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 
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
Workforce Survey
In December 2005, the NIMHE NWW for
Mental Health Pharmacy (NWWMHP)
Sub-Group of the National Steering
Group for NWW in Mental Health
commissioned researchers at the
University of Bath to undertake a survey of the
pharmacy services of all Mental Health
Trusts (MHTs) in England. The aim of the
workforce survey was to ascertain the
pharmacy workforce available to provide
services to MHTs in England, and the
services actually provided.
The final survey received data from 59
of the 79 MHTs (72%). Non-responders were
predominantly from PCT providers of
mental health services. Only nine specialist
MHTs failed to return a completed
questionnaire.
NWW in Mental Health Pharmacy
– The continuing story...
In line with other professional
groups, the final piece of work will be a document that
incorporates the lessons from the
Spread Programme and the Workforce Surveys.
Products
Products from the Spread
Programme:
• 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)
The Spread Programme
All of these programmes and
initiatives demonstrated the potential benefits of
Pharmacy NWW. However, although
significant changes to roles within pharmacy
can achieve some improved services to
service users, major changes are dependent on the capacity of a
pharmacy workforce.
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
NWW initiatives have identified
pharmacy staff as being one of the groups of staff
that can develop new roles.
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.
However, for most MHTs, the pharmacy
workforce is too small to provide effective
medicines-related services to service
users and new ways of working.
Contact details for chair of the
NWWMHP sub-group: Dr D. Branford,
Chief Pharmacist, Derbyshire Mental
Health Services NHS Trust at
david.branford@derbysmhservices.nhs.uk,
Back to
top.