1. Non Medical Prescribing Making a Difference Marie Brazil Consultant Pharmacist Haematology Services Wirral University Teaching Hospital NHS Foundation Trust

2. Background  Haematology ….. Wirral from 1994  Qualified as Supplementary Prescriber July 2004  Inpatient prescribing and discharges  June 2007 Outpatient Clinics  Independent Prescriber Feb 2008

3. For patients Ensuring fair access to healthcare is at the heart of Lord Darzi’s recent report on the future of the NHS

4. “Ensuring timely access …….” There was a strong message that people can still find it difficult to access services. Improving access is a priority articulated in every vision, across every pathway of care. Each region will continue to improve the quality of access by reducing waiting times for treatment, …….” High Quality Care For All June 2008 NHS Next Stage Review Final Report June 2008

5. Service redesign + Use of skills of the whole MDT = Improved access

6. Previous Clinic Structure  Monday (Haem Day Ward) Consultant 1 plus Registrar Consultant 1 plus Registrar  Tuesday (Haem Day Ward) Consultant 2 plus Registrar Consultant 2 plus Registrar  Wednesday (Outpatient Department) Anticoagulant Clinic (Outpatient Department) Anticoagulant Clinic (Haem Day Ward) Nurse led bone marrow clinic (Haem Day Ward) Nurse led bone marrow clinic  Thursday (Outpatient Department) Consultant 1 and Consultant 2 plus Registrar Consultant 1 and Consultant 2 plus Registrar

7. New Structure  Monday (Haem Day Ward) Consultant 1 plus Registrar Consultant 1 plus Registrar  Tuesday (Haem Day Ward) Consultant 2 plus Registrar Consultant 2 plus Registrar  Wednesday (Outpatient Department) Anticoagulant Clinic (Outpatient Department) Anticoagulant Clinic (Haem Day Ward) Nurse led bone marrow clinic (Haem Day Ward) Nurse led bone marrow clinic  Thursday (Outpatient Department) Consultant 1 and Consultant 2 plus Pharmacist and Clinical Nurse Specialist (Outpatient Department) Consultant 1 and Consultant 2 plus Pharmacist and Clinical Nurse Specialist (Haem Day Ward) Consultant 3 plus Registrar (Haem Day Ward) Consultant 3 plus Registrar  Friday (Haem Day Ward) Consultant 3 plus Pharmacist and Clinical Nurse Specialist Consultant 3 plus Pharmacist and Clinical Nurse Specialist

8.  Follow up patients seen by specialist nurses or pharmacist Pharmacist  MDS, Chronic anaemia  Essential Thrombocythaemia  CML (molecular monitoring)  ITP  Haemochromatosis Increase in available clinic slots Increase in available clinic slots

9. Patient Satisfaction Survey  March 2008 Brief survey n=40  98% of patients completely confident with service  2% less confident than when seeing a doctor  Quality of consultation rated 100%

10. Patient Expectation Survey  Jan/ Feb 2009 (LJMU)  More representative sample of patients managed and not managed by pharmacists in clinic  Patients happy and confident in service  Others more confident with traditional roles

11.  Individuals  Professional bodies

12. Professionally  Rewarding  Challenging  Lead by example (NPSA)  Role model

13.  Greater understanding “Walk a mile in another man’s shoes”  Greater integration / a more confluent service

14. Blurring the Lines Who checks the checker?  Chemotherapy – outpatient prescribing of oral agents.  Inpatient chemotherapy – prescribed by consultant medics and accredited registrars

15. Never say never…  Traditional to innovative  Background to forefront Ripples are little waves and making waves can be fun

16. Any Questions?