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 pharmacistinvolvement in CAMHS. Aim: This evaluation aimed to explore the outcomes of integrating two pharmacist independentprescribers into community CAHMS and the acceptance of their roles as part of the multidisciplinaryteam (MDT). Method: Two band 8a specialist pharmacists were recruited and trained to achieve independentprescriber status as part of a service improvement strategy within the community CAMHS team atHertfordshire Partnership University NHS Foundation Trust. To evaluate the outcome of theirintegration, a purposeful documentation of the pharmacist's clinical activities, self-administeredsurveys of the families of patients and the CAMHS MDT, and focus group discussions with the MDTwere undertaken between July 2019 and March 2020. A descriptive analysis of quantitative data andcontent 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 independentprescriber status, the specialist pharmacists documented a total of 322 explicit contributions to careover a subsequent three-month period. These contributions included prescription transcribing, jointdevelopment and wellbeing assessment, monitoring of physical health parameters and provision ofmedicines-related advice to the MDT. As independent prescribers, the pharmacists' involvementexpanded to independently lead attention deficit hyperactive disorder (ADHD) clinics, with adesignated caseload to manage. Responses from surveys and focus group discussions suggested anoverwhelmingly 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 valuablemember of the ADHD team within CAMHS . The need to normalise the integration of pharmacistindependent prescribers as core members of the ADHD CAMHS team resonated in the MDT focusgroup discussions and MDT survey (62% response rate; n=13/21). Conclusion: This evaluation identifies a clear role for pharmacists in the CAMHS setting, anddemonstrates 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. Keywords: Child and adolescent mental health, independent prescriber, mental health, non-medicalprescriber, pharmacist, psychiatry.