How Hampshire and Isle of Wight pharmacy teams work together in a system

Hampshire and the Isle of Wight (HIOW) pharmacy teams have a long history of working together on prescribing and medicines optimisation issues. This is partly owing to the previous three area prescribing committees covering the geography, liaising and working closely together to avoid cross-boundary issues for patients, GPs and provider trusts — including mental health, learning disability and community. 

NHS planning guidance, published in 2015, announced the development of sustainability and transformation plans (STPs). Within HIOW, executives then agreed that organisations would work together to develop an STP-wide medicines optimisation plan. This galvanised the pharmacy leads (i.e. clinical commissioning groups, providers, local pharmaceutical committees [LPCs] and the then Academic Health Science Network) to come to together to develop a plan that had the following overarching themes:

• Medicines safety, including shared care, polypharmacy and antimicrobial stewardship;
• Medicines value, including self-care, National Institute for Health and Care Excellence (NICE) implementation, reducing waste and biosimilars;
• Digital, including electronic prescribing and medicines administration, transfers of care around medicines and the electronic prescription service;
• Pharmacy workforce, including clinical pharmacists in GP practices — note this was before primary care networks (PCNs).

The STP work programme set out the principle that organisations would have an ‘open book’ approach to organisations’ prescribing savings plans and early engagement, as well as discussions to avoid a savings plan in one sector adversely affecting another part of the system. There was also an acknowledgement that developments that delivered overall savings for the system might require a transfer of funding between organisations.

The COVID-19 pandemic greatly accelerated the need for pharmacy leaders to work effectively together to address the emerging medicines-related challenges. In December 2020, a collaborative approach was required to effectively introduce the COVID-19 vaccination programme for patients and healthcare workers. This obviously required mutual aid, rapid communication, flexibility and all the expertise and capacity within healthcare teams. 

This need to meet regularly and frequently continued beyond the COVID-19 pandemic. Currently, the HIOW chief pharmacist group currently meet every two weeks. The group includes representatives from all providers, including the ambulance service, LPC, Health Innovation Network (HIN) and specialised commissioning. This group reports to the HIOW Prescribing Committee, which in turn reports to the HIOW Clinical Professional Leadership Group.

The development of a single HIOW Prescribing Committee — which first met in October 2022 — and a single joint medicines formulary proved less contentious than anticipated. Similarly, many of the sub-groups, including medicine safety and antimicrobial stewardship, had already been operating in HIOW and system-wide, which required minimal changes to membership and purpose. We believe that we are now well placed to adopt the single national medicines formulary as recently announced in the NHS ten-year plan.

Developing sustainable aseptic services are also a priority within HIOW, and the University Hospital Southampton is one of the national pathfinder sites. Recognising that services must meet the needs of HIOW — and beyond — the aseptic services development has been included in the HIOW provider collaborative.

Progress and collaboration

Collaboration has developed over time through a long history of effective teamwork and an inclusive approach that involves all stakeholders. 

In the south east of England, work has focused on ensuring groups are complementary and not duplicating work. This has extended to participation in HIOW-wide initiatives beyond medication, such as the HIOW’s ‘signature moves’ on frailty and cardiovascular disease prevention. For frailty, the vision is to create a holistic, integrated and accessible frailty care pathway that empowers individuals to live healthier, more independent lives. For cardiovascular disease, the aim is to improve the cardiovascular health of people living in HIOW. Despite existing efforts, disparities in health outcomes persist across communities, which is driven by unaddressed risk factors such as hypertension, smoking and obesity.

Progress has been supported by chief pharmacists and their teams by working together for a common purpose, including medicines safety, quality, value, analogue-to-digital transition, care closer to home and pharmacy workforce development. Executive leaders — such as chief executives, chief medical officers and chief financial officers — across all organisations have provided support. 

HIN Wessex — particularly through Clare Howard’s leadership on polypharmacy — has contributed to targeted work on opioids and antipsychotics in people with dementia.

We recognise there is more to be done. Good relationships and a collaborative approach at chief pharmacist level need to be cascaded down through all teams. We have also recognised that PCN pharmacy teams and the future neighbourhood health teams need to play a greater role in our collaborative system-wide model.

In my view, there’s something for other systems to learn from, especially around the high level of trust and shared purpose that underpins the approach. While recognising that pressures and tensions between organisations are inevitable, the focus has remained on professionalism, patient-centred priorities and collaboration, rather than hierarchy.