ucl school of pharmacy brunswick square educating pharmacists for the future science, practice and...

UCL SCHOOL OF PHARMACYBRUNSWICK SQUARE

Educating Pharmacists for the FutureScience, Practice and the Patient

Professor Duncan Q.M. Craig

Director (Dean)

University College London School of Pharmacy, UK


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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1) An Introduction to UCL and the UCL School of Pharmacy

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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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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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Located in heart of London in an easily accessible and attractive region

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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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Teaching headlines

•Four year MPharm followed by 1 year pre-registration 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!


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


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 2001Recognition of need for continuous training and governance

Stafford Hospital Scandal Inquiry in 2008, The ‘Francis Report’ 2013Recognition of need for ‘humanity’ in health care workers 11


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 12


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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


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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3) Career structures in pharmacy

• Pharmacy is moving away from supply role to a far greater advisory and decision-making 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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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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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 pre-registration training

•There is also increasing emphasis (with us anyway) on experiential learning, interprofessional learning and developing the ‘whole human being’


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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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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


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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Hospital pharmacy – career paths and new opportunities

• 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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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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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:

•cardiology•paediatric care•haematology•quality assurance•medicines information•procurement and distribution•radiopharmacy.


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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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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


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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Emerging opportunities – pharmacists in GP surgeriesEmerging 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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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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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 GPhC-approved 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 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 M.PHARM. DEGREE


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Degree highlights (1)

"Integrated Therapeutics" workshops

• In all years of the course

• Stand outside the subject areas

• 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 andheart 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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Clinical pharmacy teaching

• In all years of the course• Lectures, workshops, professional skills classes, placements

• "Spiral" curriculum and "Miller's triangle"• Increasing complexity and difficulty throughout the years

Year 4

Year 3

Year 2

Year 1Complexity 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

• Six major London teaching hospitals

• 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

• Inter-professional learning• Physicians, pharmacy technicians, nurses


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Research integration and experience

"Advancing practice through science" module in year 4

• 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


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 advisoryroles 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

ucl school of pharmacy brunswick square educating pharmacists for the future science, practice and...

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