After fighting through a pandemic, we are finally starting to settle into our new normal. Or are we?
I made the move over to the darkside in January 2021 after working 15 years in community pharmacy. I joined North Stockton PCN and like many of you, I had no idea what to expect. Community pharmacy was all I had known. The driving factor was wanting to be more clinical but looking back now is there such thing as a non-clinical pharmacist?
For a while I hung in limbo, trying to find my place in this new world when a colleague recommended that I undertake some educational sessions to help upskill. So, in search of these magical clinical powers, I came across The MORPh Diabetes Academy and it struck a chord with me. The academy started by looking at the basics of the pathophysiology of diabetes, the bread and butter and then went on to build upon those foundations, the drugs used in the treatment of diabetes as well as the complications associated with the condition. I was very lucky that I had a great mentor Helen O’Neil who helped support my learning through case studies and tutorials.
So armed with all this fresh vigour and knowledge I set out to save North Stockton PCN from T2D and within five minutes I hit my first barrier. Was this the role of a pharmacist? Can pharmacists ‘DO’ diabetes? YES, WE CAN!
I came across more roadblocks along the way, I found that colleagues lack of knowledge and interest in T2D was getting in the way of patients accessing the best care available.
The wait times for secondary care in our local hospital is 6-9 months and, in that time, patient outcomes would continue to worsen. Initially the plan was to firefight, help clear the backlog created by the covid-19 pandemic, but the more I ‘did’ diabetes the more I understood that the effect of the pandemic was only part of the problem. The way we, as HCPs treat diabetes needs to adapt. We couldn’t remain in the familiar and outdated regimens, so it was time to shake things up a bit.
It isn’t just about glycaemic control, it’s about EVERYTHING, cardio, reno, neuropathy, retinopathy, blood pressure, lipids, diet, lifestyle, it is an all-encompassing condition and that’s how I started treating it in my little corner of the world. And this is when the hard work actually began.
Eighteen months on, its more about being proactive than reactive. I have helped to set up the TeesValley DiG, a diabetes interest group that upskills HCPs and offers peer support. I am in the process of implementing the DiaST model to provide an intermediate care hub for diabetes patients, who would like specialist diabetes care closer to home, and in turn helping to reduce the pressure on our colleagues in secondary care. Using risk stratification tools, I am able to identify the patients who require more specialist care helping to reduce health inequalities.
If you had told me eighteen months ago, I would be initiating insulin in primary care which historically had only been carried out in secondary care, I wouldn’t have believed I could do it, but here I am! I am currently writing up a quality improvement project demonstrating the positive impact of a pharmacist led diabetes clinic. By using my skills in medicine optimisation, I have been able to initiate injectable GLP1-RA who otherwise would be waiting for a referral to secondary care. I am able to support patients access technology in the form of flash/CGM and empower patients to take control of their own management.
I am working with the local District Nurses to support the most vulnerable patients in our community, LD patients, housebound and care home patients, tackling poly pharmacy and deprescribing, that’s right deprescribing. Now I’m even venturing into CKD, Heart Failure and diabetes during cancer treatment.
Obesity is one of the leading causes of T2D so our PCN has worked with DUK to set up a health and well-being event and currently running a pilot for diabetes remission via a low calorie diet to help with weight loss. We are attacking T2D on all fronts.
These little milestones have paved the way for my patients to receive the very best care available to them, and allowed them to better manage their own health.
As a pharmacist I enjoy the interaction with patients and seeing the improvement my input makes to people’s day to day lives but it’s not all plain sailing. There will always be obstacles, be it capacity or funding but if you’re determined you will find a way. There is a wealth of knowledge out there, go out there and soak it all up! Build contacts within your own network and be brave and reach out to others out-with your network, you don’t have to be a Lone Ranger, we all need support. It’s not just about working harder it’s about working smarter, true story.
Nadia Malik
Nadia has worked in community pharmacy for 15 years. In 2021 she made the move to primary care to work for North Stockton PCN with a special interest in Type 2 Diabetes. Recently she has helped set-up a Diabetes Interest Group which facilitates upskilling and education of local healthcare professionals and provides a support network.
