What our Welsh Clinical Fellows have been involved in since the COVID-19 outbreak
As a result of the COVID-19 outbreak, some of our Welsh Clinical Fellows for this year have been re-deployed to help out in key areas of NHS service. Here are some of their stories.
Lloyd Hambridge
My name is Lloyd Hambridge and I am a pharmacist who has been working at Health Education and Improvement Wales (HEIW) as a Welsh Clinical Leadership Fellow. I was working within the pharmacy deanery, contributing to a variety of the pharmacy workstreams relating to workforce development which were detailed in the report Pharmacy: Delivering a Healthier Wales, the professions response to Delivering a Healthier Wales. Specifically, I was leading work to determine potential models for non-medical prescribing support post-qualification including peer support, extension of prescribers scope of practice and ongoing competency assurance.
Since the COVID-19 pandemic was declared I have been deployed into the Pharmacy and Prescribing Branch within Welsh Government (WG) to support the teams and professions response to the pandemic, and have increased my time commitments with NHS 111 Wales, where I work as the Regional Pharmacist Practitioner Lead for South East Wales. Within the WG team we have been undertaking work to ensure safe, efficient and accessible pharmaceutical services throughout the pandemic; protecting the health and wellbeing of pharmacy staff, supporting the public in obtaining advice and medicines from their community pharmacy, and ensuring community pharmacies continue to be available for the public to access during the pandemic. Whereas, in my role within NHS 111 Wales I have been helping, along with colleagues, manage the significant increase in demand in the service. Providing telephone and video consultation advice, clinical assessment, treatment and prescriptions where required to patients for a variety of medical conditions as well as managing specific concerns raised by the public around COVID-19. The variety between these two roles in terms of policy and patient care has provided many valuable learning experiences and opportunities, particularly in terms of clinical leadership.
Natalie Proctor
My name is Natalie, I’m one of two Pharmacists to be appointed to the Welsh Clinical Leadership Fellowship for 2019/20.
As a Clinical Fellow I was seconded into Welsh Government to work alongside Chief Pharmaceutical Officer for Wales, Andrew Evans. From September 2019 I took on the role as Welsh Government Lead for Pharmacy: Delivering a Healthier Wales, the pharmacy profession’s ten year vision for transforming pharmacy services by 2030 in response to the wider Government strategy for health and social care; A Healthier Wales.
As a result of COVID-19, my work with Pharmacy: Delivering a Healthier Wales was temporarily suspended and I have been redeployed onto COVID-19 work to support the pharmacy profession throughout the pandemic.
Shielding guidance published by Chief Medical Officer for Wales, Dr Frank Atherton, advised around 130,000 people to not leave their homes due to their clinical vulnerability of developing serious illness if they were to contract Coronavirus.This presented potential risk to a number of citizens across Wales who may not be able to access their regular prescribed medication. To minimise this risk, I have developed and implemented the National Volunteer Prescription Delivery Scheme on behalf of the Welsh Government. Leading on this project has been a fantastic leadership opportunity and a fantastic experience to be involved in a scheme that is directly supporting our community pharmacies and vulnerable people at this difficult time.
Outline of the scheme
An advisory report was written to outline the proposed scheme and funding subsequently approved by the Minister for Health and Social Care. The NHS Wales Informatics Service (NWIS) and NHS Shared Services were able to identify shielders by NHS number and locate the pharmacy who dispensed their prescription during the period November 2019 and January 2020. I worked alongside colleagues in Welsh Government to write a comprehensive data sharing agreement to underpin the use of such data and form part of a robust Governance structure that supports behind the scheme. A round table event was held to inform stakeholders of the intentions of the scheme, process mapping was undertaken and key deliverables defined.
Many pharmacies have existing systems for medicines delivery however a large proportion of these have reached maximum capacity and struggling to cope with the increased demand in response to COVID-19, both from the Shielded Group and other vulnerable people with no means of obtaining their prescriptions whilst in self-isolation. Having a consistent communication strategy has been vital in sharing the correct public messaging; the Shielded Group were in the first instance asked to utilise their existing social network of family, friends, neighbours or community support to identify individuals who could collect prescription on their behalf. Where this was not possible they were then advised to contact their local pharmacy to discuss options for obtaining their medicines. One of these options is the National Volunteer Prescription Delivery Scheme.
The National Volunteer Prescription Delivery Scheme has utilised an established, made in Wales, web-based application owned by the National Pharmacy Association (NPA) called Pro Delivery Manager. This system is used to enhance mobilisation and tracking of a volunteer workforce to deliver essential medicines to vulnerable people. 696 dispensing sites (made up of 652 community pharmacies and 18 dispensing doctors) originally expressed an interest in the scheme due to concerns over meeting the demand of medicines delivery during COVID-19. Of those, 364 to date have experienced significant demand and have gone on to actively participate in the scheme.
A volunteer role description was developed and approved by stakeholders. We have worked collaboratively with third sector organisations such as WCVA, British Red Cross and St John Ambulance during the implementation phase, recruiting and matching appropriate volunteers to the participating sites. Private and public sector organisations have permitted staff members who are currently unable to carry out their routine job due to COVID-19 to support the scheme in the capacity of a volunteer medicines delivery driver. Re-deployed staff have also been identified through The Association of British Pharmaceutical Industry, Optometry Wales, the Driver and Vehicle Standards Agency and a small number of Welsh Government departments, in particular Cadw.
All volunteers have either been in possession of an existing DBS certificate or have been processed to enhanced level via Welsh Government or Community Voluntary Councils. I have worked alongside Higher Education Improvement Wales (HEIW) and Pro Delivery Manager technical team to produce training manuals. This guidance is aimed at supporting volunteers with regards to best practice when undertaking the role of medicines delivery driver including respecting patient confidentiality, infection prevention measures, social distancing advice and technical detail around the use of the Pro Delivery Manager volunteer App.
The scheme was officially launched by Vaughan Gething on 5 May 2020. Around 95% of all sites have been assigned volunteer resource and as of 15th June 2020, 280 volunteers have undertaken almost 2000 medicines deliveries to support the shielding and socially isolated vulnerable people across Wales.
Anita Parbhoo
My name is Anita Parbhoo - Prior to the Covid-19 pandemic, I had spent the previous 7 months researching and designing a new service to improve the health outcomes of older people undergoing cancer treatment in South West Wales Cancer Centre. I had reached a point where I was ready to present my proposed service models to the service manager, clinical leads for the Oncology department and primary care to hear their thoughts of where to take the project next. I had begun to write a business plan, and was awaiting support from the financial department. But as the covid-19 crisis intensified, my meetings and project were no longer priority, understandably.
In order to proceed with the project, I needed engagement and buy-in from key stakeholders in my organisation. Meanwhile, my friends on the front-line all over the country were becoming ill, a couple of them were pregnant and understandably very anxious, emergency nightingale hospitals were being implemented, and in some areas retired healthcare workers were being called back into clinical practice. The guilt and anxiety I felt at that time was huge. Surely as a medical registrar out of programme, I should be there with them, and allow vulnerable colleagues and friends to isolate at home?
After contacting my training programme director, I was allocated to the UHW Covid rota within a few days. I felt nervous being out of the loop with new protocols, such as managing Covid patients, but also how everything we would normally do things was now changing rapidly. The lovely warm welcome put me at rest quickly. In fact, the uncertain transition period in the weeks leading up that point were far more stressful than actually doing the shifts, because I was working in supportive teams. I think distraction and a sense of purpose really helped my mind stay calm. Everyone was adjusting to new ways of working, and managing this new disease. We were learning all the time, and sharing our experiences. There were also weekly seminars between the senior leaders, infectious disease consultants and medical doctors, which were interesting and a helpful link between senior and junior staff. I also became a trainee representative for Cardiff and Vale, ensuring training needs were equally addressed between University Hospital Llandough, University Hospital of Wales, and Dragon’s Heart Hospital. Within this role I surveyed the trainees on how much unmet training needs they had, and organised more clinical skills teaching, fit mask testing, ALS training sessions and ensured new rotas and workforce concerns were addressed. This also meant attending daily skype update meetings with clinical and improvement leads for Dragon’s Heart hospital, which was both valuable and unique as a trainee. It was unbelievable to see how fast things can be mobilised in a crisis.
In some ways, it has been oddly easier to achieve work life balance in these strange times. Unable to travel (several trips abroad cancelled!), unable to see friends and family, the past few months have forced me to slow my life down. I am a violinist in a local amateur orchestra, and while rehearsals have been cancelled, I am continuing lessons via zoom which I find the most effective stress reliever. I’ve managed to join a virtual orchestra (The Isoulation Symphony Orchestra, a branch of the Isoulation Band) but recording videos of myself playing is quite soul-destroying, ironically. I persuaded another of the leadership fellows to also join!
Now that we are hopefully past the first peak, I hope to try and keep all of this in balance, and ease back into my project again with some fresh eyes. I am also reminded that I already have everything I need – an incredible support network, and (mostly) functional coping mechanisms, how lucky I am.
Rachel Lee
My name is Rachel Lee. When coronavirus first began to creep into our lives I was working as a clinical leadership fellow in a non-clinical role, and I felt a real pull to return to clinical work to help. I think feeling the need to help is probably embedded in anyone who works in a caring role. I saw the tragedies unfolding on the news in Italy and Spain, and I felt like I was letting my colleagues and the public down if I didn’t go and do what I was trained to do. I contacted my local hospital and asked if they needed help, and I’ve been doing virtual clinics and telephone triage two days a week since then.
I have two small children, and a husband who – although not a key worker – will not be furloughed and is expected to work just as he did before. For us all to continue working and learning we have had to adapt to a more fluid way of life. My husband works from 6am to 1pm, and I work from 1pm to 6pm. We take it in turns to home-school our five-year old, although doing anything productive with a feisty 2-year old bouncing about is… interesting! One great thing to come out of the situation is the time I spend with my girls; I had not appreciated before how much I love spending time with them – which sounds dreadful. But Coronavirus and lockdown has forced us to slow our life down, simplify, and spend more time together. I think it may have revealed the inner hermit in me.
That being said, it has been a strange few months, and I have felt a mixture of emotions. Guilt for not really being on the ‘frontline’, not really being that helpful, but still being offered special treatment in the supermarket and discounts in the local takeaway. Frustration at the stalling of important projects that I have invested months into and now may not be able to finish before my fellowship year is up. Contentment because of the luxury of the time to eat three meals a day with my hubby and kids. Tiredness brought on by spinning the many plates of family life, home-working, home-schooling, clinical working. Fear from knowing that in August I will return to clinical work without the benefit of building experience of working in a pandemic alongside others, and anxiety that I will not be up-to-scratch. Stress about managing childcare and an expectation of longer hours and clinical work that cannot be done form home, come August. Comfort in the way that my family, friends, neighbours have all pulled together to support each other when needed.
Blending working from home, with looking after children, and clinical work has come with challenges, and has really changed my perspective on what is important to us as a family; I’ve even developed a new mantra: Be the master of your work, not it the master of you!
This year’s cohort will be working with senior colleagues at healthcare organisations across Wales including HEIW, NHS Wales Informatics Service, Welsh Government, Cardiff & Vale UHB and Public Health Wales.
To ‘meet’ each of the new fellows, keep an eye out on HEIW website and social media, where will be posting their bios on a weekly basis. You can also follow our #MeettheFellows campaign on Twitter and Facebook.
For further information, or if you’re interested in contacting a fellow, please email heiw@wales.nhs.uk or follow the fellows on Twitter @WelshFellows
Applications for the 2020 – 2021 WCLTF will open between October 2020 and November 2020 and can be submitted via Oriel.