Spotting Leukaemia: The Role of Community Pharmacy with Ade Williams

The COVID-19 pandemic has revealed the key role community pharmacy plays in the early diagnosis of leukaemia, especially in minority ethnic communities. We sit down with Ade Williams, Pharmacist of the Year (2018), to find out more.

In addition to general practitioners (GPs), pharmacists play a crucial role in spotting leukaemia. On a daily basis, community pharmacies will see patients presenting with symptoms and asking for over-the-counter medicines to resolve them. In fact, research has shown that 89% of the population can walk to a community pharmacy within 20 minutes. This rises to 98% in urban areas like cities [1] and 99% in areas of high deprivation [2], indicating that community pharmacy may be the first point of contact for patients experiencing troubling symptoms.

Welcome, Ade! Please tell us a little bit about yourself and your role in community pharmacy.

I am Ade Williams, a Superintendent Pharmacist based in Bristol. I practice principally in Bedminster Pharmacy, a small healthy living pharmacy that has received unprecedented multiple national awards for our work, including the NHS Parliamentary Award for Excellence in Primary Care and various individual accolades. My wider population health management role enables me to champion shared communal well-being partnerships through better health literacy and behavioural support. We actively tackle health inequalities by dismantling cultural and structural barriers, which also hinder early cancer diagnosis. 

As a broadcaster and writer, I make sure no voice is lost and unrepresented. This is a pillar of our inclusive and accessible NHS; Community pharmacy, I believe, is the epitome of this. I am the Royal Pharmaceutical Society’s Patient Advocate, and Oncology Pharmacy lead at the Primary Care Pharmacy Association. I am also actively involved in advocacy and research that improves early cancer diagnosis by integrating the role of Community Pharmacy in the patient care pathways.

What is one thing you wish people knew about community pharmacy? 

Community Pharmacy is an integral part of the NHS. It can be argued that during the pandemic, the work of Community Pharmacy has sustained the hinges of sacrosanct universal access. A pillar of the NHS. Doing so by ensuring that the dual gateways of Primary Care: Community Pharmacy and General Practice worked together to remodel and innovate new ways of looking after people. Never be confused with the retail shell; all Community Pharmacies are linked together as your local trusted NHS outpost. Our healthcare system, though constantly under enormous strain, does not buckle, partly due to the work of community pharmacies.

The Royal Pharmaceutical Society (RPS) describes community pharmacies as ‘convenient’ and ‘accessible’ places. Would you agree with this statement, and is it consistent with your experience as a pharmacist?

Yes, I most certainly do! Why? When face-to-face access to any health care professional can sadly seem a premium, community pharmacies are always available. Our opening hours are generally longer than in many other health settings. As you already mentioned, there are over 1.6 million visits to a community pharmacy every day. Around 14 visits per person per year. We like to view this as 14 opportunities to make contact that counts in improving health and well-being. Community pharmacies offer a free NHS walk-in service, and patients generally have access to the pharmacist within minutes of entering the pharmacy. The challenge is making sure that every contact yields all the benefits derived from the input of a highly trained healthcare professional team, especially capturing and progressing any further care needs or follow-on investigations. 

The six most common symptoms of leukaemia are:

  • Fatigue
  • Bruising/bleeding
  • Repeated infections
  • Feeling weak or breathless
  • Fever
  • Repeated infections

How is community pharmacy in an ideal position to Spot Leukaemia?

Like the rest of the wider society but especially as trusted health professionals, we have a role in increasing awareness of the symptoms of leukaemia. This is no easy task due to the non-specific nature of the symptoms, but as the natural bridge linking health and social care across our communities, we are key. Proactively increasing awareness of the symptoms will also provide us opportunities to help address any lifestyle factors that increase risks. 

Community Pharmacy adopts a holistic care model, centred on good communication skills. This looks not just at presenting clinical history but takes in broader concerns and expectations. All our conversations are confidential, with the use of our consultation rooms always on offer. Our ability to offer unfettered access means we can navigate patients along the continuum of care, enabling us to note resolution, any progression, or even new symptoms. This is especially vital in building a complete picture where non-specific symptoms are at play.

Significantly more acute myeloid leukaemia (AML) patients from minority ethnic communities are diagnosed via an emergency route. How important is community pharmacy in improving early diagnosis of leukaemia, especially in minority ethnic communities?  

Statistically, community pharmacies have a more physical presence in areas with the highest social deprivation and health outcomes. So many people in our society suffer from health inequalities simply because of their socio-economic status and racial background. Even as COVID-19 decimated so much of our lives, the vulnerability of such individuals gained universal visibility. Our moral awakening must produce a detailed accelerated strategy to remove all barriers and accelerate the route to diagnosis. 

Regarding earlier cancer diagnoses, that progress made must become a measure of our work addressing health inequalities. The case for community pharmacies to make urgent direct cancer referrals using evidence-led decision support tools is self-evident as we look to correct the trajectory these statistics present. Moral conviction must bring about sweeping actions that remove barriers, building on evidence and trust. Words and good intentions alone will not save lives from cancer. Knowing that emergency cancer diagnosis is aligned to increased mortality and worse treatment outcomes is our key motivation for change. Always remember, Community Pharmacies will never let down their communities. The trust and confidence invested in us by the population are based on this premise.

And finally, why do you think it is essential for the #SpotLeukaemia campaign and other early diagnosis cancer campaigns to include community pharmacies in their outreach and engagement strategy?
The #SpotLeukaemia campaign and other early diagnosis campaigns present opportunities for community pharmacies to be part of a greater collective effort using their unique expertise. Being part of the fabric of our communities, Community Pharmacy has unparalleled reach and influence based on deep cultural and social understanding. Aligning this with the necessary knowledge and tools will provide rapid improvement in early cancer diagnosis.  

I am grateful for organisations like Leukaemia Care that view us as valued partners in their work. It is, however, crucial that Community Pharmacy brings energy and vision as part of our engagement. We are sometimes sapped, owing to the relentless daily pressures we face, I remain ever humbled to be part of a professional group that always rallies to the needs of our communities.

Want to join Ade and thousands of others in supporting the #SpotLeukaemia campaign?

Visit www.spotleukaemia.org.uk to help the 10,000 leukaemia patients diagnosed in the United Kingdom (UK) every year. 

Are you a healthcare professional and interested in learning more about leukaemia and early diagnosis?
Visit our GP Learning site or Nurse Academy e-learning to find out more about our CPD (Continued Profesional Development) accredited modules. 

Leukaemia Care is a national blood cancer support charity, committed to ensuring that anyone affected by blood cancer receives the right information, advice and support. We provide a range of support services to patients and their carers including a helpline, nationwide support groups, online webinars, nurse education, an informative website, cancer campaigning and advocacy and accredited cancer information and literature. 

For more information, call 08088 010 444 or email support@leukaemiacare.org.uk

References

[1] Todd A, Copeland A, Husband A et al. The positive pharmacy care law: an area-level analysis of the relationship between community pharmacy distribution, urbanity and social deprivation in England. BMJ Open 2014;4:e005674. doi: 10.1136/bmjopen-2014-005764

[2] Badenhorst J, Todd A, Lindsey L et al. Widening the scope for early cancer detection: identification of alarm symptoms by community pharmacies. Int J Clin Pharm 2015;37(3):465–470. doi: 10.1007/s11096-015-0078-3

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