Ajay Bhatt
Hello, ladies and gentlemen, welcome to Advanced Practice Weekly. My name is Ajay Bhatt and I will be your host. Today, we are talking to a very special guest, which is going to talk to us all about pharmacy and advanced practice, or maybe even advanced practice as a pharmacist or even maybe pharmacists within advanced practice. I’m not sure, but she’s the expert and she’s going to introduce herself and tell us all about her important work that she’s doing and where it aligns with the government three shifts. So welcome to the programme. Please tell us your name and a little bit about yourself.
Chaandni Devgon
Hi, so I’m Chaandni Devgon, I’ve got too many hats, so it’s going to be fun. So I’m the lead pharmacist and advanced clinical practitioner in practice in itself, alongside that I’m also the Southwest London education and training hub lead for pharmacist, pharmacist technicians across the whole Southwest London. I also am a lead for multiple different PCNs across kind of the patch as well. On the evenings or weekends, I’m usually trying to catch up on sleep, coaching, mentoring, trying to support other pharmacy professionals. Yeah, that’s just the start of it.
Ajay Bhatt
Wow, so you’re very, very busy. You’ve got lots going on, which is why it took us a while to pin you down for an hour today so we can have a quick chat with you.
Chaandni Devgon
Absolutely.
Ajay Bhatt
Great stuff. Okay, so that’s your current role, working as an advanced practitioner in primary care, but lots of lead and strategic roles and stuff there as well. How did you first get involved in advanced practice and what inspired you to, once you’d become an advanced practitioner, to take on a supervisory role?
Chaandni Devgon
So I kind of started as a pharmacist. I’ve been in a variety of different roles, variety of different areas, had a bit of exposure everywhere. So most recently, before the obviously going to general practice, I was in community pharmacy, I did my IP and this was well before the CPP pilots and all of that stuff that happened. Did my IP, which not a lot of pharmacists actually did back then, which helps you to boost your general knowledge, your skills in advanced assessment, got my first place in general practice. And you know where you feel like you’ve got enough, you know your stuff, you know what you’re doing in terms of being a community pharmacy, your bread and butter, you can refer to general practice. Those patients who normally would be referred into general practice, I know what I would do on one side and I’ve got the skills and kind of skills and knowledge to be able to deal with them. But actually I wanted more to my role. I wanted to take on more of an advanced role. I wanted to be able to see patients from start to finish, rather than have to say, I need to refer you elsewhere. And I need to go and see this patient or that patient. So I wanted to upskill myself. So advanced clinical practice, after I did a postgraduate diploma, actually came quite naturally to me. And it was something that I wanted to do to be able to develop myself to better than myself and then to be able to support others who are coming up through the ranks going forward. So that’s where the advanced clinical practice came from. So I did my ACP at King’s many moons ago. I’ve since been a senior lecturer there and I’ve lectured in other universities and things. So the supervisory kind of support kind of role, the education role kind of ingrained in it after I finished my ACP. But actually you take on more of a supervisory role as you become more senior, that’s normal on that front. And especially when you’ve got it inside that you want to support others, you’re going to do that naturally to nurture their confidence and competence going forward as well. So it kind of just rolled from one thing to another.
Ajay Bhatt
Yeah, it’s quite natural, isn’t it? I say, I see where you’re coming from, you want to close that circle of care to get a bit more advanced, you could be able to manage that patient on your own, on in the whole. And then moving forward, I think most of us that are in healthcare these days will always end up doing some type of mentorship or supervision along the way, don’t we? And some of us are more passionate about it than others. And you can see those that are an answer. That’s, that’s great. Okay, so you’re currently, you’re currently supervising not only pharmacists, but also other healthcare professionals, how did that come about? And what has that experience been like for you?
Chaandni Devgon
Absolutely. So when I obviously came into ACP land, that’s what I call it, I’m always going to be a clinical pharmacist, lead pharmacist as first and foremost, but I am an advanced clinical practitioner. So I’ve got my own autonomy. I’ve got that be able to support as long as I remember what’s my scope of practice and I work within that. Now, the key thing is that you go and do all of this education, this training, and be able to support yourselves. And I carried on doing that. And by the time I was doing my ACP and finished that, I then got to a point where actually there were people coming through the CPP programs. I was being their supervisor and supported them through that. So they’re doing their different kind of training courses to get them through on that side. I then decided to go and do the multi-professional educators course by NHS England itself, which then gave me the exposure to other trainers and educators who did things in the background for a variety of different healthcare professionals. And actually that opened my eyes that it’s not just pharmacists and pharmacy clinicians I could support, support a lot of others, there’s a lot of crossover. So as well as kind of doing the acute and minor illness side, again, making sure that patients are booked in appropriately and accordingly. I couldn’t see why I couldn’t supervise others because I was supporting them often enough as a DPP through the IP. So why couldn’t I do that in practice? So we just extended that forward and took it forward from there. So paramedics, nurses, pharmacists, sometimes train your GPs end up coming to me for supervision school because their specialty is not my specialism. So because I’ve got a cardioreneal metabolic background, it makes it easier to be able to then take on more and support all of those different allied healthcare professionals going forward.
Ajay Bhatt
Great. So your expertise is really well shared amongst your colleagues and people there with you. That’s, that’s really cool. Traditionally, pharmacy hasn’t always placed a strong emphasis on supervision or educator roles. What are your thoughts about this and about moving forward with the profession?
Chaandni Devgon
10 years ago, it wasn’t common to have pharmacists who were prescribing. Pharmacy first didn’t exist. So there’s been a big shift from that traditional pharmacist role that everyone sees you in a community pharmacy doing. So with that evolving and changing, just like nurses evolved their careers and evolved from practice nurses to actual educators alongside their advancement practice, why can’t pharmacists do that? There’s no reason why pharmacists can’t do that. And I’m very passionate about that, that we need to get that word out more. It’s about working within your scope, working safely, working effectively, but actually doing what we do best. We deal with these things when we’re in community pharmacy and we’ve got a patient who comes in. Nine times out of 10, we have to deal with it rather than actually sending that person away and saying, you need to go to XYZ. So it’s doing the same thing, being safe, being competent and supporting that going forward and more of it needs to be done.
Ajay Bhatt
Okay, off the back of that, what advice would you give to pharmacists who haven’t quite, who are maybe considering, there’s probably a lot of pharmacists out there with a lot of experience that haven’t thought about stepping into the advanced practice world. What would you say to them? Would you say to them, obviously, you’ve obviously, it’s been great for your career, and you’ve really enjoyed it, and you’ve flourished in it and made the best of it. But what would you say to them if they were thinking about it? If they were on the fence, if they were 50-50, what would you say to them?
Chaandni Devgon
I would say that advanced clinical practice is great because it gives you that exposure to be able to support more patients. We want to be able to do the best that we can as healthcare professionals to support our patients and look after patients and at the same time to have our autonomy that we’re used to having rather than having to report back and go backwards and forwards to someone else. Now, we always have the option of going to a duty doctor, senior clinical pharmacist, going to a senior GP, so and so forth, SDEC, A-N-E, worse comes to worse, but actually it’s going and broadening your role, giving yourself more exposure so you can enjoy the role to a better extent. Just like when I was in community pharmacy, I had my IP, I knew exactly what that patient needed, but because I was in that constraint of where I was in that community pharmacy at that time, there was no way I could prescribe and give what I needed to give to that patient with my indemnity, rain puts and dah-dah-dah 10 odd years ago. However, now things are changed and you can go and make a difference. So actually I’d say, go and actually look into it, see what you want to do and go and talk to other colleagues. There’s so many courses that are there, there’s so much funding at the moment, especially right now, that is available for you to be able to make the most of it and take it. While you’ve got those opportunities, take them. I think that’s the biggest thing and I think if you’re worried about it or you’re concerned, look into some form of coaching to build up your confidence to help with your competence going forward. So look into that kind of medical coaching, someone who’s able to help to support you, a mentor who’s maybe gone through that or someone who’s got a similar skill set who can help you to make the right decisions for you.
Ajay Bhatt
Yeah, that’s excellent advice. I think finding a bit of help beforehand and maybe speaking to somebody that’s doing it or has done it is always a good idea to see how they’ve got on. Fantastic. Okay, you’re aware of the three shifts, right, that the government has set out. So moving care from hospitals to communities, making better use of technology and focusing on preventing sickness, not just treating it. Now, when I first thought about doing this interview with you, that it was the focus is on preventing sickness, not just treating it, which came to mind, prescribing decisions, a lot of deep prescribing, a lot of reviewing of renal function, a lot of reviewing of cardiovascular disease. And as far as I can see, you guys are like at the forefront of managing long term sick people, but also preventing it. So picking up on those early blood results where someone might have high cholesterol, for instance, and then, you know, maybe talking to that patient or not, you know, I know that’s a very basic level, but that type of stuff. So I kind of wanted to explore that with you.
Chaandni Devgon
So I think the first thing is obviously you want to prevent hospitalization, that can be a big part. So you’re seeing more patients in the forefront caring for and giving that continuity of care in the general practice community that the patient wants. Because let’s be honest, a patient does not want to go into hospital. We can avoid it, we want to go and make sure. We want to make sure that we’re protecting them, we’re supporting them. And actually, pharmacists are really great because we have really key attention to detail. We’ll pick up those little triggers, those little things and want to pick up these little things that may have been overlooked previously. But actually, you can find trends, you can see little pickups. We look at the diabetes data, you know that even from just diet alone, you can reverse diabetes and bring it into remission. Those are huge things that patients need empowerment for. And pharmacists are really good at being able to do that. And as an advanced clinical practitioner, you can then support that patient to a greater detail, they build that rapport, they’ll know that they can come back to you to be able to go and see you for XYZ. They don’t need to go and be the patient who’s panicking, going and calling 111 in the weekend and saying, actually, I’m not sure where I’m going with this. They can go and discuss it with you, have a plan and plan ahead. We know CBD prevent is huge this year, whether we look at cough, whether we look at the agenda for the five-year forward or 10-year forward plans, whatever position you’re in, we know that’s huge. And pharmacists are in a great position to be able to support that and help with that. So the sooner we do it, the better.
Ajay Bhatt
So just for some of our listeners, we might not be aware of what QOF or CVD is. Can you just tell us about that? I mean, I know what they are because I’ve worked in primary care. But just give us a quick overview of what that screening process is and why we do it.
Chaandni Devgon
Absolutely. So cough essentially is a quality of framework. So essentially it’s a list of different conditions where patients have certain long-term conditions and in order for them to be best treated, reduce the risk of harm, reduce any complications, they have certain targets and need to hit all the health care. Now, when we say targets and we think targets, we’re thinking, oh my God, really? Actually, it’s about making sure they’ve got the right blood pressure, making sure that they’re treated to target. So if we’re not just going in or someone’s hovering between 141 and 140, actually, for their systolic blood pressure, it should be significantly lower anyway. Actually, it’s going and making sure we benefit that patient and go and treat them to target, make sure the cholesterol is reduced down low enough to be able to go and support that patient to reduce down the risk of any cardiovascular outcomes or issues that could happen of a heart attack, stroke, unstable angina, which could go and do those. I think I just answered your CBD, so CBD being cardiovascular disease on that side. So it’s a really big thing that we can do so well and as pharmacists and pharmaceuticals across the board.
Ajay Bhatt
And the data on this is really good isn’t it? The data shows that this actually has an impact by reducing those comorbidities and those conditions early we can actually bring down the risk of cardiovascular disease and a heart attack.
Chaandni Devgon
significantly. Absolutely. I’m quite open about this. My dad passed away at the age of 59 as a stroke patient. He had his first heart attack at 35. He had his comorbidities and things been dealt with and engaged with earlier. He probably would still be here today. And he had a plethora of issues, whether it be diabetes, heart disease, so and so forth, and whatever else. But actually, if I can prevent one person from going down that route and having their family have to go down that route, I’ve done my job. So that’s the kind of empowerment you want to be able to give patients and actually your colleagues and as advancement practitioner, lead pharmacist, whichever role I do. The patient is at the center of that. And being able to manage that patient autonomously and get the support where you need it makes all that difference to that patient.
Ajay Bhatt
So if we just wanted to talk about shift one which is moving care from hospital to communities, you’ve been a community pharmacist in the past. Now what would a community pharmacist do?
Chaandni Devgon
don’t work in a community pharmacy now. And then I’m completely honest about that one. I think especially as an ACP, you end up kind of pushing yourself out of that one, right on that front. But actually, you can work to be that person on call who can help with supporting that community pharmacist is on the other end of the call. Right. So community pharmacist picks up a patient who potentially in pharmacy first needs to be reviewed urgently itself. You can be that person on the other end of the phone. Yes, I’ll put them in the social media clinic. I’ll review if that person needs to be seen here because I’ve got the knowledge and skills to be able to assess that patient. Or do I actually need to refer them to any SDEC, which is the same day assessment unit effectively, and that will then get reviewed where that patient needs to says the right patient in the right place and treated with the right treatment at the right time. So actually, you can work across the system systems and these new neighborhoods as they call it, to make that journey seamless for that patient. You have also in terms of my role, I’ve done a lot of education and training sessions for community pharmacists to upskill them
Ajay Bhatt
So that’s really hitting that sort of leadership pillow in your advanced practice role, where you’re there, you’re supporting your other pharmacy colleagues that are working out there that may be coming up against things that they can’t quite manage and you’re then able to do it, which in turn is keeping those patients outside of the major hospitals, keeping them into the communities and we’re treating them there as much as possible.
Chaandni Devgon
But actually, by actually working in general practice, having the opportunity for appointments, more appointments in general practice, to be able to see those patients who that can be dealt with here, means they’re not gonna just get up and go to A&E or to UTC, so the urgent care, urgent treatment centers or to 111. They’re treated in community, treated in primary care. So it prevents that happening.
Ajay Bhatt
Right, great. And I suppose a lot of what the work you’re doing is about prevention, as though, like you talked about with your diabetes, a lot of it’s about giving people healthy advice about living, about their lifestyles, etc. A lot of that will in turn, hopefully long-term, keep them out of the hospitals, keep them into the communities, less engagement with the health service probably across the board.
Chaandni Devgon
Absolutely. And then I’m also doing a bit in the works force kind of side with some cardiologists in the background as well, where we’re trying to get things that traditionally we would have to do in hospital only, but we’re working to have a triage, a tertiary clinic in the middle, where actually patients can be reviewed in the middle, they get them assessed on that front with an advice and guidance kind of style, or whether it be you do a virtual clinic as a debrief with consultant. So patients don’t have to wait for those huge waiting times, it frees up the consultant time for their appointments. And you can review see that patient in the clinic in community itself, for heart failure, whether it be uptight rating up their post ACS. So that after they’ve had a curative symptoms are heart attack effectively, making sure they’re on the right things, making sure for heart failure, they’re on the four pillars of treatment for heart failure with reduced ejection fraction, lots of different things. And the new things now with the kidney side as well, making sure people are treated to the right degree, put on the right medication, treated to the right parameters, where it’s going to reduce down complications and reduce down to that point where a patient ends up having to go down the route of dialysis or even more the complications, because actually, when you look at the renal patients, a lot of those patients will end up passing away before they even get to dialysis. So you’re going and preventing those multiple morbidities, but actually mortality. So you’re saving lives, which is the key thing.
Ajay Bhatt
And is this tertiary clinic, is this a new thing that you guys have started to develop in your area, is it going to, yeah.
Chaandni Devgon
thing that we’re looking at in between at the moment, it’s a thing that we’re trying to do to make it kind of as a joined up working approach to support the patients in the community rather than having to go backwards and forwards. The community nurses are amazing, community heart failure nurses are amazing for these things, but sometimes they need a bit of support and a bit in between so we can help to support each other.
Ajay Bhatt
Great. Well you’re certainly hitting quite a few of these three shifts aren’t you? Can you tell me are you using any technology to help with your work at the moment? Any AI or anything like that?
Chaandni Devgon
I use a couple of transcription programs I’ll be honest to help to I’m talking to the patient because the patient is a forefront so I do use some of these AI functions to help with my note keeping to help with kind of the transcribing a bit it’s not 100% I’ll be honest but you can pick up the key points that you wanted to and then type it in afterwards which makes it a lot easier you’ve got the all these different things like ACURX which help you to go and digitally contact the patient or if you’re going and triaging someone ask for photos of a rash so you can see what’s going on ask for blood pressure assessments from their home readings all of these things which make it easier and help to streamline the process better remind us for example for blood monitoring that you can send out a text automatically in three months say I need you to come and have blood monitoring done for your demarred medicine so if you’re a diaprenium bifitrexate whichever way we use lots of these different things for with IT and we don’t even realize how much there is our fingertips on that front and that’s just the tip of the iceberg but that’s what I tend to use day to day
Ajay Bhatt
So that stuff just streamlines your day, makes it a bit easier. It’s about learning the systems in general practice. And I found when working in general practice, if you know how to use the systems, you can be actually be quite efficient. If you know how to navigate where all the things are on the computer, then you can know how to send them. OK, fabulous. So can you tell me what the benefits from you actually taking on the supervisory role and especially not only supervising other pharmacists, but other allied health care professionals and some junior doctors and trainee GPs? What have you got out of it personally? Which has been interesting for you.
Chaandni Devgon
for me, it’s a great piece of satisfaction. So you get a big job satisfaction part of it that actually I’m making a difference. And I’m not just sitting there in my little clinic room and just seeing patients back and forth, I’m making a difference. I’m helping to support that new coming workforce. Because if we don’t support them, who else is going to? To be honest, GPs are used to helping other GPs, nurses are helping to help nurse other nurses, pharmacists will help other pharmacists, but actually, you need to be able to support everyone across the board from no matter what background they’re for. And there’s a bit of support that comes away on that front to make sure that there’s no inequalities on that kind of side as well. Yeah, it’s given me a big boost in terms of what I do day to day. I really enjoy what I do. I get a bit of protected time to go and help it, which makes a big difference because that protected time then means I can give my all when I’ve got that time with that actual clinician in front of me who needs that support. Sometimes you just see a light switch on, which is really bizarre on that front. It takes time, especially with some of your trainees when you’ve got training pharmacists or trainee colleagues coming through, someone likes to switch on. So one of my key things for me was that I had a trainee pharmacist, hated cardiology before her exam, absolutely hated it, came to her placement, was me with me for about, I want to say about 13 weeks on that front. She’s now a cardiology pharmacist in a very good London hospital, and she loved it and she switched on. She was like, it’s you, you did it. And you get some really beautiful thoughts and really beautiful things that come through with the different cards and that kind of thing and the thank you messages. And that may also make your day a little bit better. Because let’s be honest, seeing patients sometimes isn’t the easiest things to do. But actually embedding education, training and supporting those around you makes it so much better.
Ajay Bhatt
It gives you a boost. It shows that you’re sharing your wealth of knowledge and expertise. It’s really nice to see somebody sort of achieve and strive, isn’t it, through your sort of mentorship. It’s really that’s great. Brilliant. OK, what are your core qualities for being an effective supervisor? What do you think are the sort of attributes and skills that make a good supervisor?
Chaandni Devgon
You know what, Ajay, every time that someone says this to me, I always sit back to think back about when I’ve had bad supervision and what I don’t want it to look like, which is really sad, but it’s true, we all have that one person who didn’t quite do it right. So actually for me, I try and be the opposite of that to make sure I can empower colleagues and trainees and so on and so forth. So you want to have strong clinical knowledge. If you don’t, not competent yourself, you can’t be training anyone else, you can’t support anyone else. So you need to know what you’re good at and support in that area. You imperatively need to have great communication skills. You need to be able to talk to someone, understand how they’re feeling, have that empathy, have that support system. You need to have those coaching skills that are there to be able to coach them so they get their own answers. Not that you’re just telling them the answers, because that’s sometimes where actually I’ve excelled more is where someone’s coached me to find the answer because it empowers me to make that difference. You need to have the ability to be able to provide and at the same time to take constructive feedback where it’s given, because actually, if I’m just giving it all the time, it’s not going to make a difference when someone gives it back and I just be like, actually, hold on, not appropriate. And I think more than anything else, what I do is I have ethical integrity in what I do. I work within my boundaries, I work what’s appropriately, and I support others to be the best that they can be on that front and signpost, refer, whichever way, if I need to. But I think all of those things are, or make an effective clinical supervisor, and I’d say a lot of us can easily do it on that front. We just need a bit of support to think about how we’re going to do it and which way we’re going to do it.
Ajay Bhatt
Fabulous. Great stuff. Thank you. Chandni, thank you so much for joining us today on Advanced Practice Weekly. Sound like you’re doing great work in pharmacy and a great advocate for the pharmacy profession and we hope more people will listen to this and maybe take on the mantle or become an advanced practitioner. So thank you so much for joining us on the program.
Chaandni Devgon
Thank you so much for having me on that front because actually it makes a big difference to be able to get that word out. And honestly, if anyone’s got any questions, queries on that front, my email’s on there. I’m sure you don’t mind. You can go and figure out what my email is and contact me if we need to.
Ajay Bhatt
Be careful, Channy. We have lots of listeners, you know, in the millions, so… No, I’m joking.
Chaandni Devgon
Well, maybe you’d contact Ajay then instead, and then you and Jay will contact me. That’s another way around it. So thank you so much.
Ajay Bhatt
for coming and talking to us today and we’ll hopefully talk to you again in the future.
Chaandni Devgon
Absolutely. Always happy. Take care.
Ajay Bhatt
Thanks for listening to Advance Practice Weekly, we’ll see you all again next week, take care everybody and be safe.