Ask The Experts

For this year’s final edition of the Unlicensed Expert we have gathered the thoughts and opinions of three industry specialists. Our specialists have each answered questions regarding three of the most discussed topics of the year and given their insightful opinions on what they foresee for the next twelve months. Our panel of specialists include Andrew Trouton (Managing Director of UL Medicines), Wendy Smith (Pharmacy Purchasing Manager at the Salford Royal Foundation Trust) and Louise Dark (Chief Pharmacist & Clinical Director of the Lewisham and Greenwich NHS Trust). 


What changes have you seen so far ahead of targets set by the Carter report? What further changes do you envisage for 2018?

Andrew: ‘’As a supplier to hospital pharmacy our observation would be that there has been an enormous amount of effort put into planning and structurally how to address the challenges  identified by Carter. Each Trust has had to draw up a Hospital Pharmacy Transformation Programme which will ultimately lead to more pharmacy technicians and pharmacists spending more time on patient facing medicine optimisation activities. So far we haven’t seen a change in the personnel our customer service and account management teams deal with on a day to basis but I sense this is gradual and is coming.’’

Wendy: ‘’At SRFT (in conjunction with other trusts) we are in the process of looking at the whole of pharmacy procurement across the North West. Continuous workshops are held monthly with the Chief pharmacists for each Trust. Ongoing projects are looking at reducing deliveries and reducing stock holding and the possibility of a central store.’’

Louise: ‘’Acute Trusts have now moved into the implementation phase of their HPTP plans which has shown a change in the workforce; with professional groups taking on different roles to support the enhanced clinical role of the pharmacist such as technician led dispensaries, removing the need for pharmacists to be present and stock management at ward level being solely managed by assistants. The role of each professional group will continue to expand as changes become embedded and as digital technology enables us to work differently.

There has also been a step change in collaboration across STP healthcare interfaces, with pharmacy professionals starting to work more closely together to ensure appropriate pharmacy intervention at each stage of the patient pathway to improve patient outcomes and reduce risk associated with transfer of care.

These changes require us to ensure that the workforce is equipped with the knowledge and skills to work across interfaces and in South East London we have initiated a training scheme with Health Education England between community pharmacy, secondary care and GP practices.

Collaboration is also giving us the opportunity to reduce unwarranted variation and increase efficiency by reviewing the services provided across the STP to see if there are any opportunities for centralisation /sharing of resources such as medicines procurement, distribution and aseptic services.’’


What are the biggest challenges hospital pharmacies will face in the coming year? 

Andrew: Implementing these plans, making them happened and realising the savings identified by the Carter report will be without doubt the biggest challenge, that is going to be tough, and if it is to succeed will require some dramatic changes in working practices. In addition the ongoing squeeze on public sector pay and expenditure will continue to make attracting and retaining the best staff a challenge. On top of all of these there are also some big changes coming, with a lot of uncertainty around them, in particular Brexit and the impact on our regulatory environment and the introduction of the serialisation linked to the Falsified Medicines Directive.

Wendy: ‘’Probably costs of implementing new systems, staff shortages and supply issues. As we are to move to longer working hours and days this doesn’t work in the outside world of suppliers and purchasing can be quite restricted.’’

Louise: ‘’Alongside the financial challenge which is pressing for all we need to ensure we are maximising the value patients are deriving from their medicines. This includes supporting patients to have greater control and ownership of their medicines which will increase adherence and reduce hospital admissions and we need to support national agendas such as polypharmacy and antimicrobial resistance.

We also need to move further forward on 7 day services and embrace digital technology to determine how we can use it to optimise our working practices and improve medication safety.‘’


What challenges do you foresee arising from the falsified medicines directive being introduced? 

Andrew: There is generally a low level of awareness of the implications of the Falsified Medicines Directive, especially within pharmacy. Across the wider supply chain, whilst there is a lot of focus on the introduction of serialisation many players, both manufacturers and wholesalers, are coming to this very late in the day given the regulations will come into force February 2019. All pharmacies will be required to be able to check, via a scan of a unique 2-D matrix code on a pack, that they have a legitimate pack. In order to do this they will be required have the necessary equipment and link to the national hubs within the EU database. What happens here in relation to Brexit which is due to follow later in 2019 is even more of an unknown.