Pharmacy in a New Age had not addressed the specific needs of hospital pharmacists,
said Dr Norman Lannigan (director of pharmacy, Lothian NHS trust). A hospital
pharmacy strategy was needed to inform discussions with decision makers and
to provide a clear way forward for hospital pharmacists. It was necessary to
think about the forces that would influence the practice of pharmacy in hospitals
in the next five to 10 years.
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| Norman Lannigan: traditional functions might need to be given up |
Much more emphasis would be placed on prevention strategies rather than on treatment, said Dr Lannigan. The modernisation of the NHS would mean radically different ways of delivering services. Primary care would develop and hospitals would become large intensive care units. Clinical networks would be required to ensure that standards of care were the same wherever a patient was treated.
Developing roles
Hospital pharmacists needed also to take into account the developing roles of
other health care professionals. The NHS plan had set out clear roles for nurses,
who would be able to supply medicines. Medical staff would increasingly become
more specialised and this would change the way pharmacy was practised.
Measures of effectiveness, such as clinical governance and evidence based medicine,
would influence the strategy, as would new technologies. The introduction of
automation into pharmacy practice would mean that old dispensing processes would
disappear.
Patients, too, would influence the way hospital pharmacy was practised. Patients
were much better informed and had access to more information about their medicines.
They would demand information to enable them to make decisions about their medicines
and would need help to interpret this information.
The education and professional development of pharmacists had to reflect these
changes in practice. As medicines were becoming more high-tech, undergraduate
training would, through necessity, cover less therapeutics. This had to be built
into the future strategy for hospital pharmacy. Attention also had to be paid
to the development of the roles of pharmacy technicians in delivering pharmaceutical
care.
In response to Dr Lannigan’s proposals, Mr Ian Simpson (Guild of Healthcare
Pharmacists) said that the NHS plan had provided many opportunities for pharmacists
but that hospital pharmacists had not been mentioned. Work was needed to ensure
that hospital pharmacists were included in any future strategies. The general
feeling was that hospital pharmacy was well ahead of the game in terms of clinical
governance and audit. Mr Simpson questioned this.
Ms Suzanne Khalid (chief pharmaceutical officer, Leicester general hospital)
added that pharmacists should be playing a bigger role in medicines management.
Doctors had requested greater pharmacy input in helping to rationalise patient’s
drugs and hospitals were looking at expanded roles for other health professionals.
Sometimes hospital pharmacists had a narrow focus and missed opportunities to
take on medicines management that was not being covered by other health professionals.
There was also an opportunity for pharmacy support staff to pick up clinical
roles, such as technicians organising medicine supply, at ward level.
Medicines experts
Dr Richard Needle (chief pharmacist, Essex Rivers Healthcare NHS trust) responded
to Dr Lannigan by saying that hospital pharmacists had to be confident and competent
at the patient interface. It was important not to work in isolation. The hospital
pharmacist was still seen as somebody who flitted in and out of the ward and
who was not part of the clinical team. Pharmacists should be seen as the medicines
experts and issues about being available 24 hours per day, seven days per week
had to be addressed.
Influencing factors
Mr Keith farrar (chairman, Hospital Pharmacists Group and chairman of the session)
invited comments from the audience about the future strategy for hospital pharmacy.
Responding, an audience member said that the issue of adverse drug events needed
to be a clinical priority for the Government. Hospital pharmacists needed to
be fully responsible for pharmaceutical care and it was not good enough just
to continue with what they were doing at present.
Other issues, raised by audience members, that would influence the development
of a hospital pharmacy strategy included:
Dr Lannigan went on to describe his own “wish list” of strategic
objectives for hospital pharmacy over the next five to 10 years. He believed
that hospital pharmacists needed to concentrate on the core function of patient
care and to ensure that care was consistent throughout a patient’s “journey”.
Relationships with community pharmacists needed to be developed as in the future
patients would be going home from hospital when they were still quite ill.
The traditional functions of procurement and dispensing might need to be given
up and the roles of pharmacy technicians and support staff would need to be
developed.
A novel partnership with the pharmaceutical industry was needed as without it
how could the NHS afford the new biotechnologies that were available?
Hospital pharmacists were in a good position to ensure standards of care were
adhered to. The wide variation in standards could not be tolerated and it was
important that the high standards practised in some hospitals were adopted everywhere.
Formal postgraduate training of specialist pharmacists was also needed.
The management of drug therapy in chronic conditions was poorly handled because
of the pressure on medical staff to see new patients. Pharmacists were in a
position to be able to monitor patient therapy and amend it. Pharmacists were
very process focused but needed to be outcome focused and as independent professionals
should take responsibility for their case load.
Preventable drug related problems were a major cause of morbidity, mortality
and hospital admissions. Pharmacists should take the lead in grasping this problem
and redesign the way medicines were prescribed.
In terms of embracing new technologies, automation was needed to allow pharmacists
and technicians to be more patient focused. Pharmacists also had the skills
to deal with biotechnology and ensure that genetically manipulated products
were handled safely. “We must make a stand to grasp biotechnology or someone
else will and they will do it less well,” said Dr Lannigan.
In response to Dr Lannigan’s “wish list” an audience member said
that he disagreed with the proposal that hospital pharmacists should monitor
chronic diseases and said that this should be done in the community. The proposal
to relinquish responsibility for procurement was also met with disapproval from
some audience members.
Another member of the audience, Miss Alison Ewing (Royal Pharmaceutical Society
Council member) said she thought the proposals had not gone far enough and that
hospital pharmacists had the chance to ensure prescribing was right from the
start. The concept that doctors diagnose and pharmacists treat had got to come,
she said.
The paper that was discussed at this session is available from Ms Liz Griffiths, Secretary, Hospital Pharmacists Group, 1 Lambeth High Street, London SE1 7JN. The Hospital Pharmacists Group is seeking views on the paper and comments should be sent, by November 30, to Ms Griffiths.