Rotational Pharmacist Fixed Term

at Worcestershire Acute Hospitals NHS Trust Armed Forces Covenant Disability Confident Employer UK Skilled Worker Employer Defence Employer Recognition Gold
About the job
Organisation Links
Worcestershire Acute Hospitals NHS Trust

We are seeking an enthusiastic and clinically committed pharmacist to join our team on a 12 month fixed term basis to provide clinical pharmacist services to ward, dispensary and cancer services teams.

You will:

  • Gain experience across a range of specialist services through 4-month rotations.
  • Work as the medicines expert within multidisciplinary teams.
  • Support safe and timely patient discharge, including the Discharge Medicines Service.
  • Develop clinical decision-making skills through medicines optimisation, medicines information and on-call services.

Support and Development

We are committed to helping you achieve your career goals through:

  • Tailored rotational training and personalised learning objectives.
  • Dedicated clinical supervision, coaching and mentoring.
  • Regular development reviews.
  • Opportunities to lead audits, contribute to guideline development and support incident reviews.
  • Monthly education sessions and peer learning forums.
  • Protected time for professional development.

Main duties of the job

Provide Medication History Taking, Medicines Reconciliation, provision of Patient Information and Counselling and ward-based discharge to an allocated clinical ward or area according to the rotation utilising the trusts electronic prescribing and notes system

Deliver pharmaceutical care to patients; recommend, substantiate and communicate best therapeutic options for patients and implement changes in prescribing practice to ensure evidence-based medicine is followed as appropriate.

Undertake clinical audit of medicine use and pharmacy services within WAHT

Provide the clinical professional check on prescriptions dispensed within the dispensary, ensuring that the Trust high cost drug procedure and Trust Formulary is adhered to.

Provide day to day clinical supervision for pre-registration pharmacy graduates, technical pharmacy staff and students as assigned.

Provide clinical pharmacy teaching to pharmacy, medical and nursing staff

Provide weekend pharmacy services including on call on rotation.

About us

Worcestershire Acute Hospitals NHS Trust is a large

acute and specialised hospital trust that provides a range of local acute

services to the residents of Worcestershire and more specialised services to a

larger population in Herefordshire and beyond.

The Trust operates hospital-based services from

three sites in Kidderminster, Redditch and Worcester

Our workforce is more than 7,000 strong, and our

caring staff are recognised as providing good and outstanding patient-centred

care. You could be one of them.

We are committed to recruiting the best people to

work with us. Our values, which we ask all staff to demonstrate, underpin our

everyday work and remain firmly at the heart of all we do.

Being open and honest

Ensuring people feel cared for

Showing respect to everyone

We are committed to developing a culture of continuous improvement by embedding the principles of our Improvement System.

We are proud to have achieved Timewise

accreditation - this means we are committed to embedding flexible working

within our organisation as a flex positive employer.

DBS Checks and Costs

Any applicants who are offered posts requiring a

DBS check as part of their employment check will have the cost of this check

(at the current rate) deducted from their salary. Please see link in Supporting

Information section for more details on DBS checks and costs.

Details

Date posted

14 October 2026

Pay scheme

Agenda for change

Band

Band 6

Salary

£39,959 to £48,117 a year

Contract

Fixed term

Duration

12 months

Working pattern

Full-time,

Flexible working

Reference number

C9365-26-0821

Job locations

Charles Hastings Way

Worcester

Worcestershire

WR5 1DD

United Kingdom

The Alexandra Hospital

Woodrow Drive

REDDITCH

Worcestershire

B98 7UB

United Kingdom

Job responsibilities

Provide

clinical pharmacy services on rotation to the medical, surgical, urgent care

and paediatric wards on rotation under

the clinical supervision of Lead Specialist Pharmacists.

Provide

specialised pharmaceutical advice concerning the care of patients and undertake

pharmaceutical risk management for the Units where duties are being carried

out.

Ensure

compliance with medicines legislation, the Trust Medicines Policy, and

medicines related national and local guidelines within the Units where duties

are being carried out.

Be

accountable for his or her own professional actions guided by appropriate

technical and professional SOPs and associated policies, national directives,

standards, guidelines, senior pharmacist colleagues, and the post-holders own

specialised knowledge.

Plan

his or her duties and prioritise workload where duties are being carried out

according to the needs of patients, medical and nursing staff in order to

complete the following within the time available:

Analysing

patients individual pharmaceutical care needs

Identifying

and correcting prescribing errors/unclear prescriptions with medical staff.

Advising

prescribers on doses, side effects, alternative treatments

Communicate

complex pharmaceutical recommendations and advice concerning patients

treatment effectively to medical and nursing staff and other health care

professionals.

Interview

newly admitted patients to construct an accurate medication history, assess

compliance/concordance issues, and:

Review

information against the admission details and prescription chart.

Identify

to medical staff any potential or actual medicines-related hospital admissions

or associated issues and outline any required action to resolve identified

discrepancies.

Construct

pharmaceutical care plans for patients, assess and monitor clinical progress

and outcome with regard to their medication and actively intervene to ensure

that patients receive optimal care with minimal side effects.

Monitor

TPN on a daily basis against individual patients need and clinical condition.

Assess

patients discharge information requirements as early as possible in the

admission stay to be able to prepare information on medicines for them based on

individual need.

Assist

with the therapeutic blood monitoring of identified drugs within the

post-holders clinical area including:

Initial

patient assessment and initiation of appropriate loading or starting doses

Completion

of digital request cards for level assaying

Interpretation

of blood level results and subsequent adjustment of the patients dose of

medicine and amendment of the patients prescription in order to optimise the

beneficial results of therapy whilst minimising any potential toxicity.

Use

MS Word, Excel and Powerpoint to produce patient information, information for

medical and nursing staff, audits and project reports.

Provision

of Information and Counselling:

The

post holder will:

Advise

medical, nursing and technical pharmacy staff on the safe and appropriate

management of medicines together with the safe handling and disposal of

medicines including those which are noxious or harmful.

Advise

all health care professionals on storage, stability, compatibility and expiry

issues regarding medicines.

Assist

in the provision of medicines information to consultants, General

Practitioners, medical, nursing and pharmacy staff on all aspects of medicines

and therapy with medicines for individual patients and patient groups.

Counsel

and provide information about their medicines to patients with complex needs

such as a physical disability which may affect information requirements or language difficulties.

Provision

of Professional Dispensary Services:

The

post holder will be responsible for:

Providing

on a rotational basis the clinical pharmacist check on all prescriptions

dispensed by the Dispensary. This will require the scrutiny of prescriptions

from medical and other practitioners to ensure they are accurate, appropriate

for the patients needs, legal and cost-effective with respect to:

o

Appropriate

therapeutic selection of medicines

o

Appropriate

dose, frequency and quantity

o

Avoidance

of potentially harmful drug-drug interactions or side effects

o

Adherence

to the Trust Formulary, unlicensed medicines policy and high cost drug

procedures.

Questioning

and challenging the prescriptions of prescribers whenever the post holder

perceives it to be professionally appropriate and in the best interests of the

patient.

Ensuring

the accurate dispensing and documentation of clinical trial material as

requested.

Use

the Pharmacy Computer System to query the availability, location and cost of

medicines, and to dispense and supply medicines.

Use

the Electronic Discharge System for processing discharge prescriptions

Provision

of cancer services:

Provide

on a rotational basis the professional checking of chemotherapy prescriptions

for patients. This will require the scrutiny of prescriptions from oncologists

and haematologists to ensure they are

accurate,

appropriate for the patients needs and supplied within appropriate

commissioning frameworks with respect to:

Appropriate

therapeutic selection of medicines

Appropriate

dose, frequency and quantity

Avoidance

of potentially harmful drug-drug interactions or side effects

Adherence

to the Trust Formulary, unlicensed medicines policy and high cost drug

procedures.

Questioning

and challenging the prescriptions of prescribers whenever the post holder

perceives it to be professionally appropriate and in the best interests of the

patient.

Pre-check

and release chemotherapy in the aseptic units of the trust ensuring compliance

with GMP.

Use

the Electronic prescribing system as required to facilitate management of

chemotherapy patients.

Managerial

responsibilities:

The

post holder will:

Provide

day to day clinical supervision for pre-registration pharmacy graduates,

pharmacy technicians, assistant pharmacy technicians, and students within the

WRH dispensary and other pharmacy services.

Financial

Responsibilities:

The

post-holder will:

Help

to maintain the security of medicines and supplies within the Pharmacy

Department.

Undertake

regular statutory checks of Controlled Drugs on hospital wards.

Provide

advice and support to their allocated wards in relation to the Safe and Secure

Handling of medicines

Provision

of Education, Training and CPD:

The

post holder will be responsible for:

Agreeing

service and personal objectives with their line manager and being responsible

for self audit to demonstrate both achievement of objectives and evidence of

value to the Directorate or Trust.

Identify

personal training and development required to ensure the quality of the

service.

Agreeing

and completing a yearly training plan with the line manager in line with

PDR objectives

Other

Operational Responsibilities:

The

post holder will:

Assist

in the delivery of the pharmacy departments dispensing and other operational,

and clinical, services as required to meet the needs of the service:

Accurately,

with no margin for error, dispense and prepare medicines ensuring doses are correct

and accurately weighed, measured and or counted.

Enter

patient details on the Pharmacy Computer System from prescriptions of doctors

and other practitioners and produce medicine labels.

Check

medicines that other pharmacy staff have dispensed and prepared to ensure they have

been dispensed correctly.

Participate

in the Weekend service and additionally in the Bank Holiday rota.

Undertake

emergency duties of a pharmaceutical nature integral to fulfilling an Emergency

Duty Commitment, on a rota with other pharmacists at WAHT.

Job responsibilities

Provide

clinical pharmacy services on rotation to the medical, surgical, urgent care

and paediatric wards on rotation under

the clinical supervision of Lead Specialist Pharmacists.

Provide

specialised pharmaceutical advice concerning the care of patients and undertake

pharmaceutical risk management for the Units where duties are being carried

out.

Ensure

compliance with medicines legislation, the Trust Medicines Policy, and

medicines related national and local guidelines within the Units where duties

are being carried out.

Be

accountable for his or her own professional actions guided by appropriate

technical and professional SOPs and associated policies, national directives,

standards, guidelines, senior pharmacist colleagues, and the post-holders own

specialised knowledge.

Plan

his or her duties and prioritise workload where duties are being carried out

according to the needs of patients, medical and nursing staff in order to

complete the following within the time available:

Analysing

patients individual pharmaceutical care needs

Identifying

and correcting prescribing errors/unclear prescriptions with medical staff.

Advising

prescribers on doses, side effects, alternative treatments

Communicate

complex pharmaceutical recommendations and advice concerning patients

treatment effectively to medical and nursing staff and other health care

professionals.

Interview

newly admitted patients to construct an accurate medication history, assess

compliance/concordance issues, and:

Review

information against the admission details and prescription chart.

Identify

to medical staff any potential or actual medicines-related hospital admissions

or associated issues and outline any required action to resolve identified

discrepancies.

Construct

pharmaceutical care plans for patients, assess and monitor clinical progress

and outcome with regard to their medication and actively intervene to ensure

that patients receive optimal care with minimal side effects.

Monitor

TPN on a daily basis against individual patients need and clinical condition.

Assess

patients discharge information requirements as early as possible in the

admission stay to be able to prepare information on medicines for them based on

individual need.

Assist

with the therapeutic blood monitoring of identified drugs within the

post-holders clinical area including:

Initial

patient assessment and initiation of appropriate loading or starting doses

Completion

of digital request cards for level assaying

Interpretation

of blood level results and subsequent adjustment of the patients dose of

medicine and amendment of the patients prescription in order to optimise the

beneficial results of therapy whilst minimising any potential toxicity.

Use

MS Word, Excel and Powerpoint to produce patient information, information for

medical and nursing staff, audits and project reports.

Provision

of Information and Counselling:

The

post holder will:

Advise

medical, nursing and technical pharmacy staff on the safe and appropriate

management of medicines together with the safe handling and disposal of

medicines including those which are noxious or harmful.

Advise

all health care professionals on storage, stability, compatibility and expiry

issues regarding medicines.

Assist

in the provision of medicines information to consultants, General

Practitioners, medical, nursing and pharmacy staff on all aspects of medicines

and therapy with medicines for individual patients and patient groups.

Counsel

and provide information about their medicines to patients with complex needs

such as a physical disability which may affect information requirements or language difficulties.

Provision

of Professional Dispensary Services:

The

post holder will be responsible for:

Providing

on a rotational basis the clinical pharmacist check on all prescriptions

dispensed by the Dispensary. This will require the scrutiny of prescriptions

from medical and other practitioners to ensure they are accurate, appropriate

for the patients needs, legal and cost-effective with respect to:

o

Appropriate

therapeutic selection of medicines

o

Appropriate

dose, frequency and quantity

o

Avoidance

of potentially harmful drug-drug interactions or side effects

o

Adherence

to the Trust Formulary, unlicensed medicines policy and high cost drug

procedures.

Questioning

and challenging the prescriptions of prescribers whenever the post holder

perceives it to be professionally appropriate and in the best interests of the

patient.

Ensuring

the accurate dispensing and documentation of clinical trial material as

requested.

Use

the Pharmacy Computer System to query the availability, location and cost of

medicines, and to dispense and supply medicines.

Use

the Electronic Discharge System for processing discharge prescriptions

Provision

of cancer services:

Provide

on a rotational basis the professional checking of chemotherapy prescriptions

for patients. This will require the scrutiny of prescriptions from oncologists

and haematologists to ensure they are

accurate,

appropriate for the patients needs and supplied within appropriate

commissioning frameworks with respect to:

Appropriate

therapeutic selection of medicines

Appropriate

dose, frequency and quantity

Avoidance

of potentially harmful drug-drug interactions or side effects

Adherence

to the Trust Formulary, unlicensed medicines policy and high cost drug

procedures.

Questioning

and challenging the prescriptions of prescribers whenever the post holder

perceives it to be professionally appropriate and in the best interests of the

patient.

Pre-check

and release chemotherapy in the aseptic units of the trust ensuring compliance

with GMP.

Use

the Electronic prescribing system as required to facilitate management of

chemotherapy patients.

Managerial

responsibilities:

The

post holder will:

Provide

day to day clinical supervision for pre-registration pharmacy graduates,

pharmacy technicians, assistant pharmacy technicians, and students within the

WRH dispensary and other pharmacy services.

Financial

Responsibilities:

The

post-holder will:

Help

to maintain the security of medicines and supplies within the Pharmacy

Department.

Undertake

regular statutory checks of Controlled Drugs on hospital wards.

Provide

advice and support to their allocated wards in relation to the Safe and Secure

Handling of medicines

Provision

of Education, Training and CPD:

The

post holder will be responsible for:

Agreeing

service and personal objectives with their line manager and being responsible

for self audit to demonstrate both achievement of objectives and evidence of

value to the Directorate or Trust.

Identify

personal training and development required to ensure the quality of the

service.

Agreeing

and completing a yearly training plan with the line manager in line with

PDR objectives

Other

Operational Responsibilities:

The

post holder will:

Assist

in the delivery of the pharmacy departments dispensing and other operational,

and clinical, services as required to meet the needs of the service:

Accurately,

with no margin for error, dispense and prepare medicines ensuring doses are correct

and accurately weighed, measured and or counted.

Enter

patient details on the Pharmacy Computer System from prescriptions of doctors

and other practitioners and produce medicine labels.

Check

medicines that other pharmacy staff have dispensed and prepared to ensure they have

been dispensed correctly.

Participate

in the Weekend service and additionally in the Bank Holiday rota.

Undertake

emergency duties of a pharmaceutical nature integral to fulfilling an Emergency

Duty Commitment, on a rota with other pharmacists at WAHT.

Person Specification

Qualifications

Essential

  • Professional knowledge acquired through a vocational degree in pharmacy
  • Currently Registered as member of the GPhC
  • Currently meeting the GPhC standard for continuing professional development.

Experience

Essential

  • Current experience of successfully delivering NHS pharmacy services to a range of general and specialist areas

Desirable

  • Experience of delivering NHS pharmacy services in a secondary care environment

Personal Qualities

Essential

  • Can demonstrate commitment to delivering the best possible services to patients and the trust.
  • Able to meet deadlines and manage time effectively
  • Able to work well on own initiative and effectively within a team to deliver best possible care
  • Able to communicate information about medicines when there are barriers to understanding

Person Specification

Qualifications

Essential

  • Professional knowledge acquired through a vocational degree in pharmacy
  • Currently Registered as member of the GPhC
  • Currently meeting the GPhC standard for continuing professional development.

Experience

Essential

  • Current experience of successfully delivering NHS pharmacy services to a range of general and specialist areas

Desirable

  • Experience of delivering NHS pharmacy services in a secondary care environment

Personal Qualities

Essential

  • Can demonstrate commitment to delivering the best possible services to patients and the trust.
  • Able to meet deadlines and manage time effectively
  • Able to work well on own initiative and effectively within a team to deliver best possible care
  • Able to communicate information about medicines when there are barriers to understanding

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

UK Registration

Applicants must have current UK professional registration. For further information please see

NHS Careers website .

Additional information

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

UK Registration

Applicants must have current UK professional registration. For further information please see

NHS Careers website .

Employer details

Employer name

Worcestershire Acute Hospitals NHS Trust

Address

Charles Hastings Way

Worcester

Worcestershire

WR5 1DD

United Kingdom

Employer's website

https://www.worcsacute.nhs.uk/ (Opens in a new tab)

Employer details

Employer name

Worcestershire Acute Hospitals NHS Trust

Address

Charles Hastings Way

Worcester

Worcestershire

WR5 1DD

United Kingdom

Employer's website

https://www.worcsacute.nhs.uk/ (Opens in a new tab)

Job responsibilities

Provide

clinical pharmacy services on rotation to the medical, surgical, urgent care

and paediatric wards on rotation under

the clinical supervision of Lead Specialist Pharmacists.

Provide

specialised pharmaceutical advice concerning the care of patients and undertake

pharmaceutical risk management for the Units where duties are being carried

out.

Ensure

compliance with medicines legislation, the Trust Medicines Policy, and

medicines related national and local guidelines within the Units where duties

are being carried out.

Be

accountable for his or her own professional actions guided by appropriate

technical and professional SOPs and associated policies, national directives,

standards, guidelines, senior pharmacist colleagues, and the post-holders own

specialised knowledge.

Plan

his or her duties and prioritise workload where duties are being carried out

according to the needs of patients, medical and nursing staff in order to

complete the following within the time available:

Analysing

patients individual pharmaceutical care needs

Identifying

and correcting prescribing errors/unclear prescriptions with medical staff.

Advising

prescribers on doses, side effects, alternative treatments

Communicate

complex pharmaceutical recommendations and advice concerning patients

treatment effectively to medical and nursing staff and other health care

professionals.

Interview

newly admitted patients to construct an accurate medication history, assess

compliance/concordance issues, and:

Review

information against the admission details and prescription chart.

Identify

to medical staff any potential or actual medicines-related hospital admissions

or associated issues and outline any required action to resolve identified

discrepancies.

Construct

pharmaceutical care plans for patients, assess and monitor clinical progress

and outcome with regard to their medication and actively intervene to ensure

that patients receive optimal care with minimal side effects.

Monitor

TPN on a daily basis against individual patients need and clinical condition.

Assess

patients discharge information requirements as early as possible in the

admission stay to be able to prepare information on medicines for them based on

individual need.

Assist

with the therapeutic blood monitoring of identified drugs within the

post-holders clinical area including:

Initial

patient assessment and initiation of appropriate loading or starting doses

Completion

of digital request cards for level assaying

Interpretation

of blood level results and subsequent adjustment of the patients dose of

medicine and amendment of the patients prescription in order to optimise the

beneficial results of therapy whilst minimising any potential toxicity.

Use

MS Word, Excel and Powerpoint to produce patient information, information for

medical and nursing staff, audits and project reports.

Provision

of Information and Counselling:

The

post holder will:

Advise

medical, nursing and technical pharmacy staff on the safe and appropriate

management of medicines together with the safe handling and disposal of

medicines including those which are noxious or harmful.

Advise

all health care professionals on storage, stability, compatibility and expiry

issues regarding medicines.

Assist

in the provision of medicines information to consultants, General

Practitioners, medical, nursing and pharmacy staff on all aspects of medicines

and therapy with medicines for individual patients and patient groups.

Counsel

and provide information about their medicines to patients with complex needs

such as a physical disability which may affect information requirements or language difficulties.

Provision

of Professional Dispensary Services:

The

post holder will be responsible for:

Providing

on a rotational basis the clinical pharmacist check on all prescriptions

dispensed by the Dispensary. This will require the scrutiny of prescriptions

from medical and other practitioners to ensure they are accurate, appropriate

for the patients needs, legal and cost-effective with respect to:

o

Appropriate

therapeutic selection of medicines

o

Appropriate

dose, frequency and quantity

o

Avoidance

of potentially harmful drug-drug interactions or side effects

o

Adherence

to the Trust Formulary, unlicensed medicines policy and high cost drug

procedures.

Questioning

and challenging the prescriptions of prescribers whenever the post holder

perceives it to be professionally appropriate and in the best interests of the

patient.

Ensuring

the accurate dispensing and documentation of clinical trial material as

requested.

Use

the Pharmacy Computer System to query the availability, location and cost of

medicines, and to dispense and supply medicines.

Use

the Electronic Discharge System for processing discharge prescriptions

Provision

of cancer services:

Provide

on a rotational basis the professional checking of chemotherapy prescriptions

for patients. This will require the scrutiny of prescriptions from oncologists

and haematologists to ensure they are

accurate,

appropriate for the patients needs and supplied within appropriate

commissioning frameworks with respect to:

Appropriate

therapeutic selection of medicines

Appropriate

dose, frequency and quantity

Avoidance

of potentially harmful drug-drug interactions or side effects

Adherence

to the Trust Formulary, unlicensed medicines policy and high cost drug

procedures.

Questioning

and challenging the prescriptions of prescribers whenever the post holder

perceives it to be professionally appropriate and in the best interests of the

patient.

Pre-check

and release chemotherapy in the aseptic units of the trust ensuring compliance

with GMP.

Use

the Electronic prescribing system as required to facilitate management of

chemotherapy patients.

Managerial

responsibilities:

The

post holder will:

Provide

day to day clinical supervision for pre-registration pharmacy graduates,

pharmacy technicians, assistant pharmacy technicians, and students within the

WRH dispensary and other pharmacy services.

Financial

Responsibilities:

The

post-holder will:

Help

to maintain the security of medicines and supplies within the Pharmacy

Department.

Undertake

regular statutory checks of Controlled Drugs on hospital wards.

Provide

advice and support to their allocated wards in relation to the Safe and Secure

Handling of medicines

Provision

of Education, Training and CPD:

The

post holder will be responsible for:

Agreeing

service and personal objectives with their line manager and being responsible

for self audit to demonstrate both achievement of objectives and evidence of

value to the Directorate or Trust.

Identify

personal training and development required to ensure the quality of the

service.

Agreeing

and completing a yearly training plan with the line manager in line with

PDR objectives

Other

Operational Responsibilities:

The

post holder will:

Assist

in the delivery of the pharmacy departments dispensing and other operational,

and clinical, services as required to meet the needs of the service:

Accurately,

with no margin for error, dispense and prepare medicines ensuring doses are correct

and accurately weighed, measured and or counted.

Enter

patient details on the Pharmacy Computer System from prescriptions of doctors

and other practitioners and produce medicine labels.

Check

medicines that other pharmacy staff have dispensed and prepared to ensure they have

been dispensed correctly.

Participate

in the Weekend service and additionally in the Bank Holiday rota.

Undertake

emergency duties of a pharmaceutical nature integral to fulfilling an Emergency

Duty Commitment, on a rota with other pharmacists at WAHT.

Qualifications

Essential

  • Professional knowledge acquired through a vocational degree in pharmacy
  • Currently Registered as member of the GPhC
  • Currently meeting the GPhC standard for continuing professional development.

Experience

Essential

  • Current experience of successfully delivering NHS pharmacy services to a range of general and specialist areas

Desirable

  • Experience of delivering NHS pharmacy services in a secondary care environment

Personal Qualities

Essential

  • Can demonstrate commitment to delivering the best possible services to patients and the trust.
  • Able to meet deadlines and manage time effectively
  • Able to work well on own initiative and effectively within a team to deliver best possible care
  • Able to communicate information about medicines when there are barriers to understanding

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