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The bus stops here

 By Victoria Birchall

I start the week in a primary care network-led Covid vaccination centre at a GP practice in Preston. The medicines optimisation team of pharmacists, pharmacy technicians and an administrator at NHS Midlands and Lancashire Commissioning Support Unit (MLCSU) have been heavily involved since December, when these clinics across Greater Preston and Chorley and South Ribble (GP & CSR) CCGs began.  

Our main role is to ensure the safe and accurate dilution of the Pfizer vaccines, ready for use. But while we’re in the clinics, we will answer queries about the vaccination programme, make sure the fridges are set up correctly and being monitored, and that PCN staff are trained in the dilution and safe handling of the vaccine. It’s fair to say this work is quite different from our usual role, but our skills have transferred well and we’ve become an integral part of the vaccination teams locally.

Next day is an office day. In a new project, I’m part of a diabetes task and finish group made up of MLCSU, GP & CSR CCG, care home provider, general practice and local authority staff. Following safety incidents, I’ve been tasked with writing a policy to ensure safe administration of insulin within the care home setting, working closely with the other members.  

It’s become clear that we need to raise awareness about the types of equipment (for example, safety needles) required, to ensure insulin is delivered as intended, safely and accurately. With different combinations of insulin, devices, needles and lancets, making sure all staff involved know what to look out for will reduce the risk of serious harm to patients.  

After a chat with my managers and the deputy chief nurse, we’ve come up with a plan to produce a prescribing tip for the newsletter which goes out weekly to all GP practices, and the care home bulletin. We’ll produce a poster to go on the wall in the care homes and deliver a training session to PCN and practice-employed pharmacists and pharmacy technicians who carry out care home medication reviews. Diabetes specialist nurses are already planning to provide training to care home staff.

It’s a different project for the next couple of days, completing a urinary incontinence prescribing audit, then contacting patients to discuss their current symptoms and the benefits and risks of continuing their medicines. Most of the drugs are anticholinergics and the evidence shows the benefits of use are quite small, with only one in five female patients experiencing complete resolution of symptoms. Some patients can go into natural remission, but it is difficult to know if this has happened while they are still taking the medicine. Lastly, there is an increased risk of falls, cognitive impairment and dementia associated with long-term use in the over-65s. 

My telephone consultations go well. Patients are glad to have the chance to discuss their symptoms and go through the information. With the agreement of their doctor, I offer them the chance of a ‘drug holiday’ for four weeks to establish if it’s still required and if they notice a difference in side effects. Almost all patients decide to give this a go; it’s interesting to hear their reasons why (having family with dementia, experiencing more trips and loss of balance, being troubled with memory symptoms, wanting to stop medicines which are no longer needed). One patient tells me she’s never had such care and really appreciated me phoning her.

Vaccination drive

For the end of the week, I’m working on the Covid vaccination bus in Preston, which has been commissioned to help with rising infection rates and to improve vaccination rates, which have been low in certain wards. I don’t sleep very well the night before – working on a bus is a different challenge to a vaccination centre. The Pfizer vaccine is fragile, and the mRNA strands need to stay intact to be effective. The vaccine can only be transported twice when defrosted – once from the hub to storage at the practice, and then to the bus. 

We don’t know how many are going to turn up, so we run back and forth, taking small quantities in specialised cool boxes which act as portable fridges, to ensure enough stock while minimising waste. It’s a lovely atmosphere as around 650 people are vaccinated in a steady flow on the bus in front of the Harris Museum in the centre of Preston. We have college students and workers dropping in, as well as others who have seen the communications on social media, in texts and in newspapers. One particular council worker is talented at persuading passers-by to have the jab too. 

For my final shift of the week, the bus is at a different location. Life as a medicines optimisation pharmacist is varied. There’s lots of job satisfaction; it’s good to be able to see the effect we can have as a team. 

Victoria Birchall is a medicines optimisation pharmacist with MLCSU, working with Greater Preston and Chorley and South Ribble CCGs




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