As principal pharmacist for research and development at Betsi Cadwaladr Health Board in Wales, Geraldine McCaffrey is at the forefront of significant changes happening in the profession.
McCaffrey, who was elected chair of the Royal Pharmaceutical Society’s (RPS’s) Welsh Pharmacy Board in June 2023, is involved with both the delivery of the Welsh government’s plans to fully digitise prescribing across the NHS and the design and development of pharmacogenomics services for Wales.
She is also a member of the RPS Assembly and on the board for ‘Pharmacy: Delivering a Healthier Wales‘ — the profession’s strategy for transforming pharmacy services in Wales by 2030.
The Pharmaceutical Journal sat down with McCaffrey to discuss the strategy’s progress, workforce challenges and what’s next for digital prescribing in Wales.
What inspired you to stand for chair of the Welsh Pharmacy Board?
The RPS has had a real influence in being able to advocate for the profession and make the changes that have moved us from where we were 25 years ago, when I first qualified, to where we are today.
We’re at such an exciting time for the profession, and there’s so much happening, that it’s a real privilege to be in the position of chair.
What in particular are you excited about?
Independent prescribing for pharmacists is a real step change for the profession. I qualified as an independent prescriber (IP) part way through my career, around 15 years ago. It changed the way I consulted with patients and how I could contribute to their care, so I think it’s transformational to have newly registered pharmacists coming into the profession with those skills. It helps us to improve patients’ experience and contribute to their health and wellbeing.
At a time when the NHS is under such pressure, if a pharmacist sees a patient and gets things right with their medicines on that first contact, it’s brilliant in terms of patient safety and experience.
Health Education and Improvement Wales published its ‘Strategic Pharmacy Workforce Plan’ in June 2023. Is there anything that you think the Royal Pharmaceutical Society could help with?
One of the areas in practice that’s very close to my heart is research. It’s one of the pillars of advanced practice that practitioners tend to struggle with, so it’s great that RPS has some resources to support people with developing those skills.
The Health Education and Improvement Wales workforce plan is looking at how we can grow our practitioners in many ways through foundation and advanced consultant-level practice. There’s a huge role for the RPS in supporting people through that career pathway and in the development of their portfolios, providing educational opportunities and the structure that gives practitioners an understanding of the domains they need to develop in and a way of collating and tracking that progress.
There are lots of new spaces that pharmacy needs to get into. We’ve done quite a lot of work in the space around pharmacogenomics. That’s a fairly new area for pharmacy. There’s a key role about supporting practitioners to develop those skills, and providing educational opportunities, but there will be more that we can do in that space.
If you look at digital, there are roles that we need to create in the workforce for pharmacy professionals, such as chief clinical information officers. Chief nursing information officers are pretty well established, but we don’t necessarily have that equivalent for pharmacy. It’s critical that we do, because medicines form a key piece of digital transformation. I would like to see the RPS supporting the career development of members of our profession who are interested in that area.
As a member of the board for ‘Pharmacy: developing a healthier Wales’, what’s your assessment of the progress made so far?
‘Pharmacy: Delivering a Healthier Wales’ was published before the pandemic, so the way things were expected to progress changed. Last year, we reviewed the strategy and created milestones along the way to our 2030 vision.
Some things are progressing well, such as the development of more clinical services in community pharmacy, particularly with the IP services. Wales and Scotland are leading the way in that space. We’ve got the community pharmacy contract in Wales, which gives a strategic way forward to achieve the vision of having an IP pharmacist in each community pharmacy, so that patients can consistently access enhanced clinical services.
The advances we’re making in digital and pharmacogenomics in Wales are also really exciting.
We also had the launch of the hospital pharmacy review, which will give us a more focused vision around hospital pharmacy clinical services and how we can move forward together, collectively, around a vision in Wales.
Are there any targets that pharmacies are finding more challenging than expected?
We would have been a few years ahead of the work we’re doing around the vision for hospital pharmacy were it not for the pandemic.
Workforce is a challenge across the UK. Within Wales, there are some pockets where there’s less of an issue and some areas, particularly in rural communities, where it may be more difficult to attract and retain members of the profession.
Is there anything around rural workforce problems that you think the Royal Pharmaceutical Society could help with?
That is a particular challenge for Wales because of the rurality of large areas of the country. There’s been a school of pharmacy in Cardiff for 100 years and, more recently, we’ve seen the school of pharmacy in Swansea come online, which will serve south-west Wales in terms of those opportunities.
We’re quite excited in north Wales, where I work, that we’re on the journey to open a school of pharmacy in Bangor. There may be people who’ve grown up in rural areas who never wanted to move away from them, particularly if they’re Welsh speaking, so the opportunity to have a school of pharmacy in north-west Wales, where people from the community can be supported to enter the profession, is hugely exciting.
I’m sure there’ll be some offers around Welsh language there as well, which is really important, so that we have practitioners who can speak to members of the community in their first language to better understand their health needs. I think that will help us tackle our workforce challenges in the long term. It will be a few years before we have graduates come through, but we may start to attract different people into the region if they want to have roles connected with the school of pharmacy.
In the ‘Prescribing progress: transforming clinical hospital pharmacy in Wales for enhanced patient care’ report, there are 36 recommendations for enhanced patient care. What do you think the top priorities for the Welsh government should be?
The number one priority for me would be the recommendation of having pharmacy professionals in each of the multidisciplinary teams (MDTs). The value that members of our profession bring to the MDT and to patients who are cared for by the MDT is tremendous, and bringing that expertise around medicines is critical. It’s clearly not a quick win, but it’s something that we need to be actively working towards.
How do you think the development of pharmacogenomics services could change pharmacists’ day-to-day practice?
Patients will be able to be offered treatment that’s tailored to them as individuals to help them experience less adverse effects and get better outcomes from medicines. Sometimes what happens is a patient gets a diagnosis and the treatment guidelines say start with treatment A and then if they don’t respond, you go to treatment B and then if they don’t respond, you go to treatment C. Pharmacogenomics might tell us straight away that, for this patient in front of you, treatment C is going to be the right option, so it will help shorten the journey from diagnosis to effective treatment and avoid the period of either ineffective treatment or experiencing unwanted effects.
These test results are going to impact on what decisions pharmacists need to make with the patient about their treatment. There’s a lot of work that needs to happen to underpin that. We need to have things like the clinical guidance and digital technology in place, so that practitioners are presented with something meaningful that they can discuss with patients. We can’t expect everybody to undertake a Master’s in pharmacogenomics to be able to interpret the nuances of metaboliser status and apply it to different patients and medicine. The work needs to happen to make that information meaningful to healthcare professionals and patients.
The government’s been working on implementing an electronic prescribing system for pharmacies. How is that progressing?
We’re starting to see some proof-of-concept trials of transmitting electronic prescriptions from a GP practice to a community pharmacy. The key to this is having the systems in general practice and the systems in community pharmacy be developed in such a way that they can talk to each other. Funding has been made available for system providers to do that work.
I’m closely involved with the electronic prescribing medicines in administration programme. All the health boards in Wales and the trusts are going through the process of going out to tender to purchase their electronic prescribing and medicines administration systems. Some have already done that and are working to award contracts and others will be coming online in the coming months. It’s all happening at real pace and it’s going to be a huge transformation.
We’re also going to be creating the shared medicines record, which will collect together patients’ medicines data and their medicines information from the different digital systems, so that we’ll have a single patient medicines record, and patients will be able to have access to that information and add information into it through an app.
What work is RPS Wales doing to engage with the Senedd?
We’ve been having sessions in the Senedd, where RPS staff, RPS board members and RPS members who are experts in certain areas engage in meaningful, deep conversations on important topics, such as sustainability, workforce wellbeing and the role of pharmacists in chronic conditions.
We’re also trying to take members of the Senedd out to see pharmacists in practice so they start to understand more about what the profession can offer patients. We were really pleased that there was a speech on World Pharmacists Day on the floor of the Senedd in support of pharmacists.
Do you have a closing message for readers?
I would encourage members of the pharmacy profession to consider how they can contribute to the professional leadership agenda, so that we can spread the message more strongly about what pharmacy professionals are able to contribute to patient care, how we can support the NHS and how we want to move our profession forward to advance those goals.