Making sure the drugs do work in fast-changing field

It's the job of nearly 350 registered hospital pharmacists provincewide to see that patients get the right medicine, as pharmacy manager Anne Friel tells Jane Bell

There are 348 registered hospital pharmacists working throughout the five new hospital Trusts. What does the job involve and what qualifications and experience are needed?

I manage the Pharmacy and Hospital Sterilisation and Disinfection services to the Western Health and Social Care Trust. The service is staffed by just over 100 people and has an annual budget of 16m. The Western Trust provides pharmacy services to 290,000 people living across the Western area. The pharmacist's role is very varied and important in making the whole of the medicines management process effective so that patients get the right medicine to treat their illness. Pharmacists have a degree in Pharmacy (currently a 4-year M Pharm) and must be registered with the Pharmaceutical Society of NI to practice here.

The registration process involves successfully completing a pre-registration year in practice and passing a registration examination. Most pharmacists have a postgraduate qualification and more recently, a prescribing qualification. Hospital Pharmacy Managers will have at least 10 years experience - everyone's experience will be varied.

I worked for 10 years as a clinical pharmacist in haematology and bone marrow transplantation in Leeds. I have worked also as a radiopharmacist making up radioactive injections for use in diagnostics and also as a Teacher Practitioner and Course Director with the University of Leeds. Before coming to the Western Trust's Altnagelvin Hospital I was Director of Pharmacy for the hospitals in the Southern Board for seven years.

The number, types and classes of drugs have increased enormously since you qualified 20 years ago. What have been some of the most significant changes?

There have been drug developments in nearly every clinical area from cardiology to cancer. As we learn and understand more about diseases such as cancer we are able to develop new drugs with better, more effective and efficient outcomes for patients and clients. Monoclonal antibodies, for example, have come onto the market over the last five years and they have benefited patients with rheumatoid arthritis, lymphomas, Crohn's disease and psoriasis.

Most of us patients can't even pronounce the names of the drugs we are prescribed. How do pharmacists go about educating the public to be more aware and safety conscious?

By encouraging patients to bring their medicines into hospital and by using these medicines during their hospital stay, we reduce the risk of confusion between the supply of medicines from the community pharmacist and the hospital. This also helps us to use our drugs stock resource more effectively. A patient leaving hospital will receive up to 28 days supply of medicines in their original pack with a medicines information leaflet.

Guidance on generic prescribing in NI also supports safety by encouraging the prescription of medicines using their generic as opposed to brand name (where appropriate), reducing confusion. There have been a number of DUMP campaigns that encourage patients to return unused medicines to their local community pharmacists for destruction.

You and other management colleagues are involved in lobbying manufacturers - for example?

Some medicines have similar sounding names and some drug companies supply medicines in boxes of a similar colour or design. This can cause confusion for patients and also can contribute to errors when dispensing medicines. Pharmacists have been working with our colleagues in the pharmaceutical industry to ensure that packaging and labelling is designed for safety.

Pharmacists in the Health Service have affected considerable cost cutting. To what extent, and how has this been managed?

The focus has been on delivering better quality and safer services for patients by re-designing the systems associated with the use of medicines in hospital and in community. This includes choosing and purchasing medicines in a different way, having more pharmacists and pharmacy technicians working clinically at ward level, 28-day dispensing at discharge and community schemes such as minor ailments and repeat dispensing. These developments have improved the efficiency of the Western Trust's service delivery as well as providing financial efficiencies that have been reinvested in health trust services and in the use of new medicines.

Media stories often claim there's a 'postcode lottery' on drugs availability. Does NI purchase as a region or do the five Trusts buy individually?

All NI health and social care Trusts take a regional approach to the purchase and use of drugs. This means that we can use the buying power of all the Trusts to get both best value for money for the health service as well as adopting purchasing strategies to maximise the safe use of medicines. Funding for new drugs in NI comes from the DHSSPSNI and this means that these drugs are made available across the province as opposed to in individual areas.

What are the main challenges of the job and what do you find most satisfying?

Ensuring that patients get the right medicine makes the job a very satisfying and challenging one. The role of the hospital pharmacist is predominantly one of problem-solver. The Pharmaceutical Services Improvement Programme has shown how we can re-design the way we work with medicines to improve the quality of patient care across NI. This challenges all of us to further streamline the way we use medicines and reduce waste.

A key challenge of the post is being able to recruit and retain qualified pharmacists in the west of the province. Many pharmacists opt to work in community pharmacy or across the border where salaries are greater than in hospitals. I hope that the Western Trust's new Pharmacy Department in Altnagelvin Area Hospital will help to attract staff to work in such a fantastic modern, state-of-the-art facility.

I enjoy the job because every day presents new challenges - no two days are the same. Working across the whole of the new Western Trust and getting to know staff has been a new challenge due to size and geography but I'm getting there!