The role of Consultant Pharmacist in the myeloma clinical team

Elizabeth Davies describes her role as Consultant Haematology Pharmacist at Manchester Royal Infirmary (MRI) NHS Foundation Trust. Elizabeth has worked in haematology for 18 years and is an independent medical prescriber with an advanced clinical skills qualification. Her unique role as a Consultant Pharmacist includes the outpatient clinical review of patients at all stages of their disease. Elizabeth told us more about how this role evolved.

The haematology pharmacy service at MRI

Our service model in Manchester encompasses a near patient pharmacy service, ie it brings the medicines to the patient. This model was introduced in 2010, after a successful business case, and has continually generated excellent patient feedback. All SACT is prescribed in advance, then verified by the haematology pharmacy team, before being dispensed and delivered to the outpatient clinic. Patients are reviewed and receive their medicines within the clinic environment which avoids an extra visit and wait at pharmacy. A haematology pharmacist with specialist training in the treatment of myeloma, is in clinic to give patients their medicines and answer any questions they may have. If treatment adjustments are required, the pharmacist is supported by a technician and patients can usually stay in the waiting room while these changes are made. Following the success of the service at MRI, we have also now expanded this service model to one of our other hospital sites, Trafford General Hospital.

Introducing the role of the Consultant Pharmacist

In 2020, the pharmacy role within the myeloma service at MRI was further developed with the creation of a Consultant Pharmacist post in haematology. This was in response to the clear need for expert pharmacist input to keep pace with the expanding treatment options in haematology, such as CAR-T and gene therapy. A pharmacist working at consultant level, who could provide patient-facing care, was identified as a key area for service development within the myeloma setting. As such, the myeloma clinical team at MRI now consists of two Consultant Haematologists, Dr Phillip Crea and Dr Jenna Fielding, plus my position as Consultant Pharmacist.

How does your role differ from other models of pharmacist-led care?

We decided not to have a dedicated pharmacist-led clinic for a defined group of patients, a model which has been successfully established in other hospitals for many disease areas, including myeloma. Instead, we integrated the Consultant Pharmacist fully into the myeloma outpatient service to manage patients collectively as a clinical team within a ‘shared myeloma clinic’. Rather than being linked to a particular consultant, patients see any of the three consultants, depending on their needs. The team discusses and agrees on the management of all the patients before and after each myeloma clinic.

This clinic model allows me to provide complete care for most of our patients, including those early in their diagnosis, those on active monitoring, those with relapsing disease, and patients coming towards end-of-life. For any patient I see I am responsible for their overall care from that clinical episode. This may include ordering diagnostic tests, prescribing SACT, reviewing supportive medicines, managing treatment related toxicities, making referrals to other specialties, and communicating with other healthcare providers in both primary and secondary care.

What are the advantages of this model of care?

The myeloma treatment landscape is now very complex, and we feel giving patients access to a highly specialised Consultant Pharmacist on a regular basis is invaluable to their overall management. By seeing different members of the clinical team throughout their disease, patients can be managed more holistically, with different team members bringing their own expertise and strengths to a patient’s individual situation. Furthermore, as I also see patients who are on active monitoring, I can develop a good relationship with them before they might need to start treatment in the future.

Most of our myeloma patients are older adults, many of whom have multiple comorbidities, advancing frailty and are taking several other medicines (polypharmacy). In addition, treatments are increasingly complex. To address these issues, many patients benefit from seeing a Consultant Pharmacist, rather than a Consultant Haematologist.

We believe that by forming a relationship with all three members of the Consultant Clinical Team, as well as the Clinical Nurse Specialist, the patients benefit from a true multidisciplinary approach and receive expertise from different professionals to provide optimal patient care. It also means patients develop a relationship with all members of the team and can feel reassured that all the staff know them and their history. This avoids concerns such as their consultant being on annual leave when they need medical input.

How important is the role of the consultant pharmacist in myeloma?

Myeloma treatment options are growing at a rapid pace, which is excellent news for our patients. Pharmacists increasingly play a key role in enhancing patient care, given the evolving treatment landscape. There are many highly specialised pharmacists working within myeloma providing excellent patient care, and there is a defined pathway to becoming a consultant pharmacist. Pharmacists working at this level are experts within their chosen field and accredited as working at consultant level. Because of this, patients can have confidence in seeing a highly trained and qualified member of the clinical team who is equipped to provide holistic care, particularly if complex pharmaceutical support is needed.

Q&A with Elizabeth Davies
Consultant Haematology Pharmacist
Manchester Royal Infirmary NHS Foundation Trust