Meet Dr. Rachel Britton, FDB UK’s new Head of Clinical Operations

With 30 years’ experience as a pharmacist across the NHS, third sector, mental health and substance misuse services, Rachel brings a broad clinical perspective to her new role at FDB. In our conversation, she reflects on her career and the role of clinical content and decision support in improving patient care.

What drew you to FDB and your role as Head of Clinical Operations?

Thirty years ago last month, I qualified as a pharmacist. I thought my career would be about medicines, but it has become just as much about people, clinical decision-making and how we can support better patient care.

I worked in primary care commissioning in the NHS (what would now be the integrated care boards, but back then were primary care trusts) and was a medicines management pharmacist for 12 years. While I was there, we introduced OptimiseRx and so I was actually a customer of FDB.

More recently, I’ve worked in a direct clinical role as an independent prescriber in mental health and substance misuse.

Across my career, I’ve increasingly found myself asking: how do we help every clinician make the right decision more often?

That’s what excites me about FDB: the opportunity to help answer that question at scale, by combining clinical expertise with technology to support safer, more efficient decisions.

You’ve experienced first-hand how technology can support clinical workflows. What opportunities and safeguards do you think are important as technologies evolve?

Well, one example I can give is that I had some previous experience with ambient voice technology - software that can transcribe and help you make clinical decisions. I used it to formulate treatment plans in my previous job, and the amount of time it saved blew me away.

I was quite sceptical because AI can’t replace a clinician, and I still firmly believe that. This isn’t about an AI tool making clinical decisions. But what it can do really well is pull information together and allow me to assimilate that information in one place.

And there’s a very important safety angle here: medicines can do good, but they can also do harm. Clinicians cannot hold all of that information in their heads, so we need to make sure that appropriate medicines safety checks are in place – that these tools are underpinned with trusted clinical decision support – to identify where we might be about to prescribe something that may not be the best choice for that particular patient.

Again, it comes back to what excites me about FDB: the opportunity to combine clinical expertise with trusted clinical decision support and technology, helping clinicians make safer, more efficient decisions and spend more time with their patients.

What does good clinical content and decision support look like in practice?

There is so much information available about medicines, conditions and which medicines should be prescribed for which conditions.

I see trusted clinical content and clinical decision support as being like a ‘right-hand person’ for the clinician. If a trusted solution triggers at the right point in a consultation and allows the clinician to make decisions more quickly, then that’s what we should do.

There’s also something important about risk management. Clinicians manage risk all the time, but there is an enormous amount of guidance, including policies from integrated care boards and NHS trusts. No one can hold all of that information in their head.

Our solutions help clinicians make the right decision and manage risk. For example, if I go to prescribe penicillin and haven’t spotted that a person is allergic to it, clinical decision support solutions can pick that up and provide a warning. Or, when we’re managing patients with long-term conditions, it’s about making sure that we’re prescribing the right things for the right patient and monitoring them appropriately.

How do you help bring clinical content into practice?

I’ve spent a long time writing guidelines and translating national NICE guidance and local guidance into something useful for people.

But with the best will in the world, you can have a great piece of guidance that sits on a shelf and gathers dust or sits in a computer file and is never looked at.

The guidance and content are the starting point. The important question is: when is that information useful for the person who needs it?

We start with the guidance, the evidence and the formulary, and then our clinical team identifies when that information needs to be surfaced and displayed to a prescriber. That’s what brings the guidance alive. It helps clinicians manage risk and make the right clinical decisions.

I’m now in a role where I am more removed from direct clinical practice, but I have the opportunity to enable that for many more people than just myself.

Where do you see the biggest opportunities to improve patient safety?

Medicines are not inherently safe, and I think sometimes we forget that.

Sometimes the best thing is not to prescribe, or to deprescribe. When I was carrying out medication reviews as a practice pharmacist, I saw people taking pages of medicines. When you looked into it, some medicines had been prescribed to deal with the side effects of something else.

Deprescribing is almost as important as prescribing. It comes back to risk and benefit: are we causing more harm than good?

Anticholinergic burden is a significant issue in older people, and we have tools that can help manage that. We have modules in AnalyseRx that support this type of work, and messages that trigger in OptimiseRx, should a chosen mediation have the potential to increase anticholinergic burden, and therefore risk of unwanted effects.

Guidelines and medicines also change, and clinicians have to assimilate that information. A solution such as AnalyseRx can look at a new guideline and identify the cohort of patients who do not meet it. That allows clinicians to focus their efforts where they are most needed.

That improves guideline adherence, but it also improves the health of the person sitting in front of you. Ultimately, that’s why we do our jobs.