Assessing the integration of pharmacist independent prescribers in child and adolescent mental health services

Abstract

Introduction: Owing to high demand and staff recruitment challenges, child and adolescent mental health services (CAMHS) in England have struggled to meet expectations set by the NHS and Royal College of Psychiatrists Quality Network for Community CAMHS, leading to long waiting times and restriction of access to services. Although nurse and pharmacist independent prescriber roles are well established in the UK, there is limited literature on specialist or independent prescriber pharmacist involvement in CAMHS. Aim: This evaluation aimed to explore the outcomes of integrating two pharmacist independent prescribers into community CAHMS and the acceptance of their roles as part of the multidisciplinary team (MDT). Method: Two band 8a specialist pharmacists were recruited and trained to achieve independent prescriber status as part of a service improvement strategy within the community CAMHS team at Hertfordshire Partnership University NHS Foundation Trust. To evaluate the outcome of their integration, a purposeful documentation of the pharmacist’s clinical activities, self-administered surveys of the families of patients and the CAMHS MDT, and focus group discussions with the MDT were undertaken between July 2019 and March 2020. A descriptive analysis of quantitative data and content analysis for qualitative data was applied to provide a general view of the pharmacists’ contributions and others’ acceptance of their role. Results: Three months post integration into the CAMHS team and prior to achieving independent prescriber status, the specialist pharmacists documented a total of 322 explicit contributions to care over a subsequent three-month period. These contributions included prescription transcribing, joint development and wellbeing assessment, monitoring of physical health parameters and provision of medicines-related advice to the MDT. As independent prescribers, the pharmacists’ involvement expanded to independently lead attention deficit hyperactive disorder (ADHD) clinics, with a designated caseload to manage. Responses from surveys and focus group discussions suggested an overwhelmingly positive reception to the pharmacist’s role. All respondents in the families’ survey (40% response rate; n=20/50) indicated that they strongly agreed that the pharmacist was a valuable member of the ADHD team within CAMHS. The need to normalise the integration of pharmacist independent prescribers as core members of the ADHD CAMHS team resonated in the MDT focus group discussions and MDT survey (62% response rate; n=13/21). Conclusion: This evaluation identifies a clear role for pharmacists in the CAMHS setting, and demonstrates high acceptability by children, young people, their families and healthcare professionals. Pharmacists can successfully be recruited, trained and integrated into a community CAMHS team, thereby supporting the alleviation of pressures within CAMHS services.