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New roles for all professions are developing rapidly in the NHS, in ways that were unthinkable only a few years ago. With this in mind, Deputy Chief Pharmaceutical Officer Bruce Warner asks, are we producing pharmacists and pharmacy technicians who are fit for purpose?
When I qualified there were four main areas that pharmacists went into following registration. The majority had a career in community pharmacy, some went into the hospital sector, and a few went into industry and academia.
Now there are well over 20 recognised careers within pharmacy as the NHS embraces multidisciplinary and multisector working.
Roles are changing, and that trend is unlikely to be reversed, and whereas some pharmacy professionals used to ‘dip their toe’ into areas like general practice or care homes, these are now becoming mainstream career paths in their own right. New settings in which pharmacy staff practice are emerging such as urgent and emergency care, including pharmacists joining the clinical assessment service in call centres for NHS111, dealing with referrals from call handlers.
With this comes the requirement for different skills. The old image of a white coated pharmacist somewhat concealed in the dispensary and only dealing with patients if he/she really had to is thankfully long gone. Now pharmacy staff are expected to spend the majority of their time speaking to, and sometimes examining, their patients, whether in hospital, GP practice, community or care home. The skill set is shifting from an emphasis on compounding to an emphasis on clinical skills and patient facing consultations.
More and more expectation is being placed on the profession to support medical colleagues to deliver clinical care. And so we have to ask ourselves if the skills and knowledge that we provide during training really equip pharmacy professionals to undertake these new roles safely and effectively? Are we preparing pharmacy professionals for a life of heightened responsibility and autonomy?
Of course the basics are there, but the honed skills of communicating with patients, examining them, understanding their needs and embracing shared decision making on medicines are not acquired overnight. Many of the tasks now being asked of pharmacy staff were traditionally done by doctors, and if we look at their training it is very different to that of pharmacy professionals. For them an undergraduate degree is only the start, and while pharmacists complete a post-registration year at Masters level, the medical undergraduate year is followed by a formally assessed and regulated foundation training lasting two years, before core and specialist training kicks in, with multiple exams. While pharmacy staff will never be medics, the edges are blurring and so it is time for us to acknowledge that the skills we currently acquire as undergraduates are no longer enough.
To this end the Pharmacy Integration Fund is being used to develop the training and preparation for new roles, with a number of programmes and pathways being established to equip pharmacy professionals for these roles and of course most importantly of all to help keep patients safe.
But how will we sustain this education provision in the long term? It is time to re-examine our training pathways from undergraduate level through to consultant pharmacist accreditation, and make sure that they are going to produce the pharmacy staff that we will need in 10 years time.
This was a theme picked up by Professor Peter Kopelman at this year’s Chief Pharmaceutical Officer’s conference in March, and we also saw this vision in the Health Education England Consultation: Facing the Facts, Shaping the Future on the NHS’ Workforce Strategy, to be published later this year.
Professor Kopelman also made the point that pharmacist post-registration education and training remains largely unstructured. Of course, some go on to do clinical diplomas and further degrees, but this is not the norm in our profession as a whole and even these training opportunities may not equip the profession with the full range of skills and knowledge required for extended roles. Professor Kopelman, working with the Royal Pharmaceutical Society, suggests a core postgraduate foundation training programme for all pharmacists, irrespective of sector of practice, followed by advanced specialist and generalist practice where applicable, backed by professional regulation and governance.
We must also consider pharmacy technician training, where similar arguments can be put forward with regards to changing roles and an aspiration to be taken seriously as clinicians in their own right as they also move to more clinical roles.
At the same time we need to consider clinical and professional leadership. All levels of the system require leadership – and it should be every pharmacy professional’s business. Examples need to be set, role models identified and the expectation of excellence is not something that we should shy away from. In this respect it is disappointing to see some of the leadership programme opportunities funded through the Pharmacy Integration Fund being undersubscribed last year.
It is a long road to a fully structured post-registration training and defined career pathways, but leadership development is a fundamental building block for all professionals and should be grasped at every opportunity in the same way the clinical training programmes are.
For details of the pharmacy integration education and training courses see the Health Education England website.