Evolution of the pharmaceutical prescribing adviser role over the next few years should result in a new breed of fully integrated professionals in the health care team and a new type of career structure for pharmacists wanting to use their skills in the primary care environment, according to Mr CLIVE JACKSON (director, National Prescribing Centre), who considered the potential roles for primary care group, practice and health authority prescribing advisers.
Mr Jackson warned that pharmacists needed to prepare for new roles now by developing the wider range of skills they required. Merely continuing to increase the numbers of today's pharmaceutical advisers was neither appropriate nor feasible in the near future. Pharmaceutical input needed to evolve in line with wider changes in health care. "Pharmacy should not just be looking to pick up opportunities offered to it, but rather should try to influence, or even create, a future development path for itself."
Mr Jackson said that, from small beginnings in the early 1990s, the prescribing adviser specialism had expanded and evolved, so that there were now about 550 prescribing advisers working at the general practice or PCG level and a further 200 or so working with health authorities.
During the next few years, further evolution of the pharmaceutical prescribing adviser role could occur at four levels: - the health authority, the practice, the PCG and the PCT. Health authority advisers, of whom by 2004 there might only be around 40-50 instead of the current 200, would then have a role broadly equivalent to the regional health authority pharmaceutical advisers of the early 1990s and be involved mainly in strategic planning and performance management.
At the practice level, pharmacists' work would essentially be "hands on", delivering change and elements of patient care (ie, medicines management or pharmaceutical care) locally. By 2004, there could be more than 600 of these individuals, working mainly on a part-time or sessional basis in practices. Comparisons might be drawn to the development of ward/clinical pharmacists in hospital.
PCG prescribing advisers, of whom there were already over 400, would reduce in numbers to around 100 within five years as PCTs emerged and evolved. With a semi-strategic and semi-hands-on role, they would usually work full time and have to become "jack of most pharmaceutical trades".
At the fourth level, the PCT, pharmacists could have a highly influential role. Each PCT should aim to have a senior pharmacist (perhaps a director of pharmaceutical care management) who would be responsible for both pharmaceutical care strategy and the management of service commissioning and delivery. These individuals might be compared to "genetically modified" district pharmaceutical officers from the 1980s. By 2004, there could be up to 100 in post, with the potential for this number to increase eventually to over 280.
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Clive Jackson: pharmacists need to develop a wider range of skills to prepare for new roles
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