As a medicines information and prescribing support pharmacist, healthcare professionals within the North East and Yorkshire area rely on me to provide accurate and evidence-based answers to complex medication-related queries. I joined the Specialist Pharmacy Service Regional Medicines Information Centre in 2018, which sits within the Regional Drug and Therapeutics Centre in Newcastle.
8:30 — start
Once in the office, I spend a little time reading the National Institute for Health and Care Excellence’s (NICE’s) medicines awareness daily bulletin to keep up to date with the most recent medicines to be licensed and trials being published. I also check if any medicines information enquiries have been emailed to us overnight. These are allocated according to the team rota — one pharmacist will answer the medicines information phone line in the morning and the other in the afternoon. Emailed enquiries are split evenly between the two pharmacists. All emailed enquires will get a response within five working days, but we endeavour to answer these as soon as possible.
I never know what I might get asked when I pick up the phone
I have an medicines information phone session in the morning, where I respond to enquiries from healthcare professionals working in primary care (GPs, nurses, community pharmacists, practice pharmacists, pharmacy technicians and community-based consultants).
I never know what I might get asked when I pick up the phone. The nature of enquires we get are vast, ranging from the management of adverse drug reactions and drug interactions, to more complex enquires related to polypharmacy, drugs in pregnancy and lactation. Complex enquires are often discussed as a team before an answer is given. This may be through an informal discussion with a colleague or a senior member of the team checking a written answer before it is sent.
I receive four enquiries — two of which are regarding stock issues. I can often provide a response over the phone, but one of the enquiries was regarding gastrointestinal protection with non-steroidal anti-inflammatory drugs and whether H2 receptor antagonists are as effective as proton pump inhibitors. As this was a more complex enquiry, a detailed written answer is necessary; however, as this was not an urgent request, the enquirer will receive an answer by the end of the week.
A call comes through regarding a patient who wants to use over-the-counter cannabidiol oil sold at pharmacies or herbal food stores. We have seen an increase in the number of these enquiries over the past year. As a result, I produced the ‘cannabis-based medicinal products — potential drug interactions’ Q&A available on the Specialist Pharmacy Service website. It provides healthcare professionals with a free and concise summary of the available evidence on this topic.
Before lunch, I sit down with our pharmacist preregistration trainee to provide feedback on a mock enquiry they answered this morning.
Medicines information skills are viewed by trainees as a vital part of their development, regardless of the pharmacy sector they work in
As a centre, we provide opportunities for preregistration pharmacists to undertake medicines information training and to experience the calls we receive. I enjoy supporting them during their time with us. We have recently undertaken an evaluation of the benefits of this rotational placement — the results of which have been presented at local and national conferences, including the 45th UKMi Practice Development Seminar. We found that medicines information skills are viewed by trainees as a vital part of their development and training, regardless of the pharmacy sector they work in.
I move to my role within prescribing support. This includes horizon scanning where monthly reports are produced for stakeholders to inform them of new products, significant changes to product licenses, significant new guidance and decisions that have been made by recognised bodies, such as the National Institute of Health and Care Excellence (NICE). Our new drug evaluations are concise, structured reviews of new drugs with particular attention to efficacy, safety and cost. They are accredited by NICE and used by medicines management committees, medicines optimisation teams and prescribers to assess these agents for formulary inclusion. Recent new drug evaluation topics include melatonin (Slenyto; Flynn Pharma) and insulin glargine plus lixisenatide (Suliqua; Sanofi).
We produce quarterly prescribing analysis reports that clinical commissioning groups use to analyse prescribing costs and trends
This afternoon, I attend a prescribing reports meeting. In attendance are pharmacists, data analysts and a statistician. We produce quarterly prescribing analysis reports that clinical commissioning groups use to analyse prescribing costs and trends, with an aim to reduce variation in prescribing and outcomes for patients. Today we are discussing the development of new indicators and how to share best practice between stakeholders. Indicators depend on the therapeutic area in question — for example, in pain management, the percentage of patients prescribed an opioid who are prescribed a ‘high-dose’ opioid.
We are also an Medicines and Healthcare products Regulatory Agency Yellow Card Centre responsible for promoting the scheme in the North East and Yorkshire. Today I visit a local trust to give a talk to the pharmacy team to explain the role of the Yellow Card scheme, how and when to report a Yellow Card and the importance of reporting. We also visit patient support groups, primary care prescriber groups and universities.
I perform a clinical check on a draft shared-care protocol for an oestrogen replacement that induces delayed puberty. The shared-care protocol will enable GPs to prescribe a treatment that was initiated by a hospital specialist under a shared agreement. After the clinical check has been performed, amendments will be made by the author before approval by the area prescribing committee. As this is an off-label use of a licensed medication, there is limited evidence or guidance in this area.
Clinical checks involve a review of draft clinical documents, such as shared-care protocols, formulary tools and clinical guidelines. Clinical checks highlight to authors where the draft guidance may deviate from the current evidence base.
16:30 — finish
To finish off my day, I update the resources I plan to use during a teaching session later in the year — I will be speaking to MPharm students at a local university regarding the Yellow Card scheme.
Unfortunately, the number of Yellow Card reports made by pharmacists dropped both regionally and nationally in 2018. I hope that promoting the Yellow Card scheme to future members of the profession will boost this.
Box: Information for pharmacists interested in a similar role
- An entry level position at the Regional Drug and Therapeutics Centre is NHS Agenda for Change band 7;
- Additional qualifications, such as a clinical diploma or being an independent prescriber, are desirable;
- Have a keen interest in evidence-based medicine and a desire to learn the skills of critical appraisal — attention to detail is important, as is the self-awareness to ensure you operate within your competency;
- The desire to learn helps as there can be a lot of reading — medicines information call handling can be challenging and a calm and helpful manner is vital. It is important to stay calm under pressure to ensure that a correct answer is given;
- You must be able to work as part of a team — you will be required to supervise and help other members of staff in answering their enquiries. Do not be scared to ask for help with your own enquiries as there is always someone who can help;
- Deadlines can creep up fast and an ability to manage your own workload is needed;
- Aim to continue developing your clinical pharmacy knowledge. In addition to my other roles, I spend half a day each week working on the medical admissions unit within the trust as a clinical pharmacist. This keeps my clinical knowledge up-to-date and maintains direct patient contact.