Pharmacy Brochure

The award-winning Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW) pharmacy team has a proven track record in delivering high quality, safe pharmaceutical services. We offer professional advice and support on medicines supply, clinical pharmacy and clinical governance functions.

Our innovative and progressive approach to service design and delivery has been recognised and commended by the Care Quality Commission (CQC), the Royal Pharmaceutical Society, Pharmacy Management and the Health Services Journal.

Our team has the right knowledge, skills and experience to support pharmacy service improvement in other organisations.

The Pharmacy team includes around 117 staff, comprised of pharmacists, pharmacy technicians, pharmacy assistants and administrative support across 4 sites:

• St Nicholas Hospital
• St Georges Park
• Hopewood Park Hospital
• Carleton Clinic

St Nicholas Hospital pharmacy is our operational and administrative centre, with all 4 sites providing clinical pharmacy services, on a hub-and-spoke basis.

We operate an in-house medicines supply service, across the entire Cumbria, Northumberland, Tyne and Wear footprint. To optimise productivity and enable service redesign, we have invested in leading edge pharmacy technologies, including tele-pharmacy and ward based automated medicines cabinets (Omnicell), for which we have won a national efficiency award.

To support better medicines adherence, we have implemented pharmacy automation, to dispense medicines within 7-day compliance aids (monitored dosage systems, MDS).

Enabling more efficient and safer dispensing, this will release more pharmacy staff to provide front-line pharmaceutical care to patients.

We provide pharmacy and medicines optimisation services to all our mental health, learning disability and neuro-rehabilitation inpatient areas, as well as community mental health teams, crisis teams, psychiatric liaison teams, medical education teams and a variety of other specialist areas.

We have pharmacist independent prescribers and specialist technicians who are active within a range of clinical services. Pharmacy staff at CNTW are valued members of the multi-disciplinary team and our service is highly regarded within the organisation.

The team has been developed using a successful workforce strategy ensuring mental health placements are provided for pharmacy students in the region along with mental health placements for trainee pharmacists in the North-East and North Cumbria region. We’ve also recently established rotational pharmacist posts with 3 of our neighbouring acute trusts ensuring exposure to mental health for early careers pharmacists which has supported some of our recruitment.

Our team delivers patient services including medicines reconciliation, medication review, prescribing and discharge planning. With new investment we continue to expand our portfolio to include pharmacy technician-led clozapine clinics and pharmacists working as part of our community mental health teams.

In their last comprehensive inspection report, the CQC identified that medicines are managed safely across our organisation. This evidences the effectiveness of our clinical governance systems for medicines.

Our Medicines Management policy, with its detailed accompanying practice guidance for all healthcare professionals, is underpinned by a robust monitoring framework.

This includes clinical audit and risk assessments, which provides ‘ward to board’ assurance regarding medicines handing, use and clinical effectiveness. This framework is managed by the Pharmacy department, but is delivered with multidisciplinary engagement across the Trust, and supporting our organisational view that medicines are everyone’s business.

CNTW started life as an amalgamation of a number of predecessor Trusts. This brought together a mix of service models, some with an in-house medicines supply service and others managed under Service Level Agreements from other organisations.

The Trust made a decision at that point to in-source the medicines supply and clinical pharmacy service on quality and cost grounds. This decision laid the groundwork for a service which has gone on to demonstrate quality and efficiency in line with the recommendations in the Carter Report and has supported the organisation’s overall ‘Outstanding’ CQC rating.

Unlike many other Mental Health Trusts, CNTW has an entirely insourced Medicines Supply service. Maintaining the relationship between, and control over, medicines supply, clinical pharmacy and governance/assurance has provided the organisation with a high level of confidence in the efficiency, effectiveness and quality of the service.

A comprehensive set of metrics provide ongoing assurance of the pharmacy service performance which are compared with local and national benchmarks. These indicate a service which is productive, safe, efficient and cost effective.

Reduction in Drug Spend
Insourcing the medicines supply service has allowed the organisation to maintain a level of control over the drug spend and take a number of innovative approaches, including local contracting arrangements.

Using technology to enhance productivity
The Trust has adopted a number of innovative technologies to deliver safety, efficiency and quality benefits:

Omnicell
Automated medicines storage cabinets (Omnicell) have been deployed in approximately 62% of in-patient units. The installation was a two-phase process; the first being Trust capital funded as part of a new build hospital and the second being funded by NHS England Technology Fund award, based on the success of phase 1.

This installation was shortlisted for an HSJ Value in Healthcare Award (2015). The cabinets facilitated a service redesign to maximise the direct clinical and patient facing activities of Pharmacy and delivered a number of other benefits, including:

• 12% reduction in drug spend
• 0.4WTE nursing time saved per ward
• 20% reduction in medicines related incidents
• Automation of controlled drug security checks

Electronic Prescribing and Medicines Administration (ePMA)
The Trust continues it’s journey to implement a closed-loop medication system and the adoption of ePMA in all areas will be a key milestone. ePMA is fully integrated within the electronic care record.

By 2023 ePMA will be in all in-patient areas and will progress to community services.

Automated Dispensing
CNTW is first NHS Trust in the country to implement cutting edge automated dispensing technology (the Omnicell Vandenbrink Blistering Machine) which, with a single operator, allows compliance aids to be dispensed at a rate of 40 trays per hour and self-checks the final product.

Comprehensive Clinical Pharmacy Services supporting in-patient areas

A clinical pharmacy service is provided to all in-patient areas, and consists of:

• Medicines reconciliation on admission for all patients
• Comprehensive medicines review including the management of high-risk medicines such as clozapine, lithium and valproate
• Electronic patient medicines administration records and in-patient prescription chart accuracy checks
• Prescribing and medicines optimisation advice to MDT during in patient stays
• Discharge planning, including patient assessment for compliance aids and liaison with primary care HCPs (e.g. care homes, GPs and community pharmacists). This includes exploring any interface issues around medicines which have a shared care arrangement.
• Comprehensive medication review
• Patient counselling and motivational interviewing to maximise adherence and engagement with treatment
• Shared decision making, providing patients and carers with medicines related information and facilitating discussion and decision making about treatment choices
• Undertaking side effect monitoring for patients
• Supporting the teams with medicines related physical health monitoring

Clinical Pharmacy teams are embedded in Crisis Resolution Home Treatment (CRHT) teams, supporting out-of-hospital care and preventing admissions through:

• Structured medication reviews and pharmacist prescribing
• Initiation and monitoring of lithium and clozapine
• Patient counselling and motivational interviewing
• Facilitating seamless, joined up care and minimising shared care prescribing issues.

In addition to these, there are a number of specialist roles pharmacy staff are funded for in the out-of-hospital setting.

The Clinical Pharmacy service model in Learning Disabilities has been recognised as being a national exemplar by NHS England, and is pioneering the STOMP initiative to reduce over-medication in this population.

The Clinical Pharmacy service model in Learning Disabilities has been recognised as being a national exemplar by NHS England, and is pioneering the STOMP initiative to reduce overmedication in this population.

Clinical pharmacy technicians lead clozapine monitoring clinics, ensuring a consistent and safe link between blood monitoring and medicines supply.

This also allows patient counselling and side effect monitoring and reduces the reliance on nursing staff in this setting.

Advanced pharmacist practitioners are embedded into our Psychiatric Liaison Teams at our local acute trusts. This allows patients with mental health issues patients with mental health issues who have concurrent physical health conditions to be treated in the appropriate setting whilst still having all aspects of their care considered holistically.

Our Pharmacist both provides advice on patients known to us that are admitted, but also identifies other patients who may benefit from our specialist advice and promotes high quality prescribing.

All Serious Incident panels have senior pharmacist representation. This focus on the use of medicines has added an extra layer of organisational learning from incidents and encourages rapid and sustainable improvements to practice.

In addition to the medicines management governance systems described above, we have published a comprehensive range of local secondary care and shared care prescribing guidelines, including for:

• Higher-risk medicines, such as clozapine, lithium, high-dose antipsychotic therapy and valproate
• Antipsychotics
• Drugs for ADHD
• Drugs for dementia

To support the effective use of shared care prescribing guidelines we have developed an implementation model built around data analysis, transparency and strong working relationships with commissioners and local area prescribing committees.

A comprehensive medicines management assurance framework provides the organisation and regulator with evidence that medicines are being used safely and effectively.

This has been developed over the last 5 years and provides data on prescribing quality, administration and safe and secure handling of medicines across all in-patient ward and community team settings.

A full programme of clinical audit and participation in the Prescribing Observatory for Mental Health (POMH) benchmarking programme provides further evidence of local improvement actions made to support the safe and effective prescribing of medicines.

Attracting, developing and retaining high quality pharmacy staff to Mental Health can be challenging, particularly in the current environment.

CNTW pharmacy have adopted novel approaches to futureproof our workforce allowing a strong pipeline of trained pharmacists in mental health.

This has included cross-sector trainee pharmacist training schemes and rotational placements for newly qualified pharmacists with local acute Trusts. This, along with comprehensive induction and career development schemes, an ever growing high quality service and the development of new roles has resulted in a department which is well regarded locally and is able to recruit and retain high calibre staff from across the country.

Our next workforce initiative involves the approval of a consultant pharmacist post which would be a trailblazing initiative for the region.

Our strategy for “growing our own” staff from trainee to consultant pharmacist ensures we have a skilled pharmacy workforce ready to collaborate across the system.

Furthermore, we have developed effective arrangements for listening and supporting the well-being of our staff, which have helped to achieve very low rates of staff sickness and turnover within the pharmacy team.

What CNTW can offer your organisation

CNTW can offer your organisation expertise, guidance and leadership in the following areas:

• Insourcing medicines supply and cost reduction plans
• Shared care
• Service redesign and Quality improvement
• Automation business case development, planning and implementation
• Implementation of a range of informatics systems
• Clinical pharmacy service development including business case development
• Service evaluation
• Governance and assurance system design and operationalisation
• National and local benchmarking
• Service Level Agreement development or dissolution
• Clinical engagement
• Staff engagement and workforce development

By telephone: 0191 245 6606

By email:
Tim Donaldson – Chief Pharmacist
[email protected]

Anthony Young – Deputy Chief Pharmacist
[email protected]

Ruth Ayre – Deputy Chief Pharmacist
[email protected]

Martina Khundakar – Lead Pharmacist for Research and Workforce Development
[email protected]