Martin Paterson Brown, clinical pharmacist from Pharm-Assist – a small group of independent NHS community pharmacies in Leeds – talks to Saša Janković about leading the medicines management team at Wetherby Young Offenders Institute.

Service type: Medicines management

Name and location of pharmacy: Pharm-Assist, Leeds

Name of pharmacist: Martin Paterson Brown

Why did you start offering this service?

This service has been running for five years now. The Institute had a very small pharmacy technician team but appreciated they needed somebody on site to lead the team in terms of responding to changes in procedures, recognising when events go wrong and seeing what could be improved.

Leeds Community Healthcare Trust (LCHT) couldn’t do that from a distance and decided they wanted someone on the ground, so they contracted out the service and that’s what I do on behalf of Pharm-Assist.

I work two days a week alongside eight pharmacy technicians and eight nursing staff in our own building within the prison, although I am available any day if they need something.

What, if any, training did you or other team members have to undergo?

The Health and Justice Pharmacy Network – part of The Specialist Pharmacist Service (SPS) – has specific resources for pharmacists working within the health and justice environment that you need to be aware of. Direction can come down from that in terms of overall services such as flu and Covid vaccination planning, and I also work with Christopher Toothill – Leeds Community Healthcare Trust’s medicines management pharmacist for governance and risk – as my immediate connection with LCHT when dealing with things.

In a nutshell, what does the service involve?

It’s my clinical responsibility to oversee the SOPs and processes and be available for the clinical service we provide to the Institute.

Our Seacroft pharmacy dispenses the named medication to the young people on site, and our Halton pharmacy has the licence to supply stock, and I am a connection between our community pharmacy and the contracted GP practice which comes in. There is a clinical paediatric psychiatrist who is the clinical lead for the whole site, plus we have non-medical prescribers from the nursing side, and the Child and Adolescent Mental Health Services (​CAMHS) team have psychiatric non-medical prescribers. Sitting over all this we have the pharmacy technician team doing medicines administration three times a day, working with nurses to provide physical as well as medical care for the young people.

I liaise between the teams and also chair a medicines management meeting once a month. When we put special medication plans in place for the young people we also have to liaise with the prison to tell them about any changes from the standard routine – such as giving medicines at the door for some young people – so we have to write a medicines plan to explain why.

It’s important to be flexible to respond to the challenges that may prevent you providing normal healthcare services to the young people, because what we do has to be a comparable service to what normal primary care would give them. Of course, there are daily challenges with behavioural issues which affect our ability to maintain clinical medication, so we have to make sure our operational procedures are safe for the medicines team but also that the young people are not denied medication for the wrong reasons.

For example, the pharmacy team will risk assess the patient along with the mental health teams to decide whether they can have the patient on medication ‘in possession’ where possible, which involves assessing the risks of overdosing etc.

Risks of self harm are also closely monitored by nursing staff and we are part of this discussion too.

Any mental health issue may lead to a young person ending up in a secure environment, but this is an opportunity for them to access an improved level of care than what they may have in their community or if they were left to their own devices. One of things we can do is check vaccination schedules for the young people – for example, for hepatitis b – and other principal areas we deal with are acne and asthma.

How have patients responded to the service?

We don’t really get direct feedback from the patients themselves, but there are certainly instances where I feel like we have made a difference.

One of our patients was a young man with treatment resistant schizophrenia. The clinical psychiatrist put him forward as a candidate under NICE guidelines for clozapine treatment, which normally takes place in a medium secure unit under a child and young adult psychiatric consultant as there are complex regulatory requirements for monitoring and titration for the patient. However, the young man - had said he didn’t want to go into hospital – he wanted to stay here as he was treated as an adult and had friends around – so the healthcare team put something together within the regs to monitor his blood results and work with the patient to make sure he could stay in the healthcare environment that he wanted. He’s been treated for over a year and half and is now on a therapeutic dose and continues to be well.

We were delighted to be able to show that we could take the patient up to the transition to therapeutic control of his condition, and the successful partnership between different teams shows it can be done with the right team members and the right approach.

Roughly how much a month do you make from offering the service?

What is important is how much wastage we’ve been able to reduce. As it’s our pharmacy that supplies the medication we can see what has been used a lot, and produce a running chart of cost of items per fee we get paid. This helped us see if, for example, the CAMHS team had been prescribing branded generics for patients. We also introduced stock products instead of named patient medication, which prevented waste in the high-use, high-value products, and we stock them on the wing. This has reduced the running costs in terms of drug use and that’s an ongoing process.

Would you recommend offering this service to other contractors?

There are plenty of pharmacists in the Health and Justice System, but Young Offenders Institutes have unique challenges, so it needs to be a fairly dedicated role. Having said that, we have a good rapport with the young people generally and are not on the receiving end of any violence as they do see us as being helpful to them.