Download Educating Pharmacists for the Future Science, Practice

UCL SCHOOL OF PHARMACY
BRUNSWICK SQUARE
Educating Pharmacists for the
Future
Science, Practice and the Patient
Professor Duncan Q.M. Craig
Director (Dean)
University College London
School of Pharmacy, UK
UCL SCHOOL OF PHARMACY
BRUNSWICK SQUARE
Contents
1) An introduction to UCL and the UCL
School of Pharmacy
2) Healthcare and pharmacy in the UK
3) Career structures in pharmacy
4) The MPharm undergraduate degree
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UCL SCHOOL OF PHARMACY
BRUNSWICK SQUARE
1) An Introduction to UCL and the
UCL School of Pharmacy
University College London (UCL)
Founded in 1826 as the London University,
UCL was remarkable for its egalitarian
approach to recruitment
Currently ranked 7th worldwide (QS 2015)
Student numbers are around 29,000
4000 academic and research staff, 650
professors (highest in UK)
32 Nobel Prize winners, most recent in 2014
(Professor John O’Keefe)
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UCL SCHOOL OF PHARMACY
BRUNSWICK SQUARE
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UCL SCHOOL OF PHARMACY
BRUNSWICK SQUARE
The UCL School of Pharmacy
• Created in 1842 as the “School of Pharmacy of
the Pharmaceutical Society of Great Britain”
• In 1926, it was incorporated into the University
of London and was known as the School of
Pharmacy, University of London (“The
Square”)
• In 2012 became part of University College
London
• Currently ranked 5th worldwide for pharmacy
and pharmacology (QS 2015)
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UCL SCHOOL OF PHARMACY
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Located in heart of London in an easily accessible and attractive region
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UCL SCHOOL OF PHARMACY
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Research headlines
87% of research judged world leading or internationally excellent in
recent Research Excellence Framework
• Drug discovery – focus on low molecular weight drugs for cancer and
neurological disease, incorporates the UCL Drug Discovery unit
• Drug delivery – nanofabrication and nanotechnology, dosage form
design, paediatric medicines
• Pharmacology – neuroscience, genetic basis of neurological disease
and gene therapy for neurological conditions, translational
neuroscience
• Pharmacy practice and – drug safety, pharmacoepidemiology,
PKPD, psychology of medicines usage
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UCL SCHOOL OF PHARMACY
BRUNSWICK SQUARE
Teaching headlines
• Four year MPharm followed by 1 year preregistration before joining register (200
students/annum)
• New course introduced in 2013, emphasis on
integrating science and practice
• Particular strengths in relationships with
partners in practice, Greenlight Pharmacy,
hospital trusts
• Also increasingly embracing new TEL
approaches
• High quality students!
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UCL SCHOOL OF PHARMACY
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Masters courses
In addition to our undergraduate degree we have a suite of masters
courses (1 year)
These include the following:
• MSc in Clinical Pharmacy, International Practice and Policy
• MSc in Pharmaceutics
• MSc in Pharmaceutical Formulation and Entrepeneurship
• MSc in Experimental Pharmacology and Therapeutics
• MSc in Drug Discovery and Development
• MSc in Drug Discovery with Pharma Management
• MSc in Medicinal Natural Products and Phystochemistry
• Master of Research in Drug Sciences
UCL SCHOOL OF PHARMACY
BRUNSWICK SQUARE
2) Healthcare and pharmacy in the UK
The bottom line – pharmacists are moving away
from supply role to becoming integral member of
healthcare advisory team
The National Health Service
Established following the Beveridge Report after
World War 2
Implemented in 1948 on basis of free treatment to all
Still very largely the case now but prescription
charges one notable exception
Funded largely by taxation, although private
healthcare is also readily available to those willing to
pay
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Drivers for change
1984-1995 ‘Heart scandal’
Kennedy report 2001
Recognition of need for
continuous training and
governance
Stafford Hospital Scandal
Inquiry in 2008, The ‘Francis Report’
2013
Recognition of need for ‘humanity’ in
health care workers
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Then came Dr Harold Shipman
Killed at least 215 of his patients, mostly
elderly women; usually via diamorphine
overdose (up to 459 possible)
Some cases involved forging of wills, but
for majority no motive was ever identified
Detected by undertaker noticing large
number of cremations
Died in his cell in 2004
The (indirect) result – health care professions were no longer allowed
to have a leadership AND regulatory role (emphatically including
pharmacy). Proper regulation and observation could have prevented
many deaths
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UCL SCHOOL OF PHARMACY
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The net result
Health care professions seen much more as a holistic whole
Regulation and patient safety and welfare pushed to the top of the
agenda
These issues have also led to a complete overhaul of the regulatory and
leadership structure of the pharmacy profession
For pharmacy this has arguably presented us with a significant
opportunity to redefine our role
This also means that we need to instil professional values into our
undergraduates from day 1
It also means that we need to have programmes of continuing
education throughout pharmacist careers
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Royal Pharmaceutical Society of Great Britain
• Scandals resulted in health professions no
longer being allowed to regulate themselves
• Royal Pharmaceutical Society previously
were responsible for leadership, registration
and regulation
• In 2011 the regulation and registration role
was removed, leaving only professional
leadership
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General Pharmaceutical Council
• Came into force in 2011
• Responsible for regulation of profession and
ensuring standards are met
• Responsible for maintaining the register
• Role to ensure that undergraduate curriculum is
fit for purpose
• Chaired by non-pharmacist, completely separate
from vested interests
• Degree accreditation, premises registration and
CPD (Continuing Professional Development)
• CPD now compulsory for all registered
pharmacists
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UCL SCHOOL OF PHARMACY
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3) Career structures in pharmacy
• Pharmacy is moving away from supply
role to a far greater advisory and decisionmaking role
• This is well established in the hospital
sector but is rapidly becoming more so in
community pharmacy
• UK pharmacists are facing an
unprecedented opportunity to redefine
their role and secure the future of the
profession
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BRUNSWICK SQUARE
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UCL SCHOOL OF PHARMACY
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Pharmacy as a profession
Classic roles for pharmacists in UK are
•community pharmacy (circa 70%)
•hospital pharmacy (circa 25%)
•industry and academia (circa 5%)
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UCL SCHOOL OF PHARMACY
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Pharmacy as a degree
•The current degree is an ‘Integrated
Masters’
•The first three years are Batchelor’s
degree and fourth year is Masters level
•The qualification is MPharm (Master of
Pharmacy)
•Currently followed by one year preregistration training
•There is also increasing emphasis (with
us anyway) on experiential learning,
interprofessional learning and developing
the ‘whole human being’
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UCL SCHOOL OF PHARMACY
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Community pharmacy – an
emerging force for change
Traditionally the role of the community
pharmacist has been to supply
medications, check prescription errors,
provide immediate (and free) advice, plus
a range of additional supply services
However in modern community
pharmacies the role has been extended
considerably
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UCL SCHOOL OF PHARMACY
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The modern community pharmacy is involved
in some or all of the following:
•diagnosis and treatment of minor ailments
•offering smoking cessation advice and
services
•alcohol management advice
•monitoring blood pressure and cholesterol
levels
•preparing dosette and cassette boxes
•offering a diabetes screening service
•offering travel vaccination and advice services
Huge ‘unofficial’ screening service to alleviate
pressure on general practitioners
(remuneration is an issue for debate)
“Healthy living pharmacies” – advanced
service status being rolled out in UK
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Commissioning of services
Four advanced services agreed which
pharmacists may engage with and be
remunerated for
•Appliance use review
•Medicines use review
•New medicine service (developed at UCL
SOP)
•Stoma appliance customisation
Likely that this type of commissioning will
increase in the future and start to replace
supply role
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UCL SCHOOL OF PHARMACY
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Hospital pharmacy – career paths and new opportunities
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Traditionally the role in hospital was not
dissimilar to community
Supply of medication, prescription
monitoring, patient advice, medicines advice
centres, contribution to prescription practices
However the role in hospital has changed
considerably
Now the norm to move into specialisation
(with postgraduate qualifications also now
more or less essential for career progression)
This has resulted in new opportunities but
need for constant upskilling
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Taken from
Central
Manchester
University
Hospital
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UCL SCHOOL OF PHARMACY
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Typically on entering the hospital sector
following registration, a pharmacist will be
Grade 6 and will be on series of rotations
These may include
• clinical pharmacy
• medicines information
• medicines management
• aseptic/technical services
• dispensary services
• community pharmacy services
• radiopharmacy
• clinical trials
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UCL SCHOOL OF PHARMACY
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After two to three years' experience,
pharmacists may apply for a Band 7
pharmacist position.
Usually a rotational role but with more
emphasis on specialising in a chosen area
of pharmacy practice
These may include:
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cardiology
paediatric care
haematology
quality assurance
medicines information
procurement and distribution
radiopharmacy.
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UCL SCHOOL OF PHARMACY
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Example – the antibiotic
pharmacist
Shrewsbury and Telford Hospital Trust cite
the following duties
• educating pharmacy, nursing and medical
staff
• auditing prescribing patterns and trends
• monitoring antibiotic use
• reviewing antibiotic prescribing to reduce
and manage the development of antibiotic
resistance
• ensuring compliance with good antibiotic
practices
• managing infection control issues,
All of which contribute to reducing hospital
associated infections
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UCL SCHOOL OF PHARMACY
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Example – the Intensive Care Unit
pharmacist
Dealing with critically ill patients requires
multidisciplinary approach
Pharmacist interventions include
• correcting/clarifying orders
• providing drug information
• suggesting alternative therapies
• identifying drug interactions
• therapeutic drug monitoring
• optimising fluid management
• reductions in the rates of adverse drug
events, medication administration errors,
and ventilator-associated pneumonia.
Furthermore, economic evaluations indicate
considerable cost savings
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UCL SCHOOL OF PHARMACY
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Consultant pharmacists
NHS ratified positions of advanced
pharmaceutical care revolving around four
principles
•Expert practice
•Research, evaluation and service development
•Education, mentoring and overview of practice
•Professional leadership
Idea is to develop group of pharmacists with
both expertise and leadership to take clinical
pharmacy forward
e.g. Dr Cathy Mackenzie – consultant
pharmacist in Guys/St Thomas’ Hospital
Intensive Care Unit. Key part of ICU team.
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Pharmacist prescribing
• Legislation introduced in 2006 to allow
pharmacists to prescribe prescription only
medicines
• Pharmacist must train on a GPhC approved
course
• A pharmacist independent prescriber may
prescribe autonomously for any condition within
their clinical competence
• Areas of specialisation identified and skills
developed to allow safe prescribing
So for example, Cathy Mackenzie regularly
prescribes antimicrobials, sedatives and
analgesics, usually in consultation with intensivist
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UCL SCHOOL OF PHARMACY
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Emerging opportunities – pharmacists in GP surgeries
Emerging role for pharmacists in helping GPs to manage their surgeries –
NOT a supply role
Current roles include
• Management of chronic conditions
• Home visits
• Monitoring repeat prescribing
• Safer management of patient on high risk medication e.g. MTX and
NTI drugs
• Act as a liaison between all healthcare interfaces – particularly safer
medicines reconciliation
Increased efficiencies means these pharmacists pay for themselves
Vision for surgeries to have doctor, pharmacist and nurse and patients
choose which they want to see
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UCL SCHOOL OF PHARMACY
BRUNSWICK SQUARE
Emerging opportunities – pharmacists in specialist
clinics/services
• Clinics with specialisation in specific
condition and associated medications
• E.g. Anticoagulation Clinics - a service
established to monitor and manage
warfarin and related medications
• Typically located within a hospital or a
medical office that is staffed or
associated with pharmacists.
• The pharmacist, working in conjunction
with the physician, will check blood, test
and adjust dose of warfarin as well as
other medicines that may be needed
• May also use community pharmacists for
this service
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UCL SCHOOL OF PHARMACY
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Emerging opportunities – new healthcare technologies
As new ideas for healthcare science come to the patient, the pharmacist
is ideally suited to become involved due to combination of science and
clinical skills
• Personalised medicine
• Gene therapy
• Combination therapies
• Drug-loaded implants and tissue regeneration materials
There is a drive (which UCL SOP enthusiastically support) to produce
‘research ready pharmacists’ who can take an active role in evaluations
and research projects to build evidence base for pharmacy
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4) The MPharm Undergraduate Degree
To become a qualified pharmacist, a student needs to:
• Successfully complete an accredited M.Pharm. degree at a UK
university
• Successfully complete one year's pre-registration training at GPhCapproved premises
• Pass the GPhC registration exam
M.Pharm. degree
• 4 years full-time
• Discussions ongoing to integrate the 4 year degree with the year long
pre-registration training
Pre-registration training / exam
• One year, with at least 6-months of patient-facing training
• Final exam
• Managed by the GPhC
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UCL SCHOOL OF PHARMACY
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UCL School of Pharmacy M.Pharm
Degree
Key philosophy
• Science and clinical practice need to be
integrated so that students can see how
the science feeds in to patient care
• We need to develop the students as
people as well as repositories of
knowledge
• Increasing trend for student involvement in
decision making
• Increasing trend for clinical placements,
interprofessional learning and patient
exposure
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UCL SCHOOL OF PHARMACY
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UCL M.PHARM. DEGREE
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UCL SCHOOL OF PHARMACY
BRUNSWICK SQUARE
Degree highlights (1)
"Integrated Therapeutics" workshops
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In all years of the course
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Stand outside the subject areas
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Example from year 1:
You are a community pharmacist providing services to a nursing
home for elderly residents. Many of these patients take dispersible
aspirin 75 mg 1 od. To save time on the drug rounds, the manager
has taken to making a large batch of solution from aspirin tablets once
a week and using this to dose the patients.
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i) Why are these patients taking aspirin 75 mg 1 od? Hint: NICE guidelines.
Secondary prevention of heart attacks and strokes
* Clinical pharmacy and therapeutics
* Underpinning biology and disease processes
ii) The patients tell you that the aspirin solution tastes of vinegar and is
unpleasant. Using appropriate chemical diagrams, explain the chemistry
behind this observation.
* Chemistry

+ CH3CH2OH
iii) What is the therapeutic significance to the patient of the manager's
actions?
Aspirin has degraded  no therapeutic effect  higher risk of strokes and
heart attacks
* Clinical pharmacy and therapeutics
* Importance of fundamental chemistry to drug action
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iv) As a pharmaceutical scientist, you are intrigued about the kinetics of the
process and do an investigative experiment on the stability of aspirin in
water.
Pseudo-first order reaction.
t90% is less than 1 day
* Chemistry
* Calculations and data interpretation
* Importance of fundamental chemistry
to therapeutic effect
v) What would you say to the manager of the nursing home?
His/her actions are inappropriate and will lead to problems for the patient.
Explain the issues and the correct actions.
* Communication skills
* Role of the community pharmacist
* Importance of the social framework for patient-pharmacist interaction
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UCL SCHOOL OF PHARMACY
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Degree highlights (2)
Clinical pharmacy teaching
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In all years of the course
• Lectures, workshops, professional skills classes, placements
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"Spiral" curriculum and "Miller's triangle"
• Increasing complexity and difficulty throughout the years
Year 4
Year 3
Year 2
Year 1
Complexity and
difficulty
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Community pharmacy placements - "Green Light" and "Pharmacy Live"
• Fully functional community pharmacy
• Integrated teaching zone
• Medicines Use Reviews, New Medicines Service, Travel Health
clinics, Vaccinations, Methadone supply, Needle exchange, Smoking
cessation clinics, NHS Health Checks
• Winner of the Health Education North Central and East London
Quality Award 2014 for Collaboration and Partnership in Education
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Hospital pharmacy placements
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Six major London teaching hospitals
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The patient journey through a hospital stay
In-patient and out-patient dispensary operations
Ward pharmacy
Clinical pharmacy
Medicines Information
Specialist roles, eg sterile products, radiopharmacy
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Inter-professional learning
• Physicians, pharmacy technicians, nurses
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UCL SCHOOL OF PHARMACY
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Degree highlights (3)
Research integration and experience
"Advancing practice through science" module in
year 4
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No fixed syllabus
Whatever is new and likely to have an impact
on pharmacy practice in its broadest sense
"Topic specialisation" - student-centred learning
including flipped classrooms
Research project in year 4
• Individual project - at SOP or outside
• Research paper (not mini-thesis), poster
conference and portfolio
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UCL SCHOOL OF PHARMACY
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Concluding comments
To maximise patient benefit and take advantage of the possibilities for the
expanded role of the pharmacist, we need to train our students to have
the skills required for the future
UK Pharmacy education is based on the expanding clinical and advisory
roles of pharmacists
Full integration of underpinning science and pharmacy practice so that
pharmacy graduates should be prepared to cope with any future
developments in science or practice
New emphasis on soft skills such as ability to communicate, empathise
and take responsibility for patient care