Surgical pharmacist Neetu Bansal spent a year as scholar for the National Institute for Health and Care Excellence (NICE). She explains what the role involves.
What is your normal role as a pharmacist?
I am currently working as a surgical pharmacist at the Central Manchester University Hospitals NHS Foundation Trust (CMFT), predominantly looking after patients with colorectal diseases. I’m also working as the pharmacy lead for enhanced recovery within the same trust.
For one day a week, I work as an honorary clinical lecturer at the University of Manchester Pharmacy School, where I split my time between undergraduate teaching and forging research links between the university and the trust. My role is dynamic and full of opportunities for working within a wide multidisciplinary team.
What led you to apply for the NICE scholarship programme?
Enhanced recovery protocols were introduced in CMFT in 2008 with no dedicated pharmacist involvement, even though a lot of the interventions proposed were medicines related, such as improved pain management and reduced post-operative nausea and vomiting. This is a national problem and I was keen to demonstrate how pharmacists can add to these pathways to improve patient outcomes. This led me to apply for the NICE scholar programme.
What does being a NICE scholar involve?
NICE scholarships provide an individual with the opportunity to undertake a research project that supports NICE guidance and has the potential to have a national impact. Scholars are expected to devote approximately one day per week on their project for a year.
For my project, I undertook a prospective study comparing the nurse led pre-admission clinic and standard post-operative care for colorectal patients at CMFT to a service where a dedicated enhanced recovery pharmacist followed patients throughout their ‘surgical journey’ from the time they are listed for surgery until discharge. The results of the project have shown that pharmacists playing an active role in enhanced recovery pathways can significantly reduce a patient’s length of stay and overall post-operative complications.
Each scholar is partnered with an experienced mentor, who, in addition to supporting scholars with their own knowledge, helps them access expertise within NICE. A series of workshops provides first-hand expert education on a variety of topics, such as implementation science and leadership skills.
Being a NICE scholar also involves acting as a local ambassador and promoting NICE principles and recommendations through teaching activities, for example.
What did you find most challenging about the NICE scholarship programme?
The programme is what you make of it so it is down to you to identify and act on opportunities. Because most of the related activities need to be completed at work, the onus is on the individual to lead and develop the project, which requires organisation and self motivation. The mentor’s role is not to supervise in the traditional sense and the scholars are certainly not micromanaged. Scholars are required to be proactive in identifying opportunities within NICE that would be beneficial to them. For example, I was keen to learn more about the principles underlying the development of NICE guidance so I spent some time with the NICE field team and colleagues from the National Prescribing Centre to achieve this.
Finding the time to complete the project is a further challenge and developing relevant contacts can be a slow process. The project must be completed within a year and I found I needed to be careful in planning and managing my time.
What skills and knowledge did you gain from the NICE scholarship programme?
Through the programme, I learnt about different tools, such as the Theoretical Domains Framework, which aim to explore behavioural and psychological barriers to change and use these as scoping tools to implement change within organisations effectively. This can be difficult, particularly in large organisations where there is a wide range of different working groups.
However, by applying my knowledge of implementation theories gained from the workshops, I have managed to integrate the role of the pharmacist into the pre-admission phase. The focus is on medicines optimisation with a multidisciplinary approach to help ensure that patients are in the best state for surgery. Recently, I have been invited to be part of the CMFT pre-admission transformation group. This is a high level group looking at how the pre-admission services should be realigned to provide a more seamless service for patients presenting to the trust for surgical procedures.
The programme has also helped me develop my leadership skills, use communication tools and models effectively and consider wider agendas, such as political and organisational objectives, when conducting projects.