New Ways of Working in Mental Health Pharmacy

Aims of the programme

• To initiate, oversee and provide national programmes of work within and across the mental health pharmacy workforce.
• To promote, support and evaluate new ways of working UKPPG that deliver improved management of medicines and pharmacy services for people with mental health problems and their carers.

Elements of the programme

The Spread Programme: To engage a number of service providers across England in testing, developing and implementing new, changed or extended ways of working in mental health pharmacy that deliver impacts on components of medicines management.

The Workforce Survey: To ascertain the workforce available in mental health pharmacy, in order to deliver new ways of working by pharmacy staff.

NWW in Mental Health Pharmacy – The continuing story...: The current document will describe how NWW in Mental Health Pharmacy can impact on the delivery of medicine-related services to users of mental health services in three ways:

• development of the roles of staff working within pharmacy, so as to release the time of pharmacists and pharmacy technicians to develop improved services to users;
• development of the roles of pharmacy staff so as to release time of other mental healthcare professionals and improve services to users; and
• development of other staff to undertake work related to the management of medicines.

Progress on NWW in Mental Health Pharmacy

The Spread Programme

• Phase 1: Northumberland locality of Newcastle, North Tyneside and Northumberland Mental Health Trust
  A major re-engineering of pharmaceutical services commenced in 2002 as part of a 12-month project supported by the Changing Workforce Programme. The main change centred on reshaping services around the patient at ward level. This required the modification of the roles of staff, creating new roles for existing and incoming staff, integrating clinical pharmacists and technicians into ward teams, and re-engineering the dispensing functions both within the pharmacy and on the wards.
• Phase 2: Replication sites
  During 2003, over a nine-month period, 14 sites were engaged, on an individual basis, with the aim of supporting organisations in meeting their obligations to provide improved medicines management to mental health service users by changing the roles of the dispensing assistant, the pharmacy technician and the clinical pharmacist.
  
  Each site was given £10,000 to support change. This ‘enabling’ money could be used in a variety of ways: project time, audit time and tools, locum costs, training requirements and equipment.
• Phase 3: Further replication sites and small medicines management innovations
  Although the primary aim of Phase 3 was to improve medicines management in mental health, providers were encouraged to develop alternative ways of working and to introduce small innovations that improved care and demonstrated NWW. The way to achieve this was by engaging with a further 32 service providers across England.

The Mental Health and Learning Disabilities Secondary Care Pharmacy

NWW in Mental Health Pharmacy – The continuing story

Products

• Project Evaluation Report, Changing Workforce Programme, Mental Health – Pharmacy Pilot September 2004. NHS Modernisation Agency.
• National Pharmacy Spread Programme Interim Report, CSIP/NIMHE, February 2006.
• Individual Project Evaluation for 43 Spread Programme Sites, CSIP/NIMHE, February 2006.
• Spread Programme Report (yet to be completed).

Products from the Workforce Surveys:

• Report on the Mental Health and Learning Disabilities Pharmacy Workforce Survey, May 2006 (the Bath Report), Taylor, D. and Sutton, J., University of Bath.
• The UK PPG and CMHP Report of the Mental Health and Learning Disabilities Secondary Care. Pharmacy Workforce Survey, September 2006, Branford, D., Parton, G. and Sutton, J.
• The UKPPG and CMHP Summary and Key Finds of the report of the Mental health and Learning Disabilities Secondary Care Pharmacy Workforce Survey, October 2006, Branford, D., Parton, G., Taylor, D. and Sutton, J.

Service user and carer leaflet ‘Medicines management – everybody’s business’.

Key points (lessons learnt)

Workforce Survey

• Mental Health Trust Pharmacy Services
  MHT pharmacy services are very complex. Ascertaining the true extent of the mental health pharmacy workforce proved a larger task than anticipated. For most other groups of staff involved in mental healthcare, information relating to the workforce and services is available from the Durham mapping. Pharmacy services, however, are not.
  
  The dependence of most MHTs on Service Level Agreements (SLAs) with other providers, usually acute Trusts, emphasises the need for a clear framework for SLAs that delivers a satisfactory level of service to the user. This should include the requirement for the personnel to be qualified and competent to work in MHTs. Unless such a framework can be achieved, it is also likely to present an obstacle to bringing about new ways of working.
• Mental Health Pharmacy Workforce
  For most MHTs, the pharmacy workforce is too small to provide effective medicines-related services to service users and new ways of working. For some MHTs, the pharmacy workforce is too small to provide a safe service to service users.

Positive practice from the Spread Programme

• The introduction of funding from the National Spread Programme project enabled the development of new ways of working for pharmacists, technicians and dispensing assistants in a Crisis Resolution Service (Huddersfield site). Changes to service users’ treatment with medicines was just one area of improvement among the many improvements achieved during the time of the project.
• A training package was devised to support medicines error reporting in Pennine Care Trust NHS Trust. The pilot ran for 12 months, and the training package was delivered to many clinical staff.
• At Merseycare NHS Trust they have introduced a medicines management competence-based training package for nursing assistants. The training package was developed using a multidisciplinary approach, and consisted of a PowerPoint presentation, practice-based assessments and a short questionnaire. So far, over 100 nursing assistants have benefited from the training delivered by the three pharmacists and two nurses.
• The purpose of this project was to introduce a pharmacy drug-monitoring service in Leeds Mental Health Trust. Pharmacists led this new service, with pharmacists making referrals for blood tests, pharmacy technicians taking blood, and pharmacists then checking the results and contacting the doctor if any abnormalities were detected.
• The two main areas of change in Derbyshire Mental Health Trust have been: – the development of a medication package to be issued to service users at the point of discharge; and – counselling was provided to service users during their stay in hospital.
• South West Dorset Primary Care Trust focused on providing and improving information on depression and its treatments directly to service users and their carers in the prison environment.

Recommendations

The Spread Programme demonstrated a wide range of potential impacts on service user care and treatment that can be achieved by the various grades of pharmacy staff, as well as the potential impact of NWW. Larger, well-funded projects should be undertaken to evaluate the full worth of those that show the greatest impact.

Most MHTs need to develop a pharmacy strategy with a clear developmental programme that ensures increased staffing and service provision over a 3–5-year period. Part of that strategy needs to include developmental posts, such as preregistration pharmacist, student pharmacy technician and trainee pharmacy assistant positions, and to make sure they are safeguarded in times of financial hardship. Local solutions are urgently required to increase the number of pharmacy technicians and develop their role.

Summary

This can occur in three ways:

• development of the roles of staff working within pharmacy so as to release the time of pharmacists and pharmacy technicians to develop improved services to users;
• development of the roles of pharmacy staff so as to release time of other mental healthcare professionals and improve services to users; and
• development of other staff to undertake work related to the management of medicines.