After Covid… a personal reflection from Scotland

When thinking about Covid and Pharmacy it might be useful to consider what didn’t happen……

Medicines did not become a crisis area like PPE and the service did not fall over; community pharmacies despite significant additional stresses remained opened and functional. These are things to be celebrated and we should reflect on why this was the case. I would contend that our preparations for EU Exit meant that our medicines supply and distribution systems and processes had been recently reviewed and strengthened. In my own area, the preparation for EU Exit meant that teams across Primary, Secondary and Tertiary care had worked more closely and we had firmer foundations than would have been the case two years ago.

It is perhaps inevitable that a new virus with no vaccine and no established effective treatment would make demands on unusual parts of the service. Oxygen became a major area of CPD for most of us. As a senior manager in the first few days I was blindsided by how much I hadn’t known about Oxygen. Up until that point, I had thought of it as a POM but not really something of much importance, it came through a pipeline and as long as the suppliers kept delivering, I had thought we were well placed. We already had frequent monitoring on site and off site through telemetry and were assured by suppliers that there wasn’t a shortage. When it became clear that our hospital wards were not built to deliver high flow rates to every patient on that ward then the potential for problems became apparent. The QA team came into their own and they ensured that supplies were maintained.

For me the past 10 weeks have been about workforce, the wonderful workforce to whom I am in debt, repeatedly staff has stepped up, worked across new teams, went where they were needed and shared their expertise and insights to deliver a high quality service. I am immeasurably grateful to them. The creation of a more flexible and responsive workforce is possible as has been demonstrated.

MS teams has been a vital link and quickly replaced teleconferences. Now however, we are becoming aware of limitations, where parts of the NHS do not have Windows 10 or O365 then full functionality is not available, this requires to be addressed. Judicious use of MS teams is helpful but in some cases it has not enabled the softer skills of team working to be fully practised. The water cooler conversations are not enabled in a system where everyone comes online at 1pm exactly and leaves promptly at the end. It may be that we need to think about how we do that better.

The increase in Joy at work and Well Being conversations has worked well and needs not to be lost. Staff wellbeing is always a priority. As we move into an era of “blended” learning for school pupils the pressure put on staff to manage work and home increases. Evidence suggests this pressure falls differentially on women and as with the rest of the NHS, pharmacy services are female dominated. I think we need to think more deeply about how address this going forward.

Finally, from a clinical and therapeutic perspective pharmacy was in a strange place, apart from the usual example of oncology and haematology the clinical and therapeutic decisions about the medicines to be used for populations of patients were often made by specialist medical groups with less input from pharmacy, nursing or other groups. I know that there is some reflection in medicine about this too and I welcome it. As a senior manager, I certainly spent much less time on clinical and therapeutics issues and more time on supply than normal and the balance did not feel right. We need, as a profession to also think about how best to address this for the future. I think oncology and haematology worked better because there is a long history of a well-resourced multidisciplinary service but that is not the case for many other areas and in a command and control situation old ways of working came to the fore.

It is easy with a retrospectroscope to identify that social care was not given enough emphasis by any of the home countries and the impact on residents of Care Homes was shocking. Could pharmacy have done more there? I think residents of Care Homes do need more pharmaceutical care and if this pandemic enables that deficiency to be addressed that would be a positive.

My reflections are just that, my reflections, I am not sure if we are at the beginning of the end or the end of the beginning but together with the views of others in these articles we can use this time to improve for next time.

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