The link between science and professionalism seems apparent. Developing professional practice upon the best available evidence is a basic rule of science, while evidence-based practice now underpins National Health Service philosophy. Best professional practice relies on the synergy between professional judgment and the best available evidence. Increasingly, there is a need to link science and professionalism further; recent changes in the NHS have highlighted the need to consolidate clinical governance within pharmacy education. Graduates need to leave university with skills to base professional judgment upon best available evidence, with a pragmatic approach and a sound ethical background and, as grant awarding bodies seek to fund research closely linked to professional and service development, academia is central to fulfilling such a cultural shift.
Clinical governance is the system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment that ensures excellence. The development of clinical governance is designed to "consolidate, codify and universalise often fragmented and far from clear policies and approaches; to create organisations in which the final accountability for clinical governance rests with the chief executive of the health organisation, with regular reports to the board, and daily responsibility rests with senior clinicians".1 Clinical governance is enabled through the Commission for Health Improvement, which aims to ensure the quality of health care delivered and address the issue of professional accountability. The National Institute for Clinical Excellence aims to promote clinical and cost effective care, produce research based guidelines and develop national service frameworks integrated through primary and secondary care. Health authorities, trusts and primary care groups have a statutory responsibility to deliver clinical governance.
These reforms ensure that clinical and medical practice will be enhanced, but what is the role of clinical governance in pharmacy and pharmacy practice? Pharmacy must adapt the conept of clinical governance into one of professional governance. Professional responsibility and accountability will form the cornerstones of professional development, grounded by the ability to put science into practice. The evolution of our profession depends upon our professional responsibility; "the failure of pharmacists to capitalise on their unique drug knowledge may threaten their professional status".2 We must base professional development upon evidence, put critical appraisal into action, address the wider issue of pharmaceutical care and set the standards for good practice. We must promote and empower pharmacy within the NHS.
So how can academia further link science and practice? Pharmacy is the health care profession that ensures safe and appropriate medicines management, but we need relevant, high-quality evidence to establish further pharmacy's place in the big picture of health care delivery. Academia can be central to the development of the profession, while the profession can inform the research agenda by highlighting areas where evidence is deficient. In this way, graduates will be able to link science and professionalism, to base professional practice upon best available evidence, and to feel part of the wider agenda.
Graduates need to be lifelong learners who can justify their approach to professional practice and develop professsionally, and who can inform the research agenda to develop the evidence base and continue to learn. Graduates need to be problem solvers who have the ability to relate knowledge to the problems faced, who know where to look for evidence and what to look for, and who will address the needs of health care professionals and patients appropriately.
Increasingly, graduates need to be team players; both the present and the previous governments have stated their commitment to ensuring that care is co-ordinated through increased multiprofessional working and partnerships. The previous Conservative government described its ideal NHS as one "where services in which individual needs are co-ordinated and integrated across the health and social care system, including primary care and social care. In a seamless service, organisational boundaries do not get in the way of care for patients, multiprofessional teams come together to provide high quality services for patients that make the best use of the specialist skills and experience of staff involved and all staff are trained to work in teams."3 More recently, the Labour government expressed a commitment to replace the internal market within the health service with "a system of integrated care, based on partnership and driven by performance".1 New Labour has initiated a local drive for quality, and wants to develop services for patients by increasing multiprofessional working. However, this does not mean that roles should be blurred: each health care profession has a unique role in the care patients receive. Pharmacists must promote themselves as the health care professional who can ensure safe and appropriate medicines management, otherwise the failure to capitalise on unique drug knowledge may threated professional status.2 We need to work more closely across the health care interfaces to deliver a robust support system to ensure effective medicines management.
Governance can be used to develop relevant standards of professional working and pharmaceutical care. The appropriate application of governance means that graduates are able to apply and use unique pharmaceutical sciences in the unique practice of pharmacy. Graduates are empowered with an education relevant to professional development; they are part of a developing profession within the evolving NHS - part of the big picture.
The authors are from the centre for pharmacy practice at the School of Pharmacy, University of London