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Pharmacy support


Pharmacy-led clinics in support of patient care


Pharmacist prescribers are developing the level of specialism seen in their medical colleagues and, as such, provide a valuable additional resource for healthcare providers when managing increasing demand and limited medical resources


Jennifer Allen MRPharmS (IPresc) Oncology Haematology Prescribing Pharmacist Steve Williamson MRPharmS (IPresc) MSc Consultant Cancer Pharmacist Northumbria Healthcare NHS Foundation Trust/ NHS England, UK


Pharmacy practice in the UK has developed to allow pharmacists to lead clinics in which they are reviewing patients, making treatment decisions and prescribing medicines. This extended role has grown since 2006 when UK pharmacists were first able to undertake an independent prescribing qualification.1 Independent prescribers are now able to prescribe for any condition within their competency. This has allowed non- medical prescribing pharmacists to develop extended roles within secondary care hospitals, primary care and community pharmacy. This article describes the role of haemato-oncology pharmacist-led clinics in the UK.


Background


Hospital-based clinical pharmacists in the UK often undertake further postgraduate education, studying for a diploma in clinical pharmacy. This increases clinical knowledge and has supported the expansion of specialist roles.2


However,


unlike the medical profession, there has been no formal route for specialisation for pharmacists. The Royal Pharmaceutical Society has addressed this with the development of its Faculty, which includes accreditation using specialist curricula, for example, the cancer curriculum.3


In this context, pharmacist- led clinics have grown as local initiatives


to meet service need and improve patient care; however, there is no nationally recognised standard role for pharmacists working in clinics. There is very little published literature on pharmacist-led clinics, the majority being on primary care models supporting public health, for example hypertension management.4,5


Which patients can be seen in pharmacist-led clinics?


There are many patients being treated in the haemato-oncology setting who are diagnosed at an earlier stage in their disease, or who are able to access many more lines of therapy than in previous years, meaning clinic capacity can be an issue. The availability of an additional healthcare professional to review patients in clinic provides time capacity and increases the accessibility of clinic


appointments for the consultant. It also reduces the level of investment needed to provide additional medical consultant sessions to manage this demand. The first stage is to identify and agree the cohort of patients that the pharmacist will see in clinic; this can be patients on oral anticancer medicines, for example tyrosine kinase inhibitors or patients with a particular condition, for example, myeloproliferative disease (MPD).6


As the


pharmacist’s primary expertise is based upon pharmacology, clinics can evolve around particular types of drugs, and most suited are those given for long-term treatment. In haematology, this can include drugs such as hydroxycarbamide for MPD, imatinib for chronic myeloid leukaemia and lenalidomide for myeloma. Key questions to consider are: Does the patient or drug require regular


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