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Pharma and the NHS – the relationship that needs to take the next step?
CONFERENCE 2021 PRESENTATION SUMMARIES
Pharma and the NHS – the relationship that needs to take the next step?
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By Anne Turnbull
In this workshop, PIPA Committee member and MI manager at Grunenthal, Harpreet Sandhu was joined by a panel of speakers to explore how Medical Information, as the non-promotional face of the Pharmaceutical Industry, can build on its relationship with the NHS, and wider initiatives, to educate healthcare professionals and promote the safe and effective use of medicines.
In the first presentation, Alan Ryan, Director of National Transformation Programmes at Health Education England (HEE), discussed the education and training of pharmacists in light of changes to the NHS environment and the introduction of pharmacy reforms including new prescribing roles. He explained that HEE are working with a variety of partners to enable development and growth of the pharmacy profession. When the General Pharmaceutical Council (GPhC) was formed around 2010, it aimed to regulate pharmacists, pharmacy technicians and pharmacies in Great Britain, and part of its remit was to reform pharmacists’ education programmes.
Pharmacist Education Reform
HEE has worked closely with employers, GPhC and pharmacists to put in place a codesigned Interim Foundation Pharmacist Programme for pharmacists who were provisionally registered during the COVID-19 pandemic. This gave them the opportunity to trial the programme to see what works well in a foundation training scheme. GPhC have recently published new standards for pharmacist training which specify a set of learning outcomes which span the full five years of pharmacist education and training. This includes allowing pharmacists to independently prescribe from registration. They have also introduced a foundation training year – traditionally the pre-registration year - (Year 5) with strengthened supervision and support and collaborative working between higher education institutions, statutory education bodies (such as HEE) and employers. This year is the first year HEE have implemented the foundation programme, based on learnings from the interim programme. An assessment strategy has been published and an e-portfolio is available to every foundation pharmacist in England. They provide very clear guidance and training materials for designated supervisors, and there is a huge amount of material and resources available for training pharmacists, curated from many sources. The education reforms based on the new standards published by GPhC will result in the undergraduate pharmacy degree being far more clinically based than previously, with students getting rotational clinical placements across all sectors. Further information about the initial education and training of pharmacists is available at: https://healtheducationyh. onlinesurveys.ac.uk/register-for-ietp-updates
Pharmacy Technician and Pharmacy Support Staff Workforce Strategy This strategy was launched to coincide with the 10-year anniversary of registration for pharmacy technicians. The initiative is around understanding what pharmacy technicians will be needed to do in the future. Currently, the exact number of people working as pharmacy technicians is unknown, and there is a survey of community pharmacy in place to try and improve on this data. However, demand is growing for pharmacy technicians to support delivery of new service models outlined in the NHS long-term plan. There is also an increasing demand for technicians to be able to support pharmacists: as pharmacists undertake more and more clinical work, so the role of the pharmacy technician will need to evolve to take on more of the tasks previously done by pharmacists. All pharmacy technicians are now trained via HEE funded apprenticeships, and an expansion programme has been launched to support the education and development of pharmacy technicians in primary care.
Pharmacy Integration Fund
This is focussed on community pharmacy and is around developing the pharmacy workforce to develop more clinical services. During the first phase of this, which ran from 2017 – 2021, the focus was on postgraduate pharmacist training, independent prescribing, supporting pharmacists to deliver safe and effective pharmaceutical services via NHS 111 and medicines optimisation in care homes. In the second phase, running from 2021 – 2024, the funding will focus on independent prescribing and clinical examination skills.
Providing Information and Advice – the UKMI experience
The second presentation of the workshop was delivered by Dave Abbott and Vanessa Chapman from UK Medicines Information (UKMI). Dave gave a brief overview to explain that UKMI are an NHS based pharmacy service which aims to support the safe, effective and efficient use of medicines through the provision of evidence-based information and advice i.e. they answer questions from HCPs and patients and provide advice on how to get the most out of their medicines.
UKMI is also part of the NHS Specialist Pharmacy Service, which supports medicines optimisation across the NHS. The remit of UKMI pharmacists is effectively to find
information and turn it into advice for the people who contact them for assistance. As a result, UKMI pharmacists are often heavy users of pharmaceutical MI departments. Dave shared some thoughts and considerations about what UKMI expect about the information they receive in response to an enquiry, as well as what they aim to do as providers of information. He then handed the presenting baton to Vanessa Chapman, who talked about UKMI’s role in developing content for the SPS website. This website was initially developed around 4-5 years ago to consolidate information from about 15 different websites. The content is designed to solve problems for its end users and there is a lot of consideration put into how the information is displayed, who the audience is and what they are looking for. Over the past year, the website has had around 6 million hits: around 20,000 – 30,000 per day. Although the site is mainly used by HCPs in the UK, it is also accessed world-wide.
The UKMI firmly believe that the audience would be lost if content were to be hidden behind logins and multiple clicks, so it is freely available at all times: providing advice and guidance to HCPs 24/7. Although there are multiple routes for content production on the SPS website, the starting point for much of it is user stories. This is a new way of working for the UKMI, and there is Government guidance on how to write these: https://www.gov.uk/service-manual/agile-delivery/writinguser-stories
Vanessa used the following user stories as examples. Here, fundamentally the same question is being asked (i.e. whether there is an interaction between miconazole and statins), and the information for the answer to each is effectively the same. BUT, the advice given on the website in response to each user story would be written in a completely different way for each one: User story 1: “As a community pharmacist, I want to safely sell some miconazole gel to a patient who’s on a statin so that I can treat the patient’s oral thrush or refer them to a prescriber, as necessary, and it’s done when I’ve made the referral”.
User story 2: “As a GP or prescriber, I want to decide whether my patient’s muscle pains are caused by their medication as they’re on miconazole and simvastatin, so that I can safely treat the oral thrush and lipids, and it’s done when miconazole or a suitable alternative has been prescribed.”
Vanessa then discussed some case studies, looking at publishing both simple and complex content:
Identifying content for the website happens in several ways – from identifying themes in frequently asked questions to working in focus groups to identify content requirements. This can be quite a lengthy process, as can the content development: it takes significant time to research, develop and review content before publishing and promoting it. After this, everything on the website must be maintained and updated to ensure it is current. However, where content requirements are urgent – which has happened a lot in response to the need for urgent COVID advice – then the content can be turned around in a matter of days.
Group Discussions
Following the presentation, Harpreet asked the speakers whether there is a forum or an opportunity for pharmaceutical companies, who hold a wealth of information, to input into the content of the SPS. Dave discussed the fact that UKMI often contact Pharma for data they need e.g. stability data. He acknowledges that there is a need for UKMI to be clear about what they are asking for, and that their members need to understand that Pharma are unable to provide advice – being only permitted to provide the information that can then be used to inform clinical decisions.
The workshop delegates then took some time to discuss whether MI teams could or should signpost enquirers to independent resources, such as the SPS website, even if they contain information and guidance on off-label use – using the advice on use of medications in patients with swallowing difficulties on the SPS website as an example. Generally, there was nervousness around referring to such sources, and most agreed that the company’s legal department would need to be consulted regarding this, particularly if the source is known to provide information that is not in line with the SmPC. However, there was also discussion around whether such signposting could be carried out if appropriate disclaimers were to be used. There was also concern about the collecting of safety data. If HCPs were signposted to the SPS page that recommends crushing a tablet for administration to a patient who has swallowing difficulties, who would have responsibility for ensuring the safety data is collected? It was agreed that although pharmaceutical MI teams can’t provide advice, they do have a role in supporting HCPs to make informed clinical decisions. It may be that such signposting can be permissible when done with clear and appropriate disclaimers. As PIPA has a strong working relationship with UKMI, it may be possible that appropriate disclaimers could be added to the SPS website to encourage the reporting of adverse events and off-label use.
Pfizer – Partner4Better
Hubinger and Mariska Lubbe from Pfizer. Mariska gave a brief overview of Pfizer MI and its vision to enable its customers to obtain information that is easily accessible and trusted via intuitive automated solutions. This is facilitated by seamless transactions across different channels, allowing customers access to global responses. In the UK, most Pfizer customers are HCPs and request information mainly via the phone, but there has recently been an increase in use of other digital channels: these include optimised IVR – so that customers can self-serve via the telephone - and use of the Pfizer MI website via which customers can search standard response documents and other data published there. The website has recently been redesigned and includes a stability calculator for some of the company’s products, a chatbot and live chat functionality. Mariska also mentioned the MI Leaders in Europe (MILE) organisation, in which Pfizer plays an active role. Pfizer makes information available through the MILE gateway, which provides easy access to trusted MI resources to HCPs and patients on behalf of various pharmaceutical companies. This resource is available in 14 countries, including the UK. Finally, Mariska introduced Partner4Better - Pfizer’s global outreach programme that is designed to empower HCPs to deliver better patient outcomes through relevant educational content.
Gudrun then guided the delegates through further detail about Pfizer’s Partner4Better programme, which aims to address health education inequity. This is often an issue for low- and middle-income countries, but can be a problem globally. Through her work in Africa, Gudrun became very aware of how challenging it is for HCPs on the continent to access medical information and clinical data. The idea of the programme was born at an International Federation of Pharmacists (FIP) conference around 5 years ago. Its aim is to offer training and education opportunities to support better access to health for all. It looks to improve safe and responsible use of medicines through innovation and education partnerships. The focus is on delivering education globally, above brand. The programme works in collaboration with different groups to leverage expertise to achieve a greater reach. There is also a focus on building trust with professional medical associations. Although the programme started in Africa, it has evolved through the Middle East into the rest of the world. Partner4Better started hosting live events in 2017, and by
2018 virtual events were introduced to enable increased access – including an event that was attended by over 700 HCPs in three African countries.
The Partner4Better programme is now offered via two
microsites – one global and one Chinese, due to the unique Chinese digital landscape. Currently there are 8 training modules that have been digitised, in 5 different languages reaching more than 20,000 HCPs. Although the programme is targeted at lower- and middle-income countries, it is accessed world-wide. Partner4Better collaborates both internally, and externally, with stakeholders:
Currently, the following modules are available via the resource:
Pfizer continually collates and analyses its customer feedback. They now have validated feedback questions to help describe and understand the impact of the educational materials.
Gudrun concluded the presentation with the following questions for the wider PIPA audience: could we ‘partner 4 better’ across the whole industry, agencies and other MI functions to connect with our HCP partners and support education and equity aims together? Are there any specific educational topics and expertise that we, as PIPA members, think are required? What channels work in European / UK markets to provide educational content? Can we work closer to fill educational gaps for HCPs, for pharmacists? Can we work together to achieve health equity? Pfizer firmly believe that, together, we can.
What next?
This workshop provided a fascinating insight into some of the resources available for educating HCPs to enable the safe and effective use of medicines, and ensure better outcomes for patients, both locally and globally. PIPA’s aim is to continue to liaise with NHS England, UKMI and potentially other stakeholders to increase the opportunity for medical information functions in the pharmaceutical industry to input into such vital education opportunities. Many pharmaceutical companies produce valuable online resources for HCPs and patients and may simply require more visible signposting. This discussion will continue…
Anne Turnbull
Operations Manager PIPA
