A day in the life of a pharmacist at a drug and alcohol service

Turning Point is a social enterprise supporting more than 83,000 people with a wide range of health, wellbeing and social care needs across England. We have worked with people who have learning disabilities, those affected by drug and alcohol problems, mental health issues, primary care needs, offending behaviours, and housing and unemployment issues. We aim to inspire and empower them to discover new possibilities in their lives.

I started working at Turning Point as a pharmacist in September 2015 after covering for a colleague’s maternity leave. Previously, I worked as a locum, a medicines management pharmacist and as a prescriber in the Plymouth Specialist Drug and Alcohol Service.

6:00 — start

I am very lucky as my role allows me to work from home in Devon for most of the week. Today, however, I am attending a national prescribers meeting in London so my day starts with an early train journey. It is a good  opportunity to catch up on my emails; I answer one about community pharmacy engagement for a bid we are working on and move on to the interpretation of an oral fluid drug test for one of our prescribers who wants to know whether the client has used street heroin.

I also review some of our reported medication incidents from DATIX, our patient safety software, and finish some work on a policy we are developing on the management of chronic pain for clients with a substance use disorder.

9:30

I arrive at our office in Aldgate, London, and catch up with Tom from our IT team to discuss the suite of data tools we have. Our insight tools are essential to my role as they allow me to assess metrics associated with prescribing. Tom is currently working on improvements to our generic benchmarking tool as the organisation is trying to manage the disproportionate increase in the costs of generic buprenorphine. We also discuss the development of a blood-borne virus (BBV) tool, which is in early stages but will monitor vaccinations and BBV testing levels across our services.

 A good pharmacy technician is worth their weight in gold

10:00

In the national prescribers meeting, the group discusses case studies from practice. This is a great opportunity for the multidisciplinary team of nurses, doctors and pharmacists to support colleagues.

Today, we talk about how to manage repeat alcohol detoxification in secure environments; prescribing antibiotics for injecting-related soft-tissue injuries; and about one client’s request for a holiday prescription for a peripatetic camping trip in Scotland.

Following this discussion, I present colleagues with an update on current clinical issues within the organisation. Turning Point’s pharmacy support services provide the substance misuse services with a monthly clinical brief that underpins our presentation at the national prescribers meeting.

During the meeting, Katherine Watkinson, Turning Point’s national pharmacy support services technician, and I discuss several topics. Katherine is my support and ‘go to’ person — a good pharmacy technician is worth their weight in gold. Our discussions cover topics such as:

• Supporting a switch from generic buprenorphine to Espranor (Martindale Pharma) following the near 900% price hike in 2018 for the 8mg generic buprenorphine tablets and around 500% for the 2mg tablets. From a financial governance perspective, the switch is better for Turning Point, but we also need to manage the clinical and ethical aspects. For example, the product contains bovine gelatin, so we needed to be mindful of this in the advice we provide clients and healthcare professionals about switching to this formulation;
• A new formulation of nasal naloxone (an opioid reversal agent) and how we are going to use it within Turning Point;
• Hepatitis B vaccination training — we have just introduced some e-learning with a third-party provider to support our governance framework for practitioners providing hepatitis B vaccinations in our services;
• Updates on the medicines in our formulary whern there is a problem with supply. Currently this includes lofexidine, which is used to relieve symptoms of opioid withdrawal. It was discontinued in 2018 and is no longer available in the UK.

After taking some questions and an update from David Bremnar, medical director at Turning Point, it is time for lunch.

14:00

Turning Point has a limited substance misuse formulary but, recently, new medicines have been introduced that necessitate review. Today I am meeting a pharmaceutical company representative to discuss its new buprenorphine depot following the ‘Opioid dependence: buprenorphine prolonged-release injection (Buvidal)’ evidence summary published by the National Institute for Health and Care Excellence in February 2019. Turning Point has been aware of the new formulation for several months and we have discussed it at previous meetings.

If we were to add the buprenorphine depot formulation to the formulary, the next stage would be to assess it against our formulary application process. We agree to take our discussions back to the senior clinical governance and senior management team meetings.

Prioritisation is a very important skill, especially with a small but highly skilled team

15:00

I receive a call from a medicines management team at a clinical commissioning group. The pharmacist in its team wants to know more about our Espranor switch as we provide a local service in their area. I discuss the clinical aspects of this and the reasons underpinning our decision and provide the assurance they need. She is more than happy with our discussions and is pleased I have responded so quickly.

One of my biggest challenges is determining how quickly I respond to calls and emails. Prioritisation is a very important skill, especially with a small but highly skilled team.

Following the call, I make a quick visit to the non-medical prescribers (NMP) breakout session of the meeting, in which we discuss NMP competencies when prescribing drugs other than methadone or buprenorphine.

16:00

Before I leave the office to make my journey home, I catch up with David, who is also my line manager. I am very lucky to work for people who trust me and allow me great autonomy. We chat about some personal issues and logistical planning around my annual appraisal, before discussing upcoming Public Health England meetings. We also discuss Brexit planning and the Falsified Medicines Directive; the uncertainty of these issues percolates into our lives too.