key: cord-1054384-iaagybhw
authors: Bond, Christine
title: Every cloud has a silver lining
date: 2020-09-26
journal: Int J Pharm Pract
DOI: 10.1111/ijpp.12672
sha: 7ec0b22d5e08124fe8dd2300001a6575615078c4
doc_id: 1054384
cord_uid: iaagybhw

nan

They say every cloud has a silver lining, but at the moment whilst the COVID-19 pandemic is still preoccupying much of our professional and personal lives, it is hard to see any silver in the current situation. However, when we reflect, we should see that there are in fact some good things which could come out of the challenging times in which we are living today. I find it helpful to first think about the changes we have all come to regard as the new normal and then consider which of these we might want to retain when, one day, we return to the old normal.

A phrase that will haunt many of us for some time is that 'we are following the science'. As scientists, pharmacists should always follow the science, but we are used to science which is tangible and (generally) certain but the COVID-19 science is definitely not that. As a new virus, the data and therefore the understanding evolve on a daily basis; what treatments work, what is safe social distancing, how accurate are the tests, how many people have been infected, how long does immunity last, when will there be a vaccineall of these at the time of writing remain somewhat elusive.

In terms of practical changes and innovations, just a few months ago few of us would have been able to continue our academic work successfully in the absence of face-to-face contact. How many times have we previously tried to avoid travelling to distant meetings but found virtual communication through videoconferencing or telephone conferencing to be completely unsatisfactory? Contrast that now with the ease with which we all communicate with students and colleagues via Zoom, or Microsoft teams or another of the many videoconferencing platforms that enable us to meet, communicate from our own office or home, and even give presentations at international conferences.

For clinical colleagues, the challenges have been arguably far greater as much of the care they provide can only be delivered face to face. For example, in terms of patient contact, our community pharmacy colleagues are rare amongst other healthcare colleagues in remaining available on the High Street to answer patients' concerns and provide continued medication supplies, be that overthe-counter remedies or prescription medicines. As an essential service, they have been universally allowed to remain open when countries are in lockdown. Indeed, many have referred to pharmacists as being one of the unsung heroes of the healthcare team during this current pandemic. Similarly, in secondary care, pharmacists have been sought for their clinical expertise and been redeployed from their normal roles to support the high workload in ICU.

The COVID-19 pandemic has also forced on clinical colleagues more efficient ways of working and there has been fast-tracking of regulatory changes, previously just dreamt of, such as a Scottish scheme set up to enable pharmacists to make small changes to prescriptions. Again, digital infrastructures have been shown to be facilitative in maintaining services safely, and where available, electronic prescribing has eliminated the risks of transmitting infection via paper; in Scotland, the 'Near me' platform is now being rolled out to support virtual consultations between community pharmacists and patients. This can allow continued individual patient support whilst complying with social distancing. These are just a few of the many examples we could cite of how the pharmacy profession has risen to the challenge.

So, looking to the future what would we want to take from the new normal into the old normal. There is generally a sense from the profession in the UK that there is greater recognition of pharmacists' expertise and of community pharmacy as being part of the NHS. We must make sure this is not lost. Looking to the future and with a hope for an effective treatment and ultimately a vaccine to prevent infections, there will be clear demand for pharmacy expertise. Many of those experiencing the most severe COVID-19 infections are older patients likely to have multimorbidities or, if younger, already have a long-term condition such as diabetes. New drugs to treat COVID-19 will need to be incorporated into polypharmacy regimes with due attention paid to drug interactions and contraindications. In many countries, pharmacists will also surely be involved in administering the millions of vaccines that will be needed to confer essential herd immunity. Virtual communicationwhether for personal interactions or transmission of information, is most likely to remain but we must also recognise when it is appropriate, and wanted by patients, and when it is unhelpful and could result in second class care.

With all of the above comes a research agenda that we must also embrace. Even now we should be collecting data to monitor the effect of the pandemic on the workforce, on how they have adapted and what has worked, and not worked. How has the mental health of pharmacists and their teams been affected and how can we support them? How have community pharmacies been adapted to be COVID-19 secure and what are the unintended consequences? Can community pharmacies be part of a surveillance system and be alert to people presenting for over-the-counter advice about symptoms suggestive of COVID-19 infection? What are the skill gaps in the profession we need to address to allow them to fulfil the extended role with respect to COVID-19? For example, are they up to date with the science on COVID-19, or at a practical level, do they know how to communicate effectively with patients on a video link? At a population level, can we use linked data sets to monitor long-term safety of new treatments, or predict subgroups of patients most likely to benefit from new treatments? Information pharmacists with skills in analysing big data will be invaluable as we look back on the pandemic and learn from the data. The list is almost endless.

Pharmacy roles have already been developing to a various extent across the globe, with national policies recommending extended clinical roles for pharmacists and their teams in all sectors. However, change does not happen just because policy dictates, and other healthcare colleagues and the public have to also endorse these new pharmacy roles. Historically, the sort of major change we are watching for pharmacy has occurred for a variety of reasons, but the driving force has most often been external circumstances such as war or an economic crisis. [1] We can therefore see that the pandemic, coupled with a pre-existing workforce crisis in health care, could be the catalyst needed to take the pharmacy profession forward. In the Northern Hemisphere, we currently face the threat of a second wave of COVID-19 as winter approaches and the flu season starts. This really is the time for pharmacists to grasp the nettle and show they are fit for the future, confirming their central place within healthcare teams. Whether in hospital, primary care or intermediate care settings, regulation, clinical trials, or drug development and discovery, there might be a small silver lining after all.

The evolution of occupational power