Prescribing with confidence podcast series

Rakhi Aggarwal
Hello and welcome to our Prescribing with Confidence podcast series from NHS Specialist Pharmacy Service [SPS]. My name is Rakhi Aggarwal. This podcast is part of a series to support prescribers on the prescribing journey. Today I’m here with two foundation pharmacists, Ella and Maimoona, and a 4th year student Harriet. Welcome all, it’s wonderful to have you here.

Ella, do you mind kicking off and introducing yourself to our listeners?

Ella Williams
Hi, my name’s Ella, I’m a trainee pharmacist. I work in the GP, and I also work in the community pharmacy. And as part of my training year [unclear] prescribing.

Rakhi Aggarwal
Maimoona?

Maimoona Hussain
Hello, I’m Maimoona and I’m a trainee pharmacist across academia and hospital. So, I work across Wye Valley NHS Trust and Aston University, and as part of my training year, I’m also completing the independent prescribing course.

Rakhi Aggarwal
Fabulous, thank you ladies. And finally, Harriet, you are a final year student about to embark upon the foundation year. Did you want to introduce yourself and tell me where you, where you plan to do your foundation year training and how you’re feeling about it?

Harriet Giles
Yes hi, I’m Harriet and I’m a 4th year pharmacy student at Swansea University, and I’m starting my foundation year in August in the community sector, which I’m looking forward to, but also have nerves that come with embarking on this new journey.

Rakhi Aggarwal
Thanks Harriett, how exciting! So, you guys have had a sneak preview of our Prescribing with Confidence podcast series, which is compiled of six episodes with real life experience guests sharing insights, resources and tips to prepare yourself for prescribing. Maimoona, do you want to share the titles of the two podcasts you listened to and some thoughts about them, if you don’t mind.

Maimoona Hussain
Thank you. Yeah, so, the two podcasts that I listened to were SPS resources and SPS tools. And what I found really useful about SPS resources is that it gives a list of all the resources that are available there for pharmacists, pharmacist prescribers, or even pharmacy students that they can utilise and learn about the different resources that are there to ensure that we make safe decisions for our patients. One of the key important aspects which I have found was the swallowing difficulties. It basically talks about all the resources that pharmacists and pharmacist prescribers can use if they come across patients who have swallowing difficulties, and we see this a lot in secondary care or in primary care. And whenever we are making any decision for a patient, whether it’s changing formulation, using different resources or different medications that are available or alternative medications that are available, it’s important that we use the correct guidelines, evidence based guidelines, and SPS gives a list of all the resources that are available out there and it helps pharmacists to make a confident decision, a safe decision for their patients.

In SPS tools, they mention about monitoring tool that is available on SPS website. And I think it was very useful because whenever we are prescribing any medication, it’s important to ensure that it’s safe for our patients. And SPS gives a list of all the monitoring requirements that we need to ensure before we prescribe the medication, after the medication is prescribed, whether we make any dose changes, once treatment is stable, what are the next steps. Because many of our patient have chronic conditions, therefore we need to ensure that any medication we’re giving our patient is safe for them in longer term as well. Not only that, it also, we know that some medications such as ACE inhibitors are used for more than one indication, such as hypertension, heart failure, and it talks about the monitoring requirements for these two different conditions. And I thought it’s really important and very useful for pharmacist prescriber because it gives them that confidence that the decisions they’re making for their patients are safe, and also because when prescribers take accountability for their decisions, it gives them that reassurance that they’re on the right track and their decisions are safe for the patient.

Rakhi Aggarwal
Thanks, Maimoona. Harriet, did you wanna come in and talk to us about the podcasts you listened to and what your thoughts were?

Harriet Giles
Yes, so I listened to two podcasts. The first podcast I listened to was the CPPE [Centre for Pharmacy Postgraduate Education] podcast, which I thought was very insightful as it gave information on how to navigate, access, and use CPPE resources in everyday practice, which I believe will be very useful in supporting pharmacy professionals from those on their trainee year to those qualified as this offers extra support to help us feel confident especially when starting the trainee year, which may feel quite daunting and nerve wracking.

The second podcast that I listened to was the when things go wrong podcast, which I really enjoyed listening to as it gave me an understanding that the role of pharmacy professionals isn’t just about blame but learning and spreading learning to prevent future patient harm. It also gave me insight into the NHS Resolution which I believe was very useful going forward especially as I’m just about to start my trainee year where we’ll be qualifying as prescribers and knowing how to avoid possible errors and what to do to prevent these from happening overall improving my confidence going forward.

So yeah, I thought they were very interesting podcasts.

Rakhi Aggarwal
Brilliant. Thank you so much, Harriet. And I’ve come to you finally, Ella, you listened to the last two podcasts. Are you happy to share the names of the podcast you listened to and your thoughts around them?

Ella Williams
Yeah, of course. So the first podcast I listened to was from a consultant pharmacist who had had years of experience with prescribing and it was a general [conversation] about how they found prescribing and their general day to day role. The second one I listened to was very similar except it was with a pharmacist who had newly qualified as a prescriber.

So, the main takeaway from the first podcast that I listened to from the experienced prescriber was that even experienced pharmacists like consultant pharmacists ask for help and it’s good to do so. I also learned that you’re never alone and you can always use your support network as well.

From the second podcast, which was from the new prescriber, the main takeaway from this was the valuable tips that they provided. And I believe the tips that they did give would be very beneficial for us as new prescribers. An example of one of the tips was to start small with your prescribing and then expand your competence slowly and that will help build your confidence as well.

I did learn from both podcasts that it’s normal to feel nervous when you first start prescribing, however, it does get better with time and that was very reassuring. Across both, I also learned the importance of both building and using support networks. And overall, I do believe that both podcasts would be very useful for pharmacists as there’s lots of key takeaways everyone can use in their practice.

Rakhi Aggarwal
Thank you. I’m so glad you guys have enjoyed listening to the podcasts. What I’m hearing is that the SPS resources and tools have been really useful, especially around the swallowing difficulties and the monitoring tool, which are able to help navigate what a patient needs depending on their condition from a monitoring perspective. The CPPE resources really help embed some of the learning. And when things go wrong, understanding about blame, and it’s actually, it’s not about blame and that, actually how to avoid possible errors in the future. And then finally moving on to the experience of the newly qualified podcasts, I think the main takeaway I’ve heard from Ella there were actually it’s invaluable the tips that have been shared about it’s ok to feel nervous, it’s important to maintain a good network and actually start small and then expand your prescribing competence.

So, I guess I would like to, if you don’t mind, ask you to finally share one tip that you would give Harriet as she’s about to embark on the journey of a found, of the foundation year. Maimoona, did you wanna come in with just a, one tip to support Harriet and others who are about to embark on this journey?

Maimoona Hussain
Thank you. Yes, of course. So, one of the key tips that I would give to any pharmacy student or students who are starting their journey of a trainee pharmacist is that you spend four years in university studying your MPharm, and I just want you to remember that you’re more than capable. The fact that you’re starting your foundation year is because you are ready to start this journey, and on this journey you will come across situations which you have never seen before and if it is your first time encountering those situations, I want you to believe in yourself because your MPharm has prepared you for this day. It’s now the time that all, to apply all your learning in your foundation year, and just remember your end goal is to become a pharmacist, and all the learnings and every scenario that you come across is to prepare you to become a pharmacist, so just believe in yourself, have faith, and you have a lot of support around you: your supervisors, your friends, your fellow trainee pharmacists, your senior pharmacists or pharmacists who have just completed their training journey. So just remember there’s a lot of support and you are more than capable to complete your foundation year and be a success, successful in this journey.

Rakhi Aggarwal
Thanks, Maimoona. Ella, did you mind coming in with your final tip?

Ella Williams
My main tip is to always speak up when you need help and to ask as many questions as possible as I’ve personally seen the benefit of doing so over my pre-reg year, and I’ve definitely learnt a lot of information by doing so. I also strongly agree with staying very organised and staying on top of your work as that will always help. And those are my main two tips.

Rakhi Aggarwal
Thank you ladies for your amazing support and thoughts on the podcast. Good luck in your foundation year exams and final year exam for you Harriett.

That’s all from us here at SPS for this episode. Thanks for tuning in and we’ll be back with another episode soon. We’re always keen to hear about your suggestions that you have for resources or events that you want to cover. Our contact details are available on our website.

Please remember to register on our website and opt in to receive our weekly SPS bulletin. This will make sure you’re always informed of our most up to date content and you will receive news of upcoming events. You can also stay with in touch with us by following us on LinkedIn search NHS Specialist Pharmacy Service.

Rakhi Aggarwal
Hello and welcome to our prescribing with confidence podcast series from NHS Specialist Pharmacy Service [SPS]. My name is Rakhi Aggarwal. This podcast is part of a series to support prescribers on their prescribing journey. Today I’ll be speaking to Shane Sweeney about his experience of being a new prescriber, when he started his journey, how his journey has gone so far, and he’ll be giving us insight to what a normal day looks like for him.

Welcome, Shane. I wonder if you wouldn’t mind telling the audience a little bit about yourself.

Shane Sweeney
Hi, Rakhi. Yeah, so I’m a community, well, I’m an ex-community pharmacist who now works in PCN based up in Liverpool. And one of my main drivers for making that switch in my career was to pursue prescribing. I felt like working in PCN was gonna be a much more comfortable environment, more supportive environment for doing my prescribing training. I was community pharmacist for about 10 or 11 years. I’ve done superintendent work and yeah, now I’m into PCN through the pathway that anybody who works in PCN will be familiar with, and a six month prescribing course at Chester Uni to qualify as a prescriber.

Rakhi Aggarwal
And when did you get your prescribing qualification, Shane?

Shane Sweeney
So, I think I was sort of annotated on the register and good to go from July 2025, so about six months ago.

Rakhi Aggarwal
Wow, amazing. So, a relatively new prescriber. And how have you found it? How have you found prescribing?

Shane Sweeney
It’s interesting. It has a lot of the same fear and, you know, worries that checking your first prescriptions as a pharmacist did. So, it was kind of quite familiar feeling, but when you reflect on it, you realise that a lot of the work you’d done up to that point was everything but signed the prescription, in much the same way as it was as a trainee pharmacist, as a pre-reg. So, I was able to sort of just take that over in, you know, like my first prescription was like atorvastatin or something and I’d done statin initiations like so many times before that. So, it gives you the confidence. And then obviously, you know, if you’ve got the structures and support of where you work, then that helps as well.

Rakhi Aggarwal
How did you feel writing that first prescription for atorvastatin?

Shane Sweeney
I’d say a little bit nervy. You have to have a sort of healthy dose of the fear. But, you know, I’d done everything but sign the prescription, everything, so many times up to that point that, you know, it’s kind of like, okay, well, I know what I’m doing, I know how the follow up goes and, you know, it’s fairly low risk, you know, I’m familiar with it. So, I think, just sticking to something that I knew very, very well was a massive help. But the safety net of it not going to someone else before it goes out is a bit scary. But that feeling sort of, you know, it doesn’t last long. I guess it’s a form of imposter syndrome…

Rakhi Aggarwal
Yes, yeah.

Shane Sweeney
…So, the more experience you get, the more confidence you get and then it sort of settles a little bit.

Rakhi Aggarwal
Amazing. Well, what has given you your confidence, if you don’t mind me asking, Shane?

Shane Sweeney
Oh, absolutely. Partly it’s the learnings, you know, it’s the doing the pathway, doing my prescribing course, those sort of things. But it’s also the on the job learning that sort of suits me a lot better as a learner. I’m very lucky where I work. We’ve got a very large pharmacy team with very different areas of expertise and levels of experience. One of my main practices, my effectively, my mentor is a friend from university. So, we have a real easy feedback conversation with each other because we’ve known each other for 20 years. So, I think that cuts through a lot of the worry about feedback and I know how to receive it from him and everything. So yeah, that’s been really good at sort of giving me that confidence that I would always have said, especially the background in community pharmacy, that clinical is my weakness. And I would still probably say that, but working with the people I work with and having that sort of time put into my development from them, being available, it’s really boosted that. When you start with one or two areas and then you expand out as you’re comfortable, and I guess that’s sort of the main thing is don’t overreach, just get your feet under you and then start to expand things out. But yeah, I guess in summary, the people have put a lot of time and effort into me and then I get my confidence from experience of doing things over and over again, really.

Rakhi Aggarwal
Thanks. Thanks, Shane. So, you’ve been prescribing for six months or just over. So, have you ever been asked to prescribe outside your clinical competence and if you have, how have you said no?

Shane Sweeney
Yeah, well, you get these for a variety of reasons. You know, sometimes you’ll get a patient who’ll ask about, oh, while we’re here, would you just, you know, restart this from my past medication? Or, you know, there’s always the classic of it’s Friday afternoon and you’re the only person available. You know, it’s up to the individual person to make their clinical judgment on that or their professional judgment on that, I guess more. But if I feel like I have to say no, I was always taught at uni, or one of the things that stuck with me from uni, is to say no, but with a second direction. So, it’s not good enough just to tell someone no, no and maybe look in this direction or go to this person for help or something. And I found that really effective, particularly when dealing with patients, it kind of shifts the focus and doesn’t create a barrier or an altercation kind of situation. You’re sort of deflecting their energy to something else. But I think a lot of people I work with know that I’ll try and help them every situation that I can and if I’m saying no, it’s with really good reason. And then having the people to escalate things too. So, my advice to any pharmacists listening that work in primary care, particularly because that’s the area I know, is put the effort into developing your relationships with your GPs, particularly your senior partner GPs, because they are the people that you will need to rely on and you will need to kick things to when you can’t deal with them. So yeah, that’s something. And I remember when I started being very afraid of the GPs and like, you know, you couldn’t possibly waste their time or anything like that. But we’re proving ourselves a very valuable asset in our setting and forging our relationship with GPs and informing their practice is a really key part of that so people shouldn’t be afraid to have those conversations.

Rakhi Aggarwal
That’s really insightful, Shane, and I think, you know, having a second path is a, that really resonates; making sure you’re not leaving that person asking that question with nothing to go on, you know, giving them an option to explore another avenue that, you know, that’s great advice. So, can I ask, have you expanded your area of competence yet and if you have, how have you gone about it?

Shane Sweeney
Yeah, so we operate like a six-week supernumerary period where I work, or the creche as I call it, where you’re expected to kind of expand to maybe four or five areas that pharmacists managing chronic conditions should really be able to deal with, so blood pressure, lipids, asthma, COPD [chronic obstructive pulmonary disease], diabetes, those sort of things. So, our team give people the time to get their feet under them in that area. So, by the time I was sort of eight, nine months in, I was pretty happy with those areas. And as I said before, I’ve got a clinical mentor in one of my practices and he sort of drip feeds me little bits, sort of the next steps. So, you know, there was a QOF [Quality Outcomes Framework] indicator on osteoporosis, and that’s a decent project for a pharmacist to have a look at. And then other things like, okay, we deal with some of the bloods for lipids and for diabetes so here’s how to read bloods for anaemia and for thyroid conditions. So, I’ve been nudged in the right direction by my mentor, but then also really supported there as well. And I think we have a really good environment across our team of not asking people to do things that they’re not comfortable with without supporting them and not isolating them or leaving them with a project and just never checking up on them. So yeah, direction has been set by my mentor and then the whole team, pharmacy team and the practice clinical staff have been really good at like supporting those developments.

Rakhi Aggarwal
So, you’ve got a bit of a network there, it sounds and can I ask how you’ve built your network, your support network because I guess that’s really important when working in that kind of setting?

Shane Sweeney
Yeah, it’s huge. You know, you’re sort of part of two teams, really. So, we’ve got a really big pharmacy team for a PCN. We’re a large PCN anyway, and our pharmacy team is about 24, 25 people in it. So, I’ve got all of them, pharmacists, pharmacy technicians, lots of different backgrounds, lots of different levels of experience so they are great. And then as I said before, I think the thing that you really have to put the effort into, especially as a new pharmacist coming into that setting, because having a pharmacist in a GP surgery most of the time is relatively new, you know, you have to establish yourself within the team, within the, you know, the partner GPs, the local GPs, the nurses, the HCAs, the physios, everybody. And I find the best way to build your network is to go out and meet people. So, like I’ll work with my door open for a bit of the day and just say hello to people as they go past. Or, you know, there’s one of my practices where I’m halfway between reception and the GPs, so they’ll naturally just pop by my room first as an option. So, it just builds those kind of relationships. The one sort of really big piece of advice I took as a pre-reg and would definitely pass on now is make sure when you are building your support network, you’ve got varying different levels of experience from people you can teach, to people who are on a sort of level with you, to people that are much more experienced. As good as it is to have the experienced people, I remember when I first qualified as a pharmacist, one of my peers from uni who I really respected, really looked up to about six months in, admitted that he’d made like a mistake, a dispensing error, and I was like, well, if he can do it, then, you know, it’s okay that I do it, like, you know, occasionally, and these things happen to people. And it’s just good to know that other people have the sort of experiences you’re having whereas your more experienced people probably look a little bit too neat and tidy and a bit too perfection. So, it’s, yeah, it’s good to have a wide range of people in your support network.

Rakhi Aggarwal
I love it, Shane. I think leaving the door open, that just invites a conversation, doesn’t it? I think that’s great advice for anyone who’s kind of going through, you know, working out in practice. That’s brilliant. And also really good advice about varying levels of people, actually, it gives you the opportunity to gain from the value from the different experiences that they’ve all had.

Shane Sweeney
Yeah, and it’s so important to teach people as well, because…

Rakhi Aggarwal
Yeah.

Shane Sweeney
…you know, there’s an old adage, like, you only know something well when you’ve taught it. And being able to pass that on, that’s sort of how my brain works anyway. I really feel like I understand something when I go to teach it to someone, you know?

Rakhi Aggarwal
Absolutely, absolutely. So, the concept of clinical supervision, how does that work within your area of practice?

Shane Sweeney
Well, at the moment, as a prescriber, there’s nothing hugely formal. Obviously, no one’s going back and checking all your prescriptions or anything, but we have standards for our follow-up notes, particularly, and how our follow-ups work. There’s built-in bits of the software, the prescribing software, the EMIS and things like that, where you can trigger review dates and things before the prescription would get issued the next time. So, just making sure that your notes are very clear on that and you’ve minimised the chance of something being accidentally issued the second time, those are where it would come up further down the line. Making sure your follow-ups are in place, that you’ve put something in place either to ring the patient back or get their bloods done or their blood pressure checked and that that’s all carefully annotated so that when repeat prescriptions come to be done, everybody knows where they stand. I’d say that’s the main trigger for spotting where we’ve maybe done something a bit of a, you know, in the wrong way or we might have had better choices. But most of the time our clinical supervision stuff is forward thinking or proactive, I guess would be the better words, where we have sort of fairly set standards that are well communicated throughout our team. There’s things you’re expected to do, you’re expected to know certain guidelines and what the local formulary preferences are, things like that. So yeah, it’s a bit of that sort of proactive teaching upfront and then reactive, you know, making sure that things are in place for secondary issues of medications just in case anything does need tidying up.

Rakhi Aggarwal
Brill, thank you, Shane. So, my final question, what key tips would you give to those that are new to prescribing?

Shane Sweeney
Well, it seems like a lot. It seems very scary. One of my colleagues is literally just starting probably some point this month and, you know, being about six months behind me, I really recognize what he’s going through at the moment. But look to your support, look to the people who have experience in the area and start small, you know, like start with things that aren’t, you know, going to cause any immediate straight issues or anything. You know, we tend to start in areas like asthma and inhalers and stuff like that, or COPD and inhalers and things like, you know, where the chances of you causing harm to the patient are pretty minimal. So, it gives you a little bit of confidence, get your feet, you know, not every decision you make is terrifying. And yeah, just look at your support network.

Yeah, so I would say as well, like document things as well as you can. Make sure your follow-ups are in place, like I explained before. Get into teaching things. And then just remember how important it is to be safe first. So, you know, you might get people putting pressure on you to prescribe outside your competence or whatever. But if it doesn’t pass, say if it doesn’t pass go, and we can’t, you know, compromise ourselves or our patients, just because someone wants it. One of the big things we have in our area at the moment is giving people the confidence to say no to what comes on a letter from secondary care. You know, just because it’s on a letter doesn’t mean we have to do it. And having those conversations back to people and all that sort of stuff. And then with any new skill or any new area, you have to remember you will have that initial period of feeling more confident than your competence justifies, sort of Dunning-Kruger kind of effect, and just be aware of where you are on that scale and making sure that you’re not compromising yourself and play it safe. And there’s plenty of people to support you and around you, or at least there should be. I know some of our colleagues do work in the dark a little bit, and I am in quite a privileged position with my team. We’ve got a very active WhatsApp group and we’re all really supportive for each other. And then you’ve got your teams within the practices. But if you feel like you’re not sort of getting that support, bring biscuits in, bake something, just start a conversation. We’re all people at the end of the day, even if we’re busy and forging those one-to-one relationships are really good. What’s really important in our area is that we are in the practice. I know a lot of PCN staff work remotely or whatever, but we are physically in our practices. And I think that just really helps build those relationships.

Rakhi Aggarwal
Amazing. Thank you so much, Shane.

Shane Sweeney
You’re very welcome.

Rakhi Aggarwal
It’s amazing that, you know, you started prescribing under a year ago and it’s just your experiences are so insightful. So, I really appreciate you sharing that with us.

Shane Sweeney
The key thing is it’s not all my experience. You know, it’s I’m lucky that the people I’ve got around me to draw on it from them. So that’s part of the reason why, again, like I said at the top, why I moved into PCN to do my prescribing. I’d imagine it’s much harder in a community pharmacy setting. It’s already a very siloed job anyway. PCN experience is very, very different.

Rakhi Aggarwal
Amazing. Thank you very much, Shane. That’s all from us here at SPS for this episode. Thanks for tuning in and we’ll be back with another episode soon. We’re always keen to hear from you about suggestions you have for resources or events that you want us to cover. Our contact details are available on our website. Please remember to register on the website and opt in to receive our weekly SPS bulletin. This will make sure you’re always informed of our most up-to-date content, and you’ll receive news of upcoming events. You can also stay in touch with us by following us on LinkedIn, search NHS Specialist Pharmacy Service.

Rakhi Aggarwal
Hello and welcome to our Prescribing with Confidence podcast series from NHS Specialist Pharmacy Service [SPS]. My name is Rakhi Aggarwal. This podcast is part of a series to support prescribers on their prescribing journey.

Today I’ll be speaking to our very own digital wizard, Ben Rehman. He’ll be talking through the SPS tools such as the medicines monitoring tool, medicines stability tool, and the medicines supply tool which SPS have developed. These tools are readily available through the website to support healthcare professionals in practice at the point of prescribing and beyond.

Welcome, Ben. I wondered if you wouldn’t mind telling us a little bit about yourself.

Ben Rehman
Yeah, of course. So, my name’s Ben Rehman, I’m the lead for Digital for the Specialist Pharmacy Service. I’m a pharmacist by background although for the past, sort of, over ten years now I’ve been working for the Specialist Pharmacy Service in a role that combines, sort of, medicines and pharmacy with digital development. So, I work with a small team of pharmacists and pharmacy technicians in SPS who are directly responsible for managing the website, and then I work with a, kind of, slightly larger team of web developers, software developers, etc., for a comp-, who are contracted with us by a, through a company called Zaltek, and are responsible for the, sort of, technical development and maintenance of the website. So, I kind of, a slightly unusual role and I straddle the boundary between medicines and medicines use in pharmacy, and the representation of all of that information on the website.

Rakhi Aggarwal
Thanks, Ben. So, Ben, there are quite a few tools on the SPS website. Can you talk me through how the medicines monitoring tool would be useful for prescribers?

Ben Rehman
Yeah, of course. So, yeah, so the medicines monitoring tool, I think was one of the first tools that we launched. And the idea of it is that, particularly for primary care, we know that there are medicines for which some fairly intensive monitoring might be required as a result of that medicine needing to be used for a particular given patient. And we wanted to ensure that for those medicines, there is the information available to people to ensure that they can be monitored safely. So, for all of those medicines that are likely to require monitoring within primary care, we break out the monitoring requirements into the things that people need to do before they start the medicines; the things that need to be done after the medicine has started or after the dose has changed, so the immediate kind of aftermath of having initiated the medicine; the things that need to be done once the treatment is stable, so for the period in which the patient, particularly for, kind of, chronic conditions is continuing to need to take the medicine for a, sort of, fairly prolonged period of time; and then the particular actions that would need to be taken were there to be abnormal results. And what we also do is for those medicines for which there’s more than one indication and for which the monitoring requirements for the medicine are different dependent upon the indication, we break out the monitoring requirements based upon the indication. So, for example, for ACE [Angiotensin-Converting Enzyme] inhibitors, we give, sort of, slightly different recommendations in relation to say heart failure or hypertension.

For most of the medicines we give an individual entry for an individual medicine, but for some medicines where it’s sensible to do so we group up the recommendations by class. So particularly for say ACE inhibitors, angiotensin 2 receptor blockers, non-steroidals, we’ve got a, kind of, single entry for all of those medicines together and then for whether a particular, sort of, attributes or particular, discrepancies, I suppose, between the recommendations for medicines within that class, we will say that too. So, for non-steroidals, for example, for some non-steroidals, there are slightly different recommendations for some of those than the other and we group everything up together cause on the whole they’re fairly similar, but where there are differences we’re sort of explicit about saying what those differences are and ensuring that they can continue to be used safely within the class that they sit.

Rakhi Aggarwal
Thanks, Ben. That’s really helpful. The medicines stability tool is….

Ben Rehman
Yeah.

Rakhi Aggarwal
…another tool which is great for prescribers, especially when they’re trying to navigate with the patients who need support in taking their medicines. Can you talk through how to navigate through that tool, please? If you don’t mind.

Ben Rehman
Yeah, of course, yeah. Okay, so, yeah, so the medicine stability tool is for, really for those people that are directly responsible for supporting patients with their compliance through the filling of compliance aids. And it’s really looking at the kind of pharmaceutical stability of medicines once they’re taken outside of their original packaging and put into a compliance aid.

It covers, it’s not, it doesn’t cover absolutely everything, but it covers a fair chunk of the medicines that are prescribed routinely in primary care, and it groups up the recommendations into different types.

For those medicines that we cover, it will give you one of three recommendations. So, it’s either compatible, which is that we’ve got evidence to suggest that it can safely be used inside an MCA [medicines compliance aid], although that use is always likely to be off-label but it, as far as we’re aware there are no particular issues with using it. One of the other recommendations is that it can be used with caution. So those are medicines for which theoretically it can be used withinside an MCA, but mitigations may need to be considered, and those mitigations are gonna be things like being careful about the period of time for which it’s put inside the MCA, so maybe just doing them a week at a time, or something like that. Or it can be incompatible, and those are things for which, they’re particularly, say hydroscopic, so they absorb water in some way, and for those things it’s not suitable to put them inside an MCA, and those would need to be given separately to the patient outside of the box. And then finally, there is a fourth one, but the fourth one isn’t really a recommendation, it’s just to say that for everything that we, for those things that we don’t cover, we’re not able to make a recommendation, so we don’t have any stability information for those medicines and we can’t make a kind of definitive recommendation one way or another.

The idea of the, this tool in particular is that it’s used as people are actually undertaking the work. So when people are in a community pharmacy or anywhere else in which they might be compiling one of these medicines compliance aids, they can use the tool at the point of which they’re undertaking that action and they can add medicines to a list that they then can take a copy of themselves via the tool. So, there’s the, sort of, huge database of stuff, and from that database of stuff, they select the medicines for which they particularly need to know about, because those are the things that are on the prescription at that particular moment in time, they compile a list within the tool itself, and then that list they can export and print. So, the, kind of, the workflow that we were working to was that people were going to need to do that because what I think tends to happen in community pharmacy from our understanding of, kind of, talking to the people that do this is that they would, say, do all the MCA boxes on a Tuesday afternoon, or something like that, and they would, then would have quite a few of them to do at the same time and they might want to sort of check all of those things and then print out the stability recommendations and put them with the box as they’re working through and filling them. So that was the kind of workflow that we were working to. Yeah, and then those lists can also then be shared with people via email if they needed to do so, you can, kind of, create the list and then share, ping that off to somebody if you’re, you know, making the list for a bunch of boxes on behalf of somebody else to, sort of, support a colleague or something.

Rakhi Aggarwal
Absolutely, Ben, I’ve certainly done that from, from a practice perspective.

Ben Rehman
Okay.

Rakhi Aggarwal
Send to the community pharmacy and to the care home, for example.

Ben Rehman
Oh okay, okay.

Rakhi Aggarwal
It’s been really, really useful. The fact that you can build the list is, you know, I love that part of the…

Ben Rehman
Okay, good. Yeah. [laughs]

Rakhi Aggarwal
[Laughs] So, if we move on to the, talk about the medicines supply tool. So, this is where healthcare professionals can find the latest information on supply issues. I think this is an absolutely fantastic tool, especially when you’re presented with a shortage. Ben, can you tell us how this is useful to prescribers and what kind of information you could find if the drug is out of stock?

Ben Rehman
Yeah, ok, so the idea of this is that for all of those live shortages issues, so all of the supply issues that are being tracked by the central team, so the central teams being the Department of Health and Social Care [DHSC] Medicine Supply Team and the Medicines Value and Access Team at NHS England. Those teams are constantly tracking supply issues and they wish to, or they need to make the results of that available to the NHS such that the NHS can take actions as and when it needs to.

So, all of those issues for which there are current supply constraints are within the supply tool. So, the idea is that it’s kind of the single point of truth for national medicine supply issues, and within that we give various information on the particular products that are affected, the dates at which those products are going to be affected for and by, the dates at which a supply is likely to come back online, and then partic-, where it’s been worked up, we also give recommendations in there on the mitigations and the alternatives that people (both prescribers and those supplying medicines) should, kind of, consider and take in relation to ensuring that, as much as possible, the supply doesn’t, or the lack of supply doesn’t, kind of, adversely affect patient care.

And then within the tool itself you’re then able to group things up, filter across the whole data set. So, at any one time there’s probably over a hundred issues being tracked and live and within the tool. It’s updated very regularly because obviously supply is a fast moving area, so it’s updated on a weekly basis by the DHSC team that manage the content, and then you’re able to track, sorry you’re able to, sort of, sort and filter by the particular issues that may be of interest to you. So, for example, see everything that affects a particular BNF [British National Formulary] chapter, see everything on the basis of when it was last put onto the tool, so you can see all the most current things first, see everything in relation to the severity, so there are various tiers that are given: one, two, and three, with four as well, with one being the least serious and four being the most serious, and you can see, you know, how many say tier two issues are there, how many tier three issues, and then build up your own, sort of, filters across the across the data sets so you can see, I don’t know, all the tier two issues that are affecting antimicrobials at the current time, for example, if that’s a particular area of interest to you.

Yeah, so, I mean that’s it. It’s the, I would say, I would hope it’s the sort of go to place for anybody that needs to ensure that they’re current for supply issues and particularly for supply issues that are nationally important because the information is all of the information that the DHSC and the MVA team are compiling and collating and updating in there and so is the single national source for medicine supply issues.

Rakhi Aggarwal
It’s absolutely, again another fabulous tool.

Ben Rehman
Yes.

Rakhi Aggarwal
It requires login, doesn’t it? This tool is probably one of the only parts of the website that requires a login.

Ben Rehman
Yeah.

Rakhi Aggarwal
Can you tell us a little bit about that, Ben, if you don’t mind?

Ben Rehman
Yeah, so to be able to access it, you need to have an account with us, with SPS, and for most of the people that need to be able to access it, once you’ve created the account, you will automatically be granted access, so it just sort of happens in the background, you don’t need to do anything about it. And for those people that have access to an NHS email address, which I would hope is most, if not all of the people that might be listening to this podcast, the easiest thing to do is to use your NHS email address to create an account with the SPS website and then log into the tool, which should be a seamless experience, I hope.

There are then some other people that we do grant access to outside of the NHS, so, for example, private providers, people working in, kind of, third sector organisations, those types of things, and those sorts of people are also given access and we do maintain a list. So, if you don’t have an NHS email address, or you’re not able to get an NHS email address, create an account with a different email address. If that’s a work email address of a certain type, you may be able to get in. If you can’t, then please let us know. But the kind of restrictions, and who is or isn’t given access to the thing, we manage and maintain, but the decisions upon who is or isn’t given access to it are really sit with the DHSC Medicine Supply Team because obviously it’s primarily their content and so it’s, sort of, up to them as to who they wish to see it and the original brief was that this is a method of communication with the NHS, hence the kind of the focus on ensuring that the NHS can have access first.

Rakhi Aggarwal
That makes sense, thanks Ben. So, finally as we come to a close, would you mind giving me three top tips that you would want to share with prescribers about the tools that we have?

Ben Rehman
Okay, [laughs] so I would say, I mean, I would encourage everyone to use them, [laughs] particularly those people in primary care that need to use these things. I would say my three top tips would be firstly don’t expect to see absolutely everything in there because that’s probably always gonna be impossible but, sort of, take at face value what is in there.

My second would be please do provide us with feedback. If there’s anything that you think should be there that isn’t, or if there’s any, if there’s any sort of gaps, or there’s anything you think could be improved, please do tell us because we are, sort of, constantly trying to learn and improve on the basis of how people are actually using our stuff in the real world. It’s very hard for us to anticipate how things are going to get used in the real world. We do as good a job as we hope we can, but it’s never gonna be perfect. So, it’s a kind of constant process of sort of iteration and improvement from our perspective, and that really benefits from people actually using this stuff in, live and, you know, in anger and hopefully not getting too stuck, but if they do get stuck then telling us they’re getting stuck.

And then what would the final one be? So, the final one is probably if you’ve got a particular thing that you think would benefit from the type of approach that we have for tools, in our other tools, then please tell us that too. So, this is not just about, sort of, revising and iterating and improving the stuff we already have, but we’re always really open to ideas for other areas of practice, other areas that are particularly pertinent to new prescribers and non-medical prescribers where there’s a gap and that gap could potentially be filled by a tool, and would help improve practice. So, we, we’re open to ideas basically. Use the stuff and then we’re open to ideas both about the things that are there and things you think we could do in the future.

Rakhi Aggarwal
Fab, thank you so much, Ben, for your time.

Ben Rehman
No problem.

Rakhi Aggarwal
That’s all from us here at SPS for this episode. Thanks for tuning in and we’ll be back with another episode soon. We’re always keen to hear from you about suggestions and how to use the resources or events that you want us to cover. Our contact details are available on our website. Please remember to register on our website and opt in to receive our weekly SPS bulletin, this will make sure you are always informed of our most up to date content and you will receive information on our upcoming events. You can also stay in touch with us by following us on LinkedIn search NHS Specialist Pharmacy Service.

Rakhi Aggarwal
Hello and welcome to our Prescribing with Confidence podcast series from NHS Specialist Pharmacy Service [SPS]. My name is Rakhi Aggarwal. This podcast is part of a series to support prescribers on their prescribing journey. Today I’ll be speaking to Maria Yousif, Associate Safety and Learning Lead, Midlands and East, working for NHS Resolution, and a pharmacist by background. She’ll be discussing what to do when things go wrong, focusing on support, learning, and duty of candour in this podcast.

Welcome Maria. Can you do me a massive favour and introduce yourself, introduce NHS Resolutions and how, and what is meant by clinical negligence.

Maria Yousif
Hi, Rakhi, thank you for having me today. It’s a real pleasure to be here. So, I’m Maria Yousif, I’m an Associate Safety and Learning Lead at NHS Resolution, and I’m a pharmacist by background. Before this I worked in health and social care regulation at the CQC, the Care Quality Commission.

So, at NHS Resolution, I work in a clinically diverse team and we’re the safety and learning team. I’m currently the only pharmacist, but as a team, we sit in quite a unique vantage point because we act as a bridge between patient safety and clinical negligence. And our role isn’t about any blame, it’s really about learning and spreading that learning in a way that helps prevent future harm.

So, a lot of our listeners may have never heard of NHS Resolution and that’s fine, but it’s helpful to know a little bit about what we do. So, NHS Resolution is the organisation that’s responsible for handling clinical negligence claims brought against the NHS in England. But just as importantly, we don’t only manage claims, we also look closely at those cases to understand what the healthcare system can learn from them. And we also provide support through our practitioner performance advice service which offers independent advice to organisations when concerns arise about the practice of individual clinicians, and that includes pharmacists.

So, when we talk about clinical negligence, in plain terms we’re talking about situations where care falls below the standard that is legally expected and harm occurs as a result of that. So, the key message for you listening as a prescriber is that our approach to clinical negligence isn’t about blaming individuals or punishment, it’s about recognising how complex healthcare environments can create risk and using that, what we learn from that to improve safety for patients and for staff.

Rakhi Aggarwal
Thanks, Maria. Why do prescribing errors happen, particularly for new prescribers?

Maria Yousif
So, I want to point out that prescribing errors are not usually due to individual incompetence or lack of skill. They tend to arise because healthcare is delivered in a complex, what we call a socio-technical system where people, processes, and technology are all interacting, and that’s where risk can arise. As an individual, you’re trying to do the right thing, but you’re working under time pressure, you’re managing interruptions, you’re dealing with incomplete information on care records, perhaps you’re navigating a new unfamiliar system, and so you’re often prescribing in a busy environment and those conditions increase risk for anyone, not just new prescribers. But what I want to stress is that there’s been a lot of developments in patient safety and they’ve really encouraged us to think about, differently how harm happens, and as I’ve mentioned, to think more about the complexity, the socio-technical systems we work in, people, processes, and technology, and how all those interact and contribute to harm. In fact, most errors are driven by those system factors as I’ve mentioned. So, for example, the workload, the communication gaps, the complexity of medicines themselves and staffing pressures, but understanding that really helps shift that conversation from blame to prevention because the goal is really to design safer systems and not to single out individuals.

Rakhi Aggarwal
Thank you. Can you talk through a simple example of a prescribing issue that might arise in practice?

Maria Yousif
Yeah, so let let’s take a common scenario: an incomplete medicine’s reconciliation. So, for example, a patient was recently admitted to hospital and their anticoagulant was switched to a different one, but the care records at your end haven’t, for example, been updated. So, you continue prescribing the original anticoagulant because that’s what’s documented and then only later on you realise that the person should have been on something different and potentially they’ve been taking two anticoagulants at the same time. Those are situations that can and do happen and we do see them reflected in claims data. And they often point to system vulnerabilities, as I’ve mentioned already, you know, the fragmented care records, rushed handovers, information gaps. But what matters is recognising that concern early, and if something doesn’t feel right, is about pausing and checking, asking your colleague and escalating uncertainty. Because prescribing safety isn’t about knowing everything, it’s about knowing the system around you and how to navigate it.

Rakhi Aggarwal
So, if a prescriber realises something’s gone wrong, what should they do?

Maria Yousif
So, first, patient safety comes before anything. Make the situation safe, seek clinical advice if needed, and escalate early. And I really want to emphasise this: don’t manage it alone because healthcare is a team sport, so involve your supervisor, your senior colleagues, your medicine safety officer, whoever is appropriate locally, because early escalation is protective not just for patients, but also for you. And I can’t also stress enough how clear documentation is absolutely essential, and that includes making sure that your notes are contemporaneous, your clinical records should reflect what you knew at the time, how you assess the situation, and how you reach your decision around diagnosis or treatment. In medico-legal terms, there’s a principle that if it’s not documented, it’s very difficult to evidence that it happened. So, your notes should give a really clear picture of your clinical reasoning. But that also supports your continuity of care, and it helps others understand your decisions, and it also provides an important record if care is ever reviewed later. But of course, you have to use your local reporting system. So reporting isn’t about getting someone in trouble, it’s how organisations learn and every report contributes to a safer system.

Rakhi Aggarwal
That’s fantastic, thank you. What does duty of candour actually mean for prescribers?

Maria Yousif
Yeah, thank you. So, duty of candour is about being open and honest when harm has occurred. If you’re a prescriber, it means acknowledging what’s happened and speaking to patients with honesty and compassion. And really to highlight this, that saying sorry is quite powerful, it acknowledges harm and the experience that person or the family has gone through. An apology is not an admission of legal liability, it’s not admitting fault, it’s about humanity, it’s about trust and doing the right thing.

So, if we break it down a bit, there are two parts to duty of candour: there’s the statutory duty which applies to organisations, and that’s regulated by CQC under regulation 20; and then the professional duty, which applies to you as an individual clinician, but both are about openness and maintaining trust with patients and families. And this applies across all sectors. So, when people don’t receive a timely, honest apology, it can push them toward legal action. So, fulfilling that duty of candour means apologising, it means being open about what happened and being transparent about what’s gonna happen next. But of course, these conversations can feel quite difficult, and again, you’re not expected to manage them alone. So, get advice and involve more senior colleagues. And NHS Resolution has practical resources to support you. We’ve got our Saying Sorry leaflet and our Duty of Candour animation, which both explain in simple, clear terms what this looks like in practice. And these resources really reinforce that apologising is the right thing to do, it’s not about blame, it’s about acknowledging that something could have gone better and it’s the first step in learning from what happened and preventing the same harm from happening again.

Rakhi Aggarwal
Prescribers often worry about indemnity, what’s helpful for them to know?

Maria Yousif
Yeah, so it’s important to understand what indemnity cover applies to the way you practice. Many NHS roles are covered by employer schemes, but depending on how you work, personal indemnity may still matter, and that’s particularly important if you have more than one role. So, you might be an employee in one setting and self-employed in another, or doing a mix of NHS and private work. So, your indemnity needs to cover everything you do, not just part of it. And the GPhC, the General Pharmaceutical Council, requires pharmacists to have appropriate indemnity arrangements, but also other professional bodies can offer guidance on this as well. So, the take-home message is don’t assume you’re covered, it’s worth checking the detail and seeking advice if you’re unsure.

Rakhi Aggarwal
What support should prescribers expect after an incident?

Maria Yousif
So, you should expect a just and learning culture, and that means a culture that’s focused on learning, accountability, and improvement, not blame. So, when something goes wrong, the response should be fair, it should be compassionate and focused on understanding what happened. Incidents don’t just affect patients, they affect staff too, so it’s normal to feel shaken after an event. But psychological safety is also part of patient safety, so if people feel afraid to speak up or struggle alone, that risk will increase. But when staff feel supported to be open, that’s when real learning happens. So again, know your support network, you know, with your supervisor, your clinical lead, your medicine safety officer, your peer colleagues, you’re not expected to carry these things alone. NHS Resolution also has a Just and Learning culture charter which is found in our Being Fair document, and that sets out what staff should expect from organisations after an incident, and I’d encourage our listeners to look at it. It reinforces that fairness, support and learning are essential to save systems.

And finally, please look after yourself as well as the patient because supporting staff after incidents is part of that patient’s safety and as we say, you know, you cannot pour from an empty cup.

Rakhi Aggarwal
Fab advice, thank you. What are the three things you’d want new prescribers to take away?

Maria Yousif
Okay, so first, you’re not alone, your prescribing should be supported. Use your peer networks, ask questions, and normalise seeking help. Even with the best intentions, things can still go wrong, and that’s exactly why support matters.

Secondly, most errors are system driven. When you report and speak up, you contribute to system-wide learning, you’re helping protect future patients.

And thirdly, openness matters. Saying sorry, escalating early and having honest conversations protects both patients and staff. Transparency is a real strength in healthcare.

So, I think if you hold onto these three ideas, you’ll already be practicing more safely.

Rakhi Aggarwal
Thank you so much, Maria, for your insights. That has been an absolutely fabulous listen to.

Just wanted to say that’s all from us here at SPS for this episode, thanks for tuning in and we’ll be back with another episode soon. We’re always keen to hear from you about suggestions you have for resources or events you want us to cover. Our contact details are available on our website. Please remember to register on our website and opt in to receive our weekly SPS bulletin. This will make sure you’re always informed of our most up to date content and will receive news of upcoming events. You can also stay in touch with us by following us on LinkedIn, search NHS Specialist Pharmacy Service.