As part of its Pharmacy in a New Age initiative, the Royal Pharmaceutical Society organised a meeting at its headquarters on November 15 to discuss pharmacy development groups. About 80 participants from a variety of backgrounds attended
Pharmacy development groups (PDGs) are a way for pharmacy to make a real difference over the next two years, Mr PETER CURPHEY (member of the Royal Pharmaceutical Society's Council) told the conference.
Currently at different stages of development, PDGs were groups of pharmacists established in England to develop the profession within a health authority or primary care group boundary. The aims of the conference were to stimulate further development of PDGs and to encourage the establishment of a national network that would maximise pharmacy's contribution to local health care and social care agendas.
The future of the National Health Service was about developing health improvement and assuring quality. As a consequence, there was a need for pharmacy services of the highest quality, and improving quality meant developing partnerships. PDGs represented a real pharmacy network, and had the potential to give pharmacy a concerted voice at local level.
Considering the challenges for pharmacy from the perspective of a primary care group, Dr RORY McCREA (chairman, Epping Forest PCG) began by describing PCGs as an "exercise in cultural anthropology". Isolated practitioners, uniprofessional mentality and unisectoral thinking were barriers to their progression. To work, PCGs needed effective leadership, vision and public involvement. Above all, they needed to be linked to patient care, with doctors being paid for things that mattered to patients.
As main players in primary care, pharmacists had a key role in PCGs. Although pharmacists had not initially been involved in PCG boards, this could change as PCGs moved to trust status simply because primary care trusts were constituted differently.
One strength of pharmacists was their accessibility to the public, and they could provide effective input into both financial and quality issues. However, effective service delivery had implications for education and training and to identify the best way of delivering a service demanded the development of a research agenda. Unfortunately, the way community pharmacists were paid made it difficult for them to get time off from work to become involved in research. Such barriers needed to be removed.
Mr JOHN STANLEY (secretary, North and South Essex local pharmaceutical committees) looked at issues related to pharmacy involvement in PCGs. What pharmacy could contribute to health care had already been made clear in the five main topics included in Pharmacy in a New age: managing common ailments; promoting healthy lifestyles; managing prescribed medicines; managing long term conditions; and providing advice and support for health care professionals.
In addition, the GP prescribing support document [GP prescribing support: a resource document and guide for the new NHS. National Prescribing Centre, NHS Executive, 1998] had promoted a role for pharmacy.
Barriers to pharmacist involvement were well recognised. They included lack of time, lack of confidence and isolation. Moreover, pharmacists had to be persuaded that PCGs were not always about politics, but about involving good practitioners. Local rivalry could be a barrier, as could the fact that pharmacists did not have the benefit of an organisation or a defined locality.
Solutions involved commitment, co-operation and communication: commitment of people with individual responsibility to work together to focus on target development; co-operation in terms of sharing information and workload; communication involving a mixture of methods (meetings, newsletters, personal visits, telephone, e-mail) and including all stakeholders, not just the core people. In addition, good support services (eg, office backup) were essential and there was a need to look at established research and apply it to local needs.
Involvement in PCGs would bring several benefits, not least increased professional satisfaction, development of a sustainable role and the ability to develop individual specialist interests. However, financial reward was vital, Mr Stanley concluded.
According to Mrs ANNE ADAMS (project manager, Building the Future, PIANA), PDGs had formed in different ways in response to local needs and interests and had different compositions and different objectives. However, all PDGs were concerned with the development of the profession and there were far more common elements than differences. PDGs fell into three categories: firstly, free-standing groups with no particular allegiance to any local pharmacy organisation; secondly, PDGs functioning as subcommittees of LPCs and thirdly, those which had evolved from, for example, health authority and LPC working groups.
Mrs Adams explained that the Society was planning how it could help PDGs. A focus group of English PDG members had been convened in June, 1999, following this up with meetings for Wales and Scotland. The focus group had identified nine common objectives for PDGs:
1. Convincing others of the value of the contribution of pharmacy
2. Influencing local strategic decisions
3. Identifying opportunities for local development
4. Developing new, sustainable models of practice
5. Disseminating details of successful initiatives
6. Meeting personal development needs of pharmacists
7. Attracting new resources for development work
8. Unifying the profession locally
9. Stimulating and mobilising the enthusiasm of pharmacists
Several obstacles to achieving these objectives had been identified. These included lack of financial support, which could undermine enthusiasm, and ineffective communication which meant that examples of successful innovation were not always well documented.
Eight discussion groups looked at the question of what needed to be done at a local level to improve pharmacy input into the current and future health and social care agenda. The issue of who should lead in the establishment of a pharmacy development group was considered, and enthusiasm was highlighted as key. Thus, whether a PDG was led, say, by an LPC secretary, a pharmaceutical adviser, or a PIANA co-ordinator was less important than making sure that the person was enthusiastic and had vision.
There was also a need for a shared pharmacy agenda in a locality, and this needed to be matched to the PCG agenda. Moreover, clinical governance, with its implications for setting standards, was important for all professional groups, and accreditation was highlighted as one way of managing this.
Additionally, PDGs needed terms of reference, and if applying for funding for pharmacy services, they needed to consider the issue of accountability and providing evidence that the service produced health gain.
Appropriate documentation was key to providing evidence, and communication with all stakeholders, including patients, was important to promoting the benefits of pharmacy involvement.
Priorities for the PDG agenda for the next 12 months to two years were also discussed. Issues identified included the need to: identify and target important topics on the health improvement programme; ask pharmacists what they considered feasible; establish credibility with stakeholders; enhance service quality in addition to service extension; integrate with the rest of the health care team; consider the educational and training needs of pharmacists; and develop a list of locums available for two-hour periods.
Drawing the meeting to a close, Mr PHILIP GREEN (the Society's Director of Professional Development) emphasised the need to look for opportunities rather than problems, to use the skills and personalities available to tackle local agendas (eg, health improvement programmes and primary care investment plans) and, above all, to communicate with each other. Establishing PDGs was now vital and progress had to be made without delay.
Hull and East Riding experience
One model for PDGs was described to the conference by Mr ANDREW HERSOM (secretary, Hull and East Riding PDG). The need for a specific group to develop pharmacy locally had been identified and this was followed by a SWOT analysis on community pharmacy in the area and later by a small audit and a survey of smoking cessation services. This had resulted in the preparation of bids for extra services. Achievements so far had included grants for a palliative care project, health promotion training for pharmacists and assistants, audit training and a millennium smoking cessation project. And in 1998, the PDG had won the shared care award in the Glaxo Wellcome/Pharmaceutical Journal Pharmaceutical Care awards.
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Manchester experience
Health action zones provided an important opportunity for the development of pharmacy services, according to Ms NICOLA GRAY (joint project manager, Pharmacy Partnerships, Manchester, Salford and Trafford). As credible organisations that had support from government and other health professionals, HAZs had access to legal advice, funding - albeit limited - and could provide publicity. In collaboration with Ms Karen O'Brien (joint project manager, Pharmacy Partnerships) and with funding from the LPC, the Society and Manchester HA, an organisation for pharmacy development had been formed in Manchester in July. Following the appointment of a steering group, ideas for pharmacy services had been generated.
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