'A digital-first approach reduces patient frustrations' – a day in the life of a pharmacist carrying out remote consultations
Understanding and improving the patient’s healthcare experience are key aspects of Farah Haque’s role.
Source: Farah Haque
I am a senior pharmacist at Babylon Health, a digital first healthcare provider. Since I started in 2018, the pharmacy team has significantly evolved to play an integral role in digital-first healthcare delivery. All pharmacists at Babylon Health are independent prescribers who consult in a wide range of areas, including cold and flu, contraception, depression and asthma.
I work as a head office pharmacist, based in London, where I conduct remote patient consultations, in addition to carrying out service delivery projects and contributing to the out of hours on-call roster. Working within a digital-first environment allows us to reduce patient frustrations through shorter waiting times, avoidance of waiting rooms and queues — all without compromising the standard or quality of our consultations.
Data protection in a digital environment is very important to us. We work closely with the technical teams to protect our patients’ data with utmost priority. Any personal or sensitive information we hold about our patients is protected by strong encryption codes and held in secure data centres. We encrypt all data transmitted to and from the app, and use strict procedures and security features to try to prevent unauthorised access.
08:30am — start
My day starts with a virtual multidisciplinary team (MDT) huddle, attended by pharmacists, nurses, advanced nurse practitioners, GPs, medical directors, mental health nurses and care coordinators. We discuss important day-to-day issues, which can include clinical or technical issues that may have arisen out of hours.
Overnight, some of the functions in the Babylon app were not accessible for a particular patient. We discuss the impact of these issues and come up with an interim management plan while we wait for the technical fix from the engineering teams.
I raise a case for MDT input regarding a patient who is refusing to be seen in the international normalised ratio (INR) clinic and wants to self-check his INR levels. After discussion as a team, we agree to continue prescribing his warfarin, providing he is reviewed annually at the haematology clinic and is competent to self-monitor.
I have a digital consultation with a patient who recently moved from the United States to the UK and has registered with GP at Hand. Our patients are either registered with Babylon’s GP at Hand NHS service or with us privately. While most patients are managed digitally, they do have access to face-to-face clinics in London or Birmingham when physical investigation or assessment is required.
This patient has a history of depression and anxiety, and has been stable on a treatment plan they were prescribed in the United States. Unfortunately, their medication Pristiq (desvenlafaxine; Pfizer) is not available in the UK. Since travel restrictions due to COVID-19 have been put in place, we have noticed a sharp increase in the number of patients unable to access some of their medicines which are not available in the UK.
Understandably, the patient has concerns about destabilisation; however, after a review and discussion, we agree to switch them to venlafaxine with careful counselling, monitoring, planned follow-up and regular ‘checking in’. The patient is also referred to a psychotherapist to supplement their pharmacological treatment. When MDT input is required to support a clinical decision, a ticket can be raised via our internal system for the attention of the duty MDT. For more complex cases, patient management can also be discussed in our monthly MDT meeting.
Going forward, the patient can continue to have appointments with pharmacists or any other clinician of their choosing. They also have the option to book in with me for future appointments for continuity of care. Until the patient is stable on their new regime, they will not have medication added to their repeat medications list and will require a digital appointment each time they need a medicine.
I attend a meeting with the five other head office pharmacists about our antibiotic stewardship audit. I implemented this in September 2018 to reduce inappropriate prescribing of antibiotics. This includes reviewing our prescribing practices against best practice guidance on a weekly basis and providing feedback to clinicians if their prescribing deviates from national guidance. This audit is ongoing to ensure we maintain a low level of antibiotic prescribing in line with guidance, and share learnings with teams internationally.
In today’s meeting, we discuss a statistically significant reduction in inappropriate prescribing and a fall below the UK threshold. Our work has been commended by the Care Quality Commission and will be presented at the now postponed Royal Pharmaceutical Society Science and Research Summit.
I am proud of our work. Getting involved with ongoing projects related to clinical service delivery and improving patient experiences is the most enjoyable part of my role.
I work with the technical team to help improve clinician and patient user experiences of our app by regularly checking service delivery through an audit of patient consultations. We look at ways to streamline this process further via developing an online chat function. This will make it easier for patients to get repeat prescriptions for their medicines, such as the contraceptive pill.
For clinicians, we discuss improving the systems used to deliver video consultations to our patients: for example, automating prescription suggestions and dosing based on the coded conditions for our private patients.
Our director of pharmacy shares updates from the daily COVID-19 directors’ meeting with us, where the impact of the pandemic on patient consultations is discussed and the need to make any changes to digital consulting is agreed.
Today we are asked to ensure we include a statement in our patient consultation notes indicating that the consultation took place during the pandemic.
After the meeting, I send an email to the remote pharmacists cascading this information to them.
I present prescription data analytics to some of our teams in Rwanda and Canada. My team and I are responsible for sharing global prescribing insights with our international teams. This data allows us to see the demand in healthcare needs in the various countries that use our services — for example, we have observed an 18% increase in the number of private prescriptions issued from March to April 2020.
I catch up on some work involving our private prescribing formulary, which head office pharmacists are responsible for. This includes making some adaptations to accommodate patients who are unable to access NHS services in a timely manner.
The formulary has been designed to manage prescribing risk in a digital environment. Our clinicians are encouraged to prescribe within the formulary; however, if the clinician decides to prescribe a medication not on our formulary, the prescription goes through an approvals process, where a second clinician checks for appropriateness before the prescription is released to the patient.
Compared with public formularies, ours tends to contain a more restrictive list of medications available for prescribing. This can lead to difficult prescribing decisions, but ultimately the decisions are made by the pharmacy team and me, as we lead in any aspect of prescribing in our organisation.
I organise a continuing professional development (CPD) webinar on digital asthma management, including how to manage exacerbations during the pandemic, as we have noticed an increase in patients requesting inhalers over the past few months.
My team and I have been working with external providers to ensure that our pharmacist workforce is kept up to date with changing advice around COVID-19. Part of this includes running CPD webinars, which has allowed more clinicians to participate. Under normal circumstances, these sessions would be delivered in person and usually run all day. We have converted them to shorter webinars, which has unfortunately restricted the amount of peer discussion and engagement. However, to help improve this, we also utilise polling apps to help with engagement.
18:00 — finish
I usually end my day by actioning any outstanding emails and reviewing my calendar for the next day. I also do one last check-in with my team to see if any of them need help with patient management or duty tasks, before signing off.
Box: Are you interested in a similar role?
- The starting salary for pharmacists at Babylon Health is between £45,000 – £50,000;
- An independent prescribing qualification is essential and continuing education is encouraged. I am currently completing a postgraduate diploma in clinical psychiatry to better support patients in need of mental health services;
- It helps to be creative, and have the ability to deliver projects quickly and in novel ways;
- Project management experience is desirable, but not essential. However, being able to demonstrate and utilise skills involved in project management is important — for example, leadership, communication, time management, scheduling and critical thinking;
- You need to be adaptable, able to problem solve, communicate well and a team player;
- In this role, the pharmacist works alongside highly skilled engineers, combining healthcare delivery with technology, such as artificial intelligence. You must therefore have a strong interest in technology, be IT-literate and able to use multiple systems (SystmOne, G drive, data analytics).
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2020.20208005
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