Jas Khambh is national pharmacy advisor to NHS RightCare, Medical Directorate, NHS England.
What is your background in pharmacy?
I had been working as a principal pharmacist for several years at the interface between Homerton University Foundation Hospital and City & Hackney Teaching Primary Care Trust (PCT) before moving into primary care at City & Hackney PCT in 2008. I led and set up an area prescribing committee and managed the local formulary. I established one of the early interface roles across primary and secondary care between those two organisations, in a joint role between a hospital and a primary care trust at that time. I have also been a trust lead for non-medical prescribing when it first came about, and did some service management before I moved into a regional medicines optimisation role in 2011 working for the NHS London Procurement Partnership (LPP).
What is NHS RightCare and how did you become a pharmacy advisor?
NHS RightCare is a national NHS England programme which supports local health economies to make the best use of resources and better understand performance through identifying variation between demographically similar populations so that optimal care pathways can be adopted efficiently and effectively. The programme also promotes collaborative working to encourage joint decision making about population healthcare; it also aims to identify programmes which offer the best opportunities to improve healthcare through sustainable, evidence-based processes which reduce unnecessary variation.
I applied for the NHS RightCare role towards the end of 2016. At the time I had been working at the LPP for several years leading the regional Quality, Innovation, Productivity and Prevention (QIPP) plan for medicines. I thought the NHS RightCare role would be an excellent opportunity to work at a national level, and was the next logical step in my career. Having worked in both a local and regional capacity, it seemed like a natural progression and would further enhance my experience by providing a different set of challenges that I could learn from.
Briefly describe a typical day in your role; what are the main challenges?
On a day-to-day basis I can be involved in any number of activities such as representing NHS RightCare as an ambassador through attending national meetings, conferences and working groups, providing education and information, and collaborating with the NHS RightCare analytical team and clinical working groups to gain insights into medicines optimisation practices and come up with solutions to issues. Identifying links with other national programmes is also something I do such as the NHS ‘Getting it right first time’ programme, that aims to improve care in the NHS by addressing variations in service.
Embedding the RightCare approach into medicines optimisation and demonstrating how the principles of medicines optimisation relate to the programme has been the biggest challenge. What is missing is the connection between clinical pathways and clinical outcomes. This is despite there being some very good synergies between the RightCare approach and medicines optimisation; and the wealth of information that pharmacy professionals possess. Identifying the gaps and trying to work on areas where there is true innovation and value can be challenging, but is also rewarding.
Working at a national level — across a large number of organisations, delivering work plans across huge geographical boundaries — I find the number of key opinion leaders to influence is much larger and this has allowed me to develop strengths in this area.
What do you enjoy most about your work and of which achievement are you most proud?
I enjoy the fact that I can work autonomously most of the time and I can influence big changes, which ultimately help to improve patient care. For example, using the NHS RightCare data it is possible to identify unwarranted variation in prescribing that can be improved. I am proud to be an NHS RightCare ambassador and have really enjoyed listening to pharmacists and taking forward their recommendations to improve the medicines optimisation outputs from the programme. I am happy that I’ve made significant progress in engaging the pharmacy profession in a very short space of time, while also dealing with the challenges of being the first clinical associate for NHS RightCare and working in a completely different political environment.
What areas of practice interest you most?
I find health informatics and prescribing data very interesting. I enjoy working to improve population healthcare by applying the NHS RightCare intelligence data that look at specific clinical areas to improve clinical outcomes. The RightCare approach enables us to look at medicines as part of whole pathways rather than in isolation and to consider clinical outcomes. This is an interesting concept, especially as it provides a step towards considering the value of medicines when treating specific conditions. NHS RightCare provides us with resources that help raise questions. These resources enable us to identify variation and question whether it is warranted or unwarranted. The resources and data are not there to provide definitive answers, but rather to help generate discussion within local health economies.
What is the most important thing that you have learnt while undertaking this role?
Having worked in a regional role for a long time I didn’t think this would be very different. I have discovered that the challenges are very similar to those working across a region but amplified because the number of stakeholders and structures which require an influence is greater. For example, we are trying to address variation in prescribing but at a much larger scale. A greater number of key players (including clinicians), are involved in agreeing on various approaches and therefore effective influencing skills are highly essential to deliver the role effectively.
What are your future career plans?
I am enjoying this role and hope to continue working in a similar role over the next few years. As far as the distant future is concerned, who knows?