Kalveer Flora
Monday
Due to the nature of my job and the varying demands of each hospital site, my working week is never always the same. I have my base hospital where I work 80% of the time, allowing 20% of my time dealing with queries or meetings scheduled at the 2 other hospital sites.
Having said this, my work schedule is always mapped out 3-4 months in advance, therefore allowing me to plan projects which need implementing in good time allowing for any contingency planning. I have overall responsibility in ensuring funding is available for patients in need of biologics (high-cost drugs). These are drugs which cost on average around £10,000 per patient per year and are funded through our local 8 clinical commissioning groups (CCGs). Biologics fall under a category known as payment by results (PBR) where we as a hospital need to provide evidence to the CCG that the drug is working for the patient and therefore its cost is justified.
Within rheumatology, there is an array of biologics available for varying indications. These need to be managed and prescribed only when appropriate, whilst considering clinical effectiveness and optimisation to ensure the best value biologic is given. Our annual spend on biologics in rheumatology is around £4 million alone at one Trust. My role is therefore crucial in ensuring we prescribe the most effective drugs in the most cost-efficient way.
Most of my Monday is spent approving applications for funding for new patients initiating treatment as well as ensuring those who need to continue to have the funds approved to do so. This is done using an electronic online portal called Blueteq and using the hospital clinical portal for clinical parameters.
On Mondays, I also cover the dispensary as part of a senior pharmacist slot for one hour over lunchtime. This keeps me in touch with dispensing and the technical role of a pharmacist. I often ensure I go to the outpatient hatch where I can hand out prescriptions and answer any medicines related questions patients have.
I’m asked by Mr X why he’s been given atorvastatin to take as he doesn’t have high cholesterol. Glancing at his prescription, I can see he attended A&E with a suspected transient ischaemic attack (TIA). I, therefore, take a few moments to explain to him the possible causes of a TIA and in his case the atorvastatin is used for prevention of any further attacks regardless of cholesterol levels. It is important to relay information in a way patients find easier to understand, allowing them to make informed decisions about taking their medicines.
Over the lunch break, I tend to work on projects and educational meetings I support. I do, however, pop over to the arthritis centre at this time to make a plan for the week ahead and touch base.
After this, I deal with a mix of queries with regards to funding, selection of the best drug to use in a patient with multiple drug allergies and check blood results for any of my patients.
At 3pm I have a meeting with a representative from a drug company about a new drug available for the treatment of psoriatic arthritis. The drug has recently been approved by NICE with a 30 day implementation period. My job is to look at where this drug can be used within our pathways. I must ask if there are any patients who can benefit from the drug and is the drug available through homecare? With so many new drugs available recently in the field of immunology it is paramount that I as a pharmacist, an expert in medicines, am aware of these developments and can thereby facilitate their adoption into our practice safely and efficiently.
Would you consider a role in rheumatology?
Have I tempted anyone in a role with high-cost drugs?
Kalveer Flora is Lead Rheumatology and Biosimilars Specialist Pharmacist, Deputy Chair, Rheumatology Pharmacists UK (RPUK).