"I'm absolutely overwhelmed. It is fantastic for the remote and rural pharmacy team. This is a team achievement and I am hugely lucky to work with them.

 

My patch is the remote and rural part of NHS Highland, primarily Caithness and Sutherland although some of our projects have been Highland-wide. I was a community pharmacist in Thurso before accepting a lead pharmacist job with the Board more than a dozen years ago.

 

I think what attracted me was the opportunity to contribute more to the design of services and to create new and more innovative services, pushing the boundaries of what we were doing as a profession. In community pharmacy I had some great experiences with the local GP practices, running prescribing clinics and working with local dispensing practices to provide medication reviews for their patients. I wanted to do that kind of work on a larger scale.

 

The challenges of serving a very sparsely populated area have played a part in some of the innovations we’ve been able to introduce. I also think NHS Highland gives its people permission to try out new models. From a remote and rural perspective, having smaller teams, good relationships and well established multidisciplinary working has meant we can test different models to provide optimal pharmaceutical care.

 

We had a bit of a crisis in Caithness with a shortage of GPs, something the rest of the country has felt since. So to support GP practices, we introduced a two-tier pharmaceutical care model. We have Specialist Clinical Pharmacists, our most senior pharmacists, who work across an area covered by about five GP practices. They provide pharmaceutical care to the top 10 per cent of patients who require the most input, usually frail patients, perhaps in care homes or receiving care at home. They may be taking lots of different medicines and they benefit from regular input from highly trained specialist clinical pharmacists, who are members of integrated health and social care teams, to ensure that they are getting safe and effective medicines. The other role we have developed is the Advanced Pharmacist Practitioner, who works in a single GP practice and effectively takes over the medicines management in that practice. They look after the remaining 90 per cent of the population, with one pharmacist for around 5000 patients. They provide annual medication reviews, look after medicines reconciliation for both hospital discharges and outpatient clinic letters, plus dose titration clinics and responding to acute requests from patients.

 

This was one of the models that helped inform the Pharmacotherapy service in the new GP contract.

 

On a national scale, the work we did as part of the Scottish Patient Safety Programme to develop the non-steroidal anti-inflammatory drugs (NSAIDs) bundle has now been rolled out across Scotland. We had 5 community pharmacies and 2 dispensing practices in the initial pilot, and together we picked the high risk medicine to tackle, developed a bundle of measures and developed the support tools like the NSAIDs cards and stickers. We then created an improvement package including laminated data collection tools and tested that with more teams, so we had 20 teams involved altogether. It was that package that formed the basis of the national NSAIDs toolkit that has been spread across Scotland this year.

 

My current role is to take forward ‘NHS Near Me’. This has developed out of ‘Pharmacy Anywhere’, a telehealth solution which we created to enable patients to access a pharmacist without those pharmacists having to spend hours travelling to reach them. ‘NHS Near Me’ is wider than pharmacy: it is for all hospital outpatient appointments, and reduces patient travel to attend appointments which might have been as much as six-hour round trips from our rural areas. It’s fantastic to see pharmacy leading the way for a big service change like this. 

 

I really hope that the MBE is seen as recognition of the work of the whole remote and rural pharmacy team. They do a great job but often aren’t noticed as they are so far away from urban centres. What we have developed here will have value in any setting. For instance, the ‘Pharmacy Anywhere’ model can maintain pharmacist cover in GP practices when the practice pharmacist is on leave. It is also a model that could be used by community pharmacists to provide services like medication reviews for GP practices. My current focus is on getting ‘NHS Near Me’ off the ground across NHS Highland, and supporting the further growth of the ‘Pharmacy Anywhere’ model in primary care services. Will the MBE help with that? I don't know."