Summary
Within dermatology there is a small cohort of secondary care pharmacists with varied additional responsibilities, whether for high-cost medicines, prescribing, NHS England or Getting It Right First Time (GIRFT) involvement. These highly specialised and experienced pharmacists have little interaction with others in similar roles, with no opportunity to share best practice or training support at national, regional or local levels. The development of the National Specialist Dermatology Pharmacist steering group has recognised this need and created a platform where common training requirements are identified and met. Best practice is shared, with a group ethos of taking back learnings to develop further locally and continuously improve national standards of care. The group is driving for Royal Pharmaceutical Society accreditation. A wider group of pharmacists has been identified and an annual conference will provide high value education and training support across the dermatology portfolio. The aim is to innovate, improve standards, provide education, offer networking, grow confidence and, ultimately, improve outcomes for dermatology patients.
Method
The first meeting, held in January 2020, involved five specialist dermatology pharmacists from Liverpool, Chester, Kettering, London and Oxford. Its purpose was to ratify the need, map out direction and gain input from all members to shape strategies and outputs. A work plan was developed, based on three key themes: clinical support and education; consistency, and to raise the profile of the dermatology pharmacist. The group decided on three steering group meetings each year and one annual conference. A network of NHS pharmacists already existed as an email group for sharing best practice and support, but it had no formal objectives or Chair. The steering group would include this wider group and hold an annual conference for all pharmacists. Each steering group member would take the lead on a different aspect, including NHS England updates, GIRFT, Clinical Reference Group (CRG), improving pathways, individual funding requests (IFR) and business cases, therapy education, and ‘specials’ updates. Agreement was made to compile a list of specials that were routinely used, and those no longer used, which would result in a consistent list with the British Association of Dermatologists (BAD), reducing waste and ensuring availability of product to patients and consistent cost to the NHS.
Results
The network group is working to improve care through pharmacy in dermatology. Improved therapy education focuses on Hidradenitis suppurativa (HS), Pyoderma gangrenosum (PG), biologics in psoriasis, pathway development, writing business cases, IFR streaming, and specials manufacturing in line with BAD. These topics have been presented and discussed: new models of medicines delivery; an overview of atopic dermatitis; joint assessment in psoriasis; a review of challenges through teleconsultation; outcome-based learning ideas; clinician, patient and commissioner values when treating psoriasis; understanding network meta-analysis (NMA) and BAD guidance update, as well as the specials collaborative task. Upskilling has been achieved through sharing best practice. There has been focus on the Dermatology Specials List, including regulation of manufacturers, quality products, reduced waste, availability of product to patients and consistent cost to the NHS. Virtual management of patients at home has helped the NHS by operating more effectively and safely than before. The group has supported pharmacists to continue to perform clinics. The Chair of the group, being a regional homecare lead pharmacist, has helped specialist pharmacists to maximise homecare delivery and speed up the delivery process to ensure patients received their first medication on time. The forum has allowed more streamlined processes to be shared, making the homecare pathway more efficient than Trusts’ internal processes. This has improved communication and given patients quicker access to their chosen treatment.
Sustainability and Spread
There is a collaboration and funding agreement in place with LEO Pharma if any funding is required for event hire. There is a low financial burden, as the network is free to join. The Network group evolution plan is continuous and allows for pharmacists’ continuing professional development (CPD) and, specifically, dermatology specialist pharmacists’ CPD. Clear and measurable outcomes have been identified and put into a three-year workplan. Stakeholders have been identified and membership is increasing. Pharmacists across England, Scotland and Wales are joining as members and on the steering group. Group meetings have been successful, with positive annual conference evaluation results and significant attendance at meetings, which continued virtually during the pandemic. The national education strategy for pharmacy as a career is to have prescribing pharmacists trained to be hospital pharmacists at band 7. The Pharmacy degree is being developed to ensure pharmacists have the skills to undertake the prescribing course at this level. This means that there will be increasing numbers of prescribing pharmacists, especially in dermatology, as the need is evident. The platform will maintain and increase the knowledge and confidence of these future pharmacists. The group will provide education on the many new molecules that are being introduced in dermatology. Homecare will be given more credit as it aligns with the goal of providing care closer to home, as well as during pandemic restrictions. The National GIRFT report for dermatology recommends that developing the dermatology expertise of pharmacists, potentially to consultant pharmacists, offers a way to meet the increasing dermatology workload. The group will create a database of members, provide quarterly updates, and has the scope to create a quarterly newsletter to publish on the Specialist Pharmacy Service website, with appropriate buy-in and resource. The NHS.net network is already set up for dermatology pharmacists. There are an additional 55 pharmacists on this network where protocols and information are posted. The initial network steering group has grown to 11 members, with Scottish, Welsh and English involvement, and the hope is that a colleague from Northern Ireland will take up the twelfth seat. The longer-term aim is to reach out to the Royal Pharmaceutical Society of Great Britain (RPSGB) to obtain national accreditation and endorsement.
