00:00:00:10 [Speaker 1]: Um, so my name is Catherine Lebowski and I have two roles. So I am the lead pharmacist for frailty and elderly medicine at midway hospital. And I was last year, the chief pharmaceutical officer's clinical fellow at NHS England. But now I am the clinical lead on the national overprescribing review.  

00:00:17:09 [Speaker 2]: Nice boy. Why pharmacy in the first place? What's that? Did you,  

00:00:24:04 [Speaker 1]: So I knew that science and math, so my strong points, I've never, I, I love talking as you're quite quickly noticed, but I've always been kind of at home in science and maths. Lots of my family are in the medical profession. My mother's an optician. My uncle is a GP, my aunt's a nurse. So I had a good kind of view of what the different options were. My uncle worked really, really long hours and it was away from home a lot. Um, and I had a lot of friends who I got through work experience, and I ended up in a community pharmacy. And in there I realized 

00:00:55:15 that you can have a really good interaction with patients. It's all about science. It's all about maths. There's so much maths in pharmacy, but you know, it's basic maths, so it's easy to get your head round, but you can really apply it and you get to interact with people. So I still got that people interaction and that opportunity to help people and the science and the maths all in one. So  

00:01:16:09 [Speaker 2]: How would you describe what you do in very simple  

00:01:18:10 [Speaker 1]: Terms? So in my role in the hospital, so I am the frailty lead. So my job is to make sure that the medicines we give to our older population are the right medicines. And we're making those adjustments that you need. As you get older, something you need, when you're 45, your body has changed between 45 and 85. Have we taken that properly into account? Does everyone really understand what the differences are? So my job is making sure that I train all of my team to understand those differences. We continue those differences. We make sure that when 

00:01:52:10 someone leaves the hospital, their medicines are better than when they came in to prevent them having that problem. One of the big problems for the elderly is they fall. A lot of that can be to do with medicines. So what can we do to those medicines, with that patient talking to the patient to make sure that they're on the right medicines when they go home. So they don't fall over again.  

00:02:11:16 [Speaker 2]: I'm going to grab my notes because I don't want to confuse my goats from other people. I remember you saying about terms of what you find frustrating about how the public misunderstands pharmacy. Can you tell us about that?  

00:02:33:10 [Speaker 1]: Yes. So whenever I tell people that I am a pharmacist, they assume that my job is sticking labels on boxes. I often get asked, why does it take so long to stick a label on a box? Um, we get a lot of anger from people about the time it takes to do something with no understanding necessarily about how we're doing a safety check. And my job is to be that safety net. So the person who writes the prescription, isn't gonna make an intentional error, but they, everyone makes mistakes. So my job is to make sure that that prescription before it gets into your hands 

00:03:04:02 is correct. And that's true in any job I'm doing where I'm working with medicines. So people always saying, Oh, I had to wait 30 minutes for one item is all that they start to talk to me about, or the advert they've seen on the telly for the latest hay fever medicine, which if you don't work with over the counter medicines, you know that we may not know all the brand names. So there is an assumption that you work in a shop and that you are a community pharmacist. There's nothing wrong with that. But then there's a big assumption about what that community pharmacist does as well, 

00:03:34:07 which is also incorrect.  

00:03:35:21 [Speaker 2]: Yeah. Let's say like someone said to us before about people think they're walking shop. Yes. So what, what excites you about what you do and pharmacy in general?  

00:03:52:05 [Speaker 1]: So in previous roles, I've got to spend even more time with patients than I do in this role. This role is about getting the medicines right, for all the patients. Whereas in previous roles, I was much more one on one with each patient, but it still excites me to find a patient. Who's got a problem that nobody realized was due to medicines that I can go, no, it's, it's, I've seen this, it's this medicine. Let's try stopping it and see if they get better. And then seeing them get better. And knowing that had you not had that conversation, it wouldn't have 

00:04:22:21 happened. So that patient would have continued to suffer with a really bad dry mouth, which sounds like nothing. But if you've ever had a dry mouth for a period of time, imagine that all the time with a split lips and a really sore mouth, and it's a side effect of a medicine that isn't actually working properly for that patient anymore.  

00:04:41:05 [Speaker 2]: That's a big thing to do for someone. Yeah. I'll tend to lot more about these things for myself. Um, so how were you able to be innovative in what you do?  

00:04:55:10 [Speaker 1]: Wow. There's so much that we can do innovatively. Um, there's, there's a very old-fashioned model of how medicine looks, how patients perceive medicine. They think I go to my GP and if you suggest that they went to the pharmacist, they think, well, no, I need to see the doctor. There's this view that the doctor is who you need when actually there's so many instances when actually the nurse might be the right person, the pharmacist is the medicines expert. So have you been to see the pharmacist if you've got a pharmacy question or is it all going through the 

00:05:26:18 GP here? We've managed recently to bring out a system where we can send your discharge letter to your community pharmacy as well as your GP, which means that before you can even get to the community pharmacy, they know those medicines have changed. So all of this kind of change and future proofing and digitalizing, how we do things just improves care. It makes it better. So there's so many ways that we can make things smoother and better.  

00:05:55:01 [Speaker 2]: That seems to really like, get your yes.  

00:05:58:08 [Speaker 1]: Yeah, no, I'm, I'm all about what we call transfer of care. We know that when you move from hospital out into the community or out in the community, into hospital, there is a room for errors to happen. So how do we prevent those errors from happening? And when it's to do with medicines is to do with pharmacists, it's should be our job to make sure that that is as seamless as possible because medicines, if they're taken incorrectly can be very dangerous.  

00:06:25:19 [Speaker 2]: So have you found a lot of opportunities at what cost on the seat?  

00:06:30:24 [Speaker 1]: I have. I have a very, um, I don't know what that job is. Therefore it seems really interesting approach to work. So I have, um, I've been really lucky. I got to do pharmacists in a and a pilot. So when we'd never had pharmacists, then Aly, I went in with a clipboard and worked out what I could do to make things better. I've done a research position where I worked for 18 months tracking patients, obviously with their consent to see what happens after they leave hospital. Um, how many of them actually come back? And if they do, is it because of medicines? 

00:07:02:14 What can we improve on? So what, how many are preventable basically? Um, and then working for NHS, England, learning about policy, how do we do things nationally? It's all well and good. One hospital being an outstanding beacon, but how do we make sure that you get that same outstanding care all over the country? And you don't have to have people in every single hospital having the same conversation. We've got to pull that resource and say, these guys did it really well. How do we spread it to other people  

00:07:31:11 [Speaker 2]: Does sound more St John's. Yeah. Camera's not just by festival hall. So I'm done. That's still 20 minutes an hour. I wonder that you, that jokes. Cause there's not, you just read it up. Boom, boom, boom.  

00:07:54:06 [Speaker 1]: I mean, I could work. You can normally work. Our dad joke that if you actually think about it, like, what is it going to be? Because it has to be obvious.  

00:08:04:14 [Speaker 2]: It's like cracking jokes.  

00:08:06:23 [Speaker 1]: Like you will know that, you know, toffee train is a caramel tube chew. If you really thought about it, anything that makes you grown is cause it's obvious.  

00:08:20:02 [Speaker 2]: So they'll punish you. It's all business. Yeah.  

00:08:23:10 [Speaker 1]: So yeah, that that's and I hang out with a lot of dads who tell me these jokes.  

00:08:27:08 [Speaker 2]: Yeah, yeah,  

00:08:29:21 [Speaker 1]: Yes. And a couple of guys who aren't dads, but I think must be because otherwise, where are these jokes coming?  

00:08:38:22 [Speaker 2]: Cool. I want to ask you, how do you balance? So you don't have this NHS income rolling.  

00:08:45:06 [Speaker 1]: I do. Yes. Yeah. So it was full-time and then when it finished, so during the fellowship, we tend to work on all kinds of things and try and get immersed across the platform. So go and work at H E go and work for a bit with the regulator, go and work to get that understanding. But alongside that you have eight projects. Normally that is your big thing. And for me, it's overprescribing. It's about when we use too many medicines for too long for people. And when we use a medicine instead of something else, because that's something else isn't available 

00:09:16:10 quick enough, or people want a tablet. So if you say to someone, your blood pressure's a bit raised, you need to do exercise, eat less salt. Actually, if they had a heart attack in that gap between their blood pressure coming down, that can't happen.  

00:09:31:05 [Speaker 1]: So we tend to jump to blood pressure tablets very, very early. So it's about, Oh, we jumping at the right point. When should we be starting medicines? When should we let people have a go? If someone's got, um, mental health problem and they wants to have CBT, there's a waiting list of 12 weeks. Well, in that 12 weeks that what's happening for that person. So we'll start an antidepressant when actually the talking therapy may have been enough, but the wait is too long. So it's about looking at the blocks in the system and making sure people are on the right medicines at the right time when they're supposed to be. And that 

00:10:03:20 continued,  

00:10:04:24 [Speaker 2]: How do you balance your regular work with this NHS England DRO?  

00:10:11:02 [Speaker 1]: So the, the benefits of being in a more senior role is there's more flexibility in what I do. So if I was on the wards, there's very little flexibility because everyone needs to be seen in that medicine needs to be sorted. Whereas I do a lot of project work in both of my roles, which means they mesh together quite nicely. I also have two bosses who are very flexible, as long as the work gets done. So I have officially two days at NHS, England and three days in my other role, but there may be a week 

00:10:41:17 where I actually have to do five days in this role and no days NHS, England, but then there'll be lots of meetings or a deadline, and I'll do more work for NHS England. So it balances, but it's definitely about being flexible, prioritizing managing your time. Well, and really understanding what a deadline is and how you work. I know I'm a last minute lady. There is no point in me booking out six weeks before something needs to be done to finish it because I'm going to procrastinate. I should work on something else. If it's a week before I'm going to work hard on it. So it's booking 

00:11:14:13 in the work to suit your personality and how you,  

00:11:17:20 [Speaker 2]: How does one inform the other? Did I so feed off each other? Do you get ideas from one to inform the other?  

00:11:22:22 [Speaker 1]: Yes. I mean, working with patients and really that's what I bring to my role. There are lots of very skilled policy working people who are professionals in this field. What I bring is the, on the ground experience of what actually happens for me. And it's just, it's only my experience, but I have lots of clinicians I can talk to. I have lots of time that I've spent where I can say, I know it says this, but this is what actually, so what can we do to make that better? Or you think it's bad, but 

00:11:57:17 actually I think it's great because these are the unintended consequences of what that means. So that's what I bring to it. Rather than the actual policy writing part.  

00:12:09:13 [Speaker 2]: What has this journey and pharmacy taught you about yourself?  

00:12:16:16 [Speaker 1]: What's it taught me about myself. Um, lots of things. Um, I'm more of a worrier than I thought I would ever have been, and that doesn't seem to go away. Um, I still worry about prescriptions. I give out two days later, um, I have a real passion for people. It's taught me that I have much more of a passion for helping the kind of frail patients than I would before and how we forget the frail patients or people. We often see them as the elderly, especially people who are housebound. And actually I spent a year doing home visits with these people 

00:12:52:10 and seeing what their lives are like. And it's taught me how important that is. And to remember, it's very easy as a pharmacist to look at list of medicines, look at a list of conditions and say, yep, they should be on all of these.  

00:13:03:23 [Speaker 1]: This is great. But when you talk to the patient, they don't want to take one of them. They have that choice. We can't make you take a medicine just because we think it's in your best interest. And also just because it sort of list on the side effect. Isn't there. If you tell me that that tablet gives you headaches or migraines, no matter what I say, if it, every time you take it, you get a migraine, you are not going to take that tablet. So just because it's not on the list, it doesn't mean it's not true.  

00:13:32:11 [Speaker 2]: That's a good point. Check on. You had some good stories. Can you tell me about, um, the person you helped who had arthritis and withdraw medication before?  

00:13:47:03 [Speaker 1]: Yeah. Yeah. So one of the home visits I did was for a gentlemen with arthritis in his hands and he was quite severe and his fingers were quite bent. And in order to try and help him, we'd given him some new pain tablets, but these tiny little tablets and he physically couldn't pick them up. So when I went to see him, we thought he was overusing these tablets, which was part of the reason I was going in. Is there an addiction problem what's going on? But no, he was sitting in his chair. So his carpet around him was covered in these tiny little tablets. 

00:14:20:16 And when I watched him try to do it, he physically couldn't pick the tablet up off. He could only pop it onto his desk and then he couldn't pick it up, even sliding it onto his other hand because of the size of the tablets they would just fall through.  

00:14:35:00 [Speaker 1]: So he was getting no additional pain relief and it was something that was so simple to fix because we have combination tablets. And normally I don't like combination tablets because it means you can only take your strong painkiller with your lower strength, painkiller, meaning that if you don't have strong pain, still taking that higher level. But for this gentlemen, the mixed tablets are about this big as opposed to tiny so he could pick them up. So it's just about using that knowledge of 

00:15:03:22 medicines and how they come and how they work to help a person.  

00:15:08:11 [Speaker 2]: And that's like such a tiny thing too. It makes just a huge, almost a measurable difference to that. Person's life. I've got to ask maybe two more questions. I'm gonna ask you very wisely going through Steven as well. Um, I was wondering in your mind, do you have a kind of mission statement of what you are trying to do in pharmacy? What we do we're very, um, arrogant or not. We're not that humble. We're trying to change the world. Look with film.  

00:15:37:10 [Speaker 1]: I mean, I think I've already said it actually. I want to make sure that all of my patients are on the right medicine for them at the right time in their life with the right access and everything we do should be working towards that.  

00:15:51:08 [Speaker 2]: Great. Okay. And then the last one, what would you say to someone who isn't quite sure about pharmacy and needs? A little bit of convincing.  

00:16:01:11 [Speaker 2]: I would say if you can try and get some experience of seeing what pharmacy really is, there's such this, um, perception of what pharmacy is, and actually there's so much more to it. So these videos are obviously helpful, but get yourself, if you can get immersed into a pharmacy to see what they do to understand. Um, and we'll talk to a pharmacist, there's a lot of us. Um, we tend to be quite welcoming. We talk to people for a living, so we're very keen to get more pharmacists in. So 

00:16:34:14 if you have an interest to have a conversation.