Reengineering Mental Health pharmacy services in line with the patient pathway

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Re-engineering Mental Health pharmacy services in
line with the patient pathway

• Ian Maidment,
• Senior Pharmacist,
• Kent Medway NHS Partnership Trust.
• Honorary Senior Lecturer, University of Kent.
• Chair, UKPPG

• Bev Faulkner
• Pharmacy Services Manager
• Oxfordshire Buckinghamshire Mental Health
  Partnership NHS Trust

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• Background
• Re-engineering roles
• Pharmacist
• Pharmacy Technicians Bev Faulkner
• Summary

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Background

• Historically - large institutions 1000-2000 beds
• Pharmacy historically in-house
• Since 1960 Mental Health re-configured community
  service
• NSF MH guidelines establishing community teams
  AOT, CRHT, EIP (DoH, 1999)
• Complex medicine management community
• On closure pharmacy service mergered acute trust
• Mental Health Pharmacy esp. clinical largely
  ignored
• National Reports e.g. NSF (DoH, 1999)

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• Numerous reports last 2 years
• Healthcare Commission report (Healthcare
  Commission, 2007)
• Pharmacy Manpower Survey (Branford et al, 2006)
• Sainsbury report (Boardman, 2007)
• New Ways of Working reports
  (DoH, 2005 NIMHE, 2007)

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Healthcare Commission - 07

• Medicines management at low level MHTs
• Low levels of mental health pharmacy staffing
• Particularly fewer assistants and technicians
• No active Mental Health Pharmacist Supplementary
  prescribers
• Need for New Ways of Working
• Service pre-dominantly via Service Level
  Agreement (SLA)
• Low levels clinical pharmacy compared
  non-psychiatric wards

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Workforce Survey 06

• Questionnaire developed with Bath University
• Survey workforce and issues in MH pharmacy
• Chief Pharmacists - 50 response
• Key findings
• Wide range staff establishments
• Mental Health particularly clinical not viewed
  priority if via SLA
• What about Pharmacy service community teams?

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The Pharmacy WMD
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MH Pharmacist in CMHTs

• Average trust
• 25 established teams
• 6-8 newly established teams since 2000
• Trusts providing any clinical pharmacy service
  to any team
• Established teams - Adult Older Adult CMHT
  6.8
• New teams established last 3-4 years e.g.
  assertive outreach, crisis team - 9.5
• Very few community teams including newly
  commissioned clinical pharmacy input

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Sainsbury Report 07

• Sainsbury Centre - very influential Mental health
• Produced document outlining staff required
  deliver DoH policies 2010/11
• Original draft no mention pharmacy
• UKPPG submitted response draft
• Mental health Pharmacy workforce zero original
  draft
• 1286 pharmacists
• 907 pharmacy technicians
• ? workforce x 4 - current UKPPG numbers 650.

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NWW in MHTs 05, 07

• 2 publications - General document Pharmacy
  specific
• Changing role of Consultant Psychiatrist
• Consultants concentrate complex cases
• Professional Leadership - Acting as consultants
• Developing other staff groups routine care
• NWW for Pharmacy
• Developing pharmacist prescribing
• Integrate pharmacist clinical teams especially
  community
• But, lack trained staff

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Re-engineering Pharmacist workforce

• DH/NWW medicines management collaborative
• Mental Health Medicines Management Self
  Assessment Toolkit
• Developing leadership Medicines Management Mental
  Health
• Service Level Agreements (SLAs)
• Extending role Pharmacy Technicians
• Two engineering issues
• 1. Training - lack of trained workforce
• 2. Clinical service community teams
• Develop collaborative relationships acute trusts,
  PCTs, HEIs

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Training Key

• Exposure under-graduate level
• 25 all scripts psychotropics
• Pre-reg programme
• Joint programmes
• New scheme - Norfolk pre-regs 4 months community
  pharmacy, mental health and acute trusts
• Mandatory component all Pre-regs
• Kent, Sussex, Surrey MHTs with South East
  Medicines Management Education (SEMMED)
  developed mandatory 1/52

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Developing future workforce

• Post-registration training
• Develop rounded pharmacists
• Recommend pharmacist specialise late 20s
• Good clinical general training
• Opportunity experience MH
• Older People, Neurology, Community sector
• Rotation programmes
• London Trusts - STEP (Structured Training
  Experience for Pharmacists) with MH rotation

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Pharmacists in CMHTs

• Organisational structure must support service
• MH community based service
• Re-engineering existing posts
• New posts
• East Kent - new CHTT
• 0.5 WTE Pharmacist
• Roles - MDT meetings, DVs , medication man.
  protocols, education training, carers groups
• Innovation all CMHTs clinical pharmacist

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Future developments

• Pharmacy workforce primary care
• Evidence primary care pharmacists lack MH
  clinical skills (Phokeo et al, 2004)
• Clinical expertise exists secondary care
• Service moving community / primary care based
• Secondary care expertise must not be lost
• Act training resource develop community based
  practitioners
• Accreditation supervision PhWSI (?)

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• Technicians
• Background - Same
• Objectives - Same
• Situation - Similar
• Barriers - Similar

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NWW for Pharmacy Technicians in Mental Health

• Identified potential new ways of working.
• Identified existing ways of working.
• Identified possible barriers to developing new
  ways of working.

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Identified 9 key roles for technicians which

• Ensures parity for patients wherever the setting.
• Follows the patient through the various care
  settings and maintains accessibility to
  specialist pharmaceutical care.

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Potential barriers

• Staff numbers
• Career development
• Service Level Agreements
• Training

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Summary

• Service for Mental Health changed radically
• Community based
• Pharmacy service re-engineered align with service
  provision.
• Innovative links with Primary Care Pharmacists
  required
• Training requires re-engineering

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• References
• Boardman J, Parsonage M - The Sainsbury Centre
  for Mental Health. 2007. Delivering the
  Governments Mental Health Policies services,
  staffing and costs. www.scmh.org.uk/80256FBD004F35
  55/vWeb/flKHAL6XCFP9/file/scmh_delivering_govt_me
  ntal_health_policy.pdf (accessed 31st Aug 2007).
• Branford D, Parton G, Taylor DA, Sutton J.
  Summary and Key Findings Report on the MH and
  LD Secondary Care Pharmacy Workforce. UKPPG
  conference. 2006.
• Department of Health. National Service Framework
  for Mental Health. London The Stationary Office.
  1999.
• Department of Health. New ways of working for
  psychiatrists Enhancing effective,
  person-centred services through new ways of
  working in multidisciplinary and multiagency
  contexts. The Stationary Office. 2005.
• Healthcare Commission. Talking about medicines
  a report on the management of medicines in trusts
  providing mental health services. 2007.
  www.healthcarecommission.org.uk/_db/_documents/Tal
  king_about_medicines_mental_health_trust_report_20
  0701113216.pdf (accessed 31st Aug 2007).
• National Institute for Mental Health in England.
  New Ways of Working for Mental Health Pharmacists
  and Other Pharmacy Staff. October 2007.
• Phokeo V et al. Community Pharmacists attitudes
  toward and professional interactions with users
  of psychiatric medication. Psychiatric Services
  2004.

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