Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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Support services for pharmacists and doctors in the United Kingdom – Part 5 National Clinical Assessment Service

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

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Kay Dunkley is a pharmacist who has worked in hospital and organisational pharmacy for over 20 years.  She has a broad experience working in public hospitals and in providing support to health professionals through government funded bodies and professional organisations.  Kay also has a strong interest in the health and well being of health professionals and especially the role of peer support.  Kay first became involved as a volunteer with the Pharmacists’ Support Service, a group which has been providing telephone support for pharmacists in Victoria since 1995.  In 2005 Kay became the Program Coordinator for the Pharmacists’ Support Service and has assisted the service to become an independent organisation which is currently seeking to expand to provide support to pharmacists throughout Australia.  In 2007, when AMA Victoria approached the Pharmaceutical Society of Australia (Victorian Branch) with a view to establishing their own Peer Support Service; Kay accepted an invitation to assist.  The AMA Victoria Peer Support Service commenced operation in February 2008.  Kay currently coordinates both of these services and also works part-time as a consultant pharmacist in Residential Care Facilities.

In Australia the Pharmacists’ Support Service (PSS) provides a listening ear and support over the telephone to pharmacists in Victoria, Tasmania, South Australia and the Northern Territory and has plans for expansion to all states of Australia.  The medical profession in Australia has a range of state based Doctors’ Health Advisory Services including the AMA Victoria Peer Support Service which provides peer support over the telephone.  Victorian is the only state to have a state based health program for doctors; the Victorian Doctors Health Program (VDHP).  At present the Medical Board of Australia is undertaking a consultation with the medical profession considering if doctors are willing to pay a levy on their registration to fund health programs for doctors throughout Australia.  If this proposal proceeds it may set a precedent which the pharmacy profession can follow.

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Funding from the Cyril Tonkin Fellowship enabled me to undertake a study tour of services which support pharmacists and doctors in the United Kingdom (UK) in March 2011.  The aim of the visit was to find out how these services support the health and well being of pharmacists and doctors, including the services provided and how they are funded.

The support services visited were Pharmacist Support, including participation in a Listening Friends training weekend; the Royal Pharmaceutical Society; the Practitioner Health Programme; the Royal Medical Benevolent Fund; the British Medical Association Doctors for Doctors program and the National Clinical Assessment Service.  In addition to obtain background material on the environment for health professionals in the United Kingdom visits were also made to the General Pharmaceutical Council; Manchester University School of Pharmacy and Pharmaceutical Sciences and the Pharmacy Department of the Central Manchester University Hospitals NHS Foundation Trust.

 

This is the fifth and final article in a series reporting on my visit and will detail the services available to doctors and pharmacists through the National Clinical Assessment Service.

 

National Clinical Assessment Service

Strictly speaking the National Clinical Assessment Service (NCAS) is not a support agency for health practitioners however it does work with healthcare employers and managers and practitioners to assist in the management of performance issues in the workplace.  In summary the NCAS is the NHS body which provides support for NHS services dealing with staff performance issues.  At present the service extends to medical practitioners, dentists and pharmacists.   It is important to note that in the UK the vast majority of healthcare practitioners are employed under the NHS umbrella and there is minimal private practice for doctors.  Pharmacists who work in community pharmacies are also considered to be NHS employees.  The incentive for establishing this service in the UK was the cost to the NHS of ill health and impairment amongst its employees as well as safety issues for consumers.  There is no equivalent organisation or similar service to the NCAS in Australia.

 

http://www.ncas.nhs.uk/

At the time of my visit the National Clinical Assessment Service (NCAS) was a division of the National Patient Safety Agency.  At the time of writing it is currently changing to be hosted by the National Institute for Health and Clinical Excellence (NICE).  NCAS aims to resolve concerns about professional practice by helping healthcare managers and practitioners to understand, manage and prevent performance concerns.  This service includes general governance questions and managing specific concerns about dentist, doctor or pharmacist performance.  Case management services include:

 

I met with Bill Rial, who was at that time Associate Director (Pharmacy); Helen Dolan, who was an NACS Adviser and pharmacist; and Florence Starr, a Project Support Manager.  Both Bill and Helen are pharmacists.  The following information is a compilation taken from our discussion.

 

Overview

NCAS was established by the Department of Health but works at arms length from the Department.  NCAS was set up as an autonomous division of the National Safety Agency. The organisation is not a regulator and has no statutory power.  There is a multidisciplinary leadership team on the Board.

 

NCAS works to resolve concerns about the practice of doctors, dentists and pharmacists by providing case management services to health care organisations and to individual practitioners.  The aim is to work with all parties to clarify the concerns, understand what is leading to them and make recommendations to help practitioners return to safe practice.

 

The NCAS started its work with doctors in 2001, then dentists in 2004/5 and pharmacists in 2007/8.  In the future nurses may also be included (there are about 600,000 nurses in the UK).

 

NCAS looks at the circumstances of each case rather than the profession itself, there are common drivers behind poor performance across the professions e.g. financial.

 

The NHS organisations and community pharmacy employees provide majority of referrals plus a small number from the General Pharmaceutical Council (GPhC), which is the regulatory body for pharmacists and equivalent to the Pharmacy Board of Australia.  There are also self referrals and inspector encouraged referrals.  It has been a challenge to point out to locum agencies that they have a responsibility to make referrals.  Over 25% of referrals relate to health issues, also workplace pressures are common.

 

Services provided

The NCAS has a phone line service which provides general information and triage on general issues and individual cases.

 

The NCAS also receives direct referrals.  When a referral is received the advisor team collects lots of detail and provides initial advice and a local plan (as averse to regulatory referral).  The whistleblower is equipped to take the situation forward.  NCAS may make a follow-up call.  NCAS can also deal with an individual health professional.  It is the intention of NCAS to keep professional working and provide impartial advice.  NCAS provides a service for the employer and manager rather than for the employee.  NCAS will monitor progress if a health practitioner requires supervision.  Assessment of an individual is undertaken when the issues are not clear.

 

Standard NCAS assessment

  1. Occupational health – health screening and if fit to undergo assessment:
    1. Screen for cognitive impairment.
    2. Alcohol screening – Liver Function Tests etc.
    3. Further screening as needed e.g. drug screen.
    4. Behavioural screen:
      1. Psychometric tests.
      2. Psychologist behavioural assessors – four to seven hour interview.
    5. Work place based – intense peer review of practice in own workplace by a team of three assessors:
      1. Assessors - one lay and two clinical.
      2. Employer facilitates informing other staff.
      3. Consent from patients (written to access records and verbal to be on-site).

 

Each case has four areas:

  1. Clinical skills.
  2. Behaviour.
  3. Work context.
  4. Health.

 

The regulatory bodies the GPhC, the General Medical Council (GMC) and the General Dental Council (GDC) provide the core standards.  The standards need to be measurable.  NCAS is looking for the minimum level of competency.

 

22% of calls relate to health concern as the primary concern (the reason for the call).  A secondary concern includes behaviour.

Health often becomes a concern during the process.  The employer has a duty to look after the health of the employee.

 

Health referrals include:

  • Mental health – a depression screen is undertaken
  • Addiction – less alcohol problems being seen now.
  • Physical e.g. degenerative physical condition.
  • Cognitive function – more cognitive problems are being detected now.

 

There is a large and extensive panel of NCAS assessors.  They receive a daily fee and are well paid therefore not hard to recruit.  Assessors are trained in use of the assessment instruments and have annual retraining.

 

A report on each case is prepared.  The report is substantial and uses individual workplace guidelines.  The report will provide examples of acceptable, poor or inconsistent practice.  The report also provides recommendations for the practitioner and the employer or manager.

 

NCAS assists with implementation of the report including facilitation, hand holding and mediating (there is no case management of the individual).  The process may stop at an earlier stage of standard NCAS assessment if it is clear what the issues are.

 

NCAS also provides education through statistics, reports, publications and presentations at conferences and external events.

 

Health issues for health professionals

The NCAS has seen an increasing number of health problems (up to 1/3 of cases seen by NCAS).  Health has a very big impact on performance.  Good doctors make for safer patients but it is difficult for doctors to access care.

A White Paper was prepared in 2007.  As a result NCAS has overseen the development of the Practitioners Health Program (PHP).  Please note that this was described in Part 2 of this series of articles.

A review of literature on health of health professionals resulted in the following report; Invisible Patients, Report of the Working Group on the Health of Health Professionals (March 2010) which provided recommendations on future research and services.  It was noted that there needs to be training of health professionals to look after other health professionals.  It is hoped that the Department of Health will pick up these recommendations.

The NCAS has close liaison with occupational health physicians.  The “good practice guide” covers issues about treating other health professionals. The Royal College of GPs and Royal College of Psychiatrists offer training in relation to treating other health professionals. However there needs to be curriculum development on the topic of health professionals treating other health professionals.

The public is seen to be very supportive of the health of health professionals and values work to address it.

 

The work and structure of NCAS continues to evolve and up-to-date information about their work can be found on their website, including a number of valuable reports evaluating their work.  The website can be found at http://www.ncas.nhs.uk/

 

Australia

In Australia the availability of support services for doctors and for pharmacists is limited.  The services that are available are also not nearly as well developed or as prominent as those I encountered in the UK.  This is particularly the case for the Australian pharmacy profession.

 

My vision for the Pharmacists’ Support Service in Australia includes:

  • National telephone and online support for pharmacists.
  • Face-to-face support for pharmacists in all states of Australia.
  • National Benevolent Fund for all Australian pharmacists.
  • Referral service for pharmacists to mental health, drug and alcohol services in all states of Australia.

 

For the Pharmacists’ Support Service to further expand in Australia we need to secure adequate ongoing funding.  The pharmacy profession can assist the Pharmacists’ Support Service to meet the needs of pharmacists throughout Australia through tax deductible donations.  Anyone wishing to support the work of the Pharmacists’ Support Service by making a donation should direct their donation to Pharmacists’ Support Service c/o 381 Royal Pde, Parkville 3052.  Donations can also be made over the phone using a credit card through the PSA (Victorian Branch) office on (03) 9389 4000 or by direct deposit into the Pharmacists’ Support Service bank account BSB 083155 and account number 481820199 (please include a name and contact details so that a receipt can be issued).

 

Pharmacists requiring assistance can contact the Pharmacists’ Support Service for anonymous and discreet support on 1300 244 910 between 8.00 am and 11.00 pm every day of the year.

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