The initiative was designed to meet a need in primary care to rapidly upskill clinical pharmacists to be able to give complete care to people living with diabetes. Surgeries are making changes to counteract the ongoing decline in numbers of GPs and Practice Nurses and greater use of pharmacists is one answer. Prescribing clinical pharmacists are a valuable asset, alleviating the burden on remaining staff and providing appointments for patients to have face-to-face, quality time with a healthcare professional. However, according to EDEN’s Training Needs Analysis (TNA) Knowledge and Confidence (K&C) questionnaire, many do not feel ready to offer diabetes care without further training and mentorship. The COMPLEMENT (Complete Mentoring and Diabetes Education for Clinically Practising Pharmacists) programme was developed to meet this need.
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The initiative was designed to advance the skills, knowledge and confidence of clinical pharmacists so they could give effective and holistic care to people living with diabetes. Pharmacists’ training needs were found to be different to those of GPs and Practice Nurses, requiring more bespoke education, including one-to-one mentoring. The TNA highlighted where more bespoke education should be offered, based on the areas where individuals felt less confident. Three strands of training were offered through COMPLEMENT: face-to-face education sessions, individual mentoring and workshops. Outcomes were measured by a post-intervention K&C questionnaire. Rapid upskilling was required in areas not traditionally included in the pharmacists’ training, such as consultation skills and patient assessment. Clinic mentoring was also needed. Evidence-based courses were provided, offering practical learning, discussion and case studies to ensure that skills were easily implemented in real life. Several mentoring visits were offered to the pharmacists to provide everything from a little encouragement to help with more complex challenges. The bespoke workshops were new and developed to meet the needs of the individual pharmacists. Detailed feedback was gathered following each session. The programme was designed to be completed in six months to meet the urgent need. Each pharmacist’s K&C was re-evaluated at six months, with a view to extending mentorship if required.
Organising the project involved the whole EDEN team. The EDEN lead highlighted the need and business case, securing funding and support from Leicester City Clinical Commissioning Group (CCG). The EDEN clinical education team provided the education and mentoring. Outcomes were measured via: the K&C questionnaires, to ascertain individual educational needs; pre- and post-intervention patient data (HbA1c, blood pressure and cholesterol), from first visit to clinician and six months later; plus by patient questionnaire regarding their experience of being seen in clinic by a pharmacist. EDEN’s TNA, which includes a pre- and post-education/mentoring K&C questionnaire, together with patient results and feedback, demonstrates and measures improvement. Education sessions comprised: full-day interactive learning modules in glycaemic treatment options (including oral and injectable therapies), insulin management (two separate days, Foundation and Advanced) and treatment targets (holistic diabetes care, including blood pressure, lipids and blood glucose management). Following the educational sessions, the pharmacists were offered clinical mentorship from EDEN mentors, who worked congruently in clinic to give appropriate guidance and reassurance. This need varied according to the clinician’s level of experience and confidence. The workshops were developed to meet a further need. The pharmacists had questions to ask and cases to discuss. The most time-efficient solution was to attend their federation meetings and make a short presentation on whatever aspect of diabetes they requested, followed by questions. They were asked to bring their difficult cases and this part of the session became very popular.
To demonstrate effectiveness, baseline readings were obtained from patients seen in clinic by the pharmacist and compared with those taken six months later. In an example audit carried out from 30 randomly-selected patients, cared for by one pharmacist over a six-month period, there was: an average HbA1c reduction of 18.2 %; average total cholesterol reduction of 12.9%; average Systolic BP reduction of 5.9%, and average Diastolic BP reduction of 7.1%. Anonymised patient feedback was obtained to build a more comprehensive picture. Patients were asked ‘How satisfied were you with your consultation with the pharmacist?’ and used a rating from: very dissatisfied, dissatisfied, neutral, satisfied and very satisfied. They scored the following areas: the pharmacist was polite; making you feel at ease; listening to you; assessing your medical condition; explaining your condition and treatment; involving you in decisions about your treatment; providing or arranging treatment; helping your understanding of diabetes?; helping understanding of your diabetes control? The results found 97% were very satisfied and 3% were satisfied. A full 100% said that they were confident in the pharmacist’s ability and would see the pharmacist again in the future.
Sustainability and Spread
The model has potential to grow and be sustainable. Funding from Leicester City CCG has been secured for the next three years. A new de-prescribing programme, developed in 2018, has been evaluated as very effective. AstraZeneca commissioned EDEN to develop competency-based modules on interactive learning platforms, purely for pharmacists in general practice. All the modules align to the pharmacist’s ‘career and competency framework’. The numbers of clinical pharmacists are rising and this will continue, ensuring ongoing demand. Amendments to GP contracts for the next five years, including the launch of primary care networks and funding for additional workforce, includes finance specifically for employing clinical pharmacists. Practices are already taking advantage of this. The ‘Train the Trainer’ approach could be adopted to develop this at scale nationally. This bespoke model, based on need, could be applied to other chronic conditions. Ongoing skill needs can be met with EDEN’s digital modules, enabling continuous embedding of knowledge. E-learning is perfect for spreading to wider geographical areas. Pharmacists are required to re-validate and this programme provides excellent data to support ongoing professional development. Outcomes can easily be measured at six months or later.
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