. Current research consistently reports that patients’ perceptions of a lack of privacy, feelings of poor confidentiality and misunderstandings about pharmacists’ expanded role present barriers to implementing innovation. While Andrew does not underestimate the size of these barriers, he notes that the increasing uptake of MURs and the NMS suggests that pharmacists can challenge these preconceptions. “Once we have collected data demonstrating the benefits of an expanded role for pharmacists, the profession and individual pharmacies need to raise awareness about the new services,” he says. “Communication is key. If patients don’t trust or understand community pharmacy, the new roles won’t work.”

Nevertheless, the CPI is testament to the much wider role that pharmacy could play. In the future, Alison envisages that community pharmacists could help manage, for example, HIV and some chronic leukaemias, while delivering chemotherapy and other medicines in the patient’s home. Andrew agrees, adding that any process that “meets the NHS’s big issues” – such as reducing demand on A&E and other acute services – could help promote pharmacy. “Patients find accessing GPs increasingly difficult and end up in A&E. Expanded pharmacy services could alleviate the pressure,” he remarks. “We need to find new ways of patientfocused working and hope to play an active part in this by collaboration with the CPI. It is at an early stage, but it’s exciting.” “Community pharmacists sometimes seem too limited in what they feel they can do. The CPI will come at the issues facing community pharmacy from different angles and with an open mind to see how we can improve care and develop their role,” Alison concludes. “Whether we work in hospitals or the community, in academia or the high street, we’re all pharmacists and we need to work together to develop the profession.”