In 1999, the Royal Pharmaceutical Society commissioned a survey among its members to identify the problems that pharmacists face in their working lives. Hundreds took part from across Britain, making the survey highly representative. Beverley Parkin, the Society's Director of Public Affairs, describes the method, highlights some of the key messages and considers how they will support the Society in its work towards pharmacy's future
In 1995, the Society embarked upon the Pharmacy in a New Age future planning work with a consultation about members' hopes and fears for their professional future. These views, along with the Council's own, were distilled into the Society's strategy for the future of the profession (Building the future, 1997).
In September of this year, the Government set out its own strategy for the future of pharmacy in England. The accord between the Society's vision and the Government's plan is extraordinary, demonstrating the accuracy of the Society's analysis and vindicating its decision to develop its role as advocate on behalf of the profession. Separate pharmacy plans are to follow for Wales and Scotland, where work on new pharmaceutical service developments already points to a more integrated role for pharmacists.
The Society is committed to helping the profession negotiate the challenge of the changes to come. Throughout the Pharmacy in a New Age programme, it has recognised that its work must be based on deep understanding of the real world in which members practise. Like all professions, pharmacy has vocal people who make their views known. In 1999, the Council embarked on a project to tap into the views of the normally silent majority of the profession. The objective was simple: to find out what problems they experienced in their everyday practice and to see how these affected the realisation of their aspirations identified in the Pharmacy in a New Age consultation.
Because a standard questionnaire-based survey would not provide the breadth or depth of response needed, work was commissioned using the Catalyst process, a research technique used extensively by major organisations and companies to produce a clear picture of issues of concern to their client groups. Directed by two teams consisting of both Council members and Society staff, the project began by extracting problem statements from pharmacists. This was achieved through more than 75 hours of facilitated discussion with practising hospital and community pharmacists, who gave their views on the root causes of hundreds of problems that they face in their working lives.
Several hundred randomly selected pharmacists were then asked to rank the problems using a card sorting technique (the CatMat). A response of over 90 per cent ensured that we secured our primary objective of including views from the full range of members. The responses were analysed to create ranked lists of problem statements for both hospital and community practice which could then be subdivided into different segments within each group. The process enabled us to identify problems that were shared between, for example, proprietor pharmacists and employee pharmacists and between clinical hospital pharmacists and their managers and where priorities differ.
Two important points emerged. First, most of the issues on which pharmacists expressed concern were professional matters that involve providing care to patients and supporting the work of colleagues. Secondly, the professional future foreseen in the Pharmacy in the New Age initiative and now signposted in the Government's plan for pharmacy appears to be well supported by most members. However, it is evident that real difficulties prevent pharmacists fulfilling these ambitions and making their fullest contribution to health care.
The Catalyst project was designed as a working tool for those taking forward the Society's Pharmacy in a New Age strategy. Catalyst has created a huge body of knowledge, which, when considered in the context of the Government's pharmacy strategy, will provide an accurate sounding of what the members regard as barriers to progress. This will allow the Society to address those difficulties faced by pharmacists over which it has direct control and to work to influence external decision-makers who hold the key to other solutions. Repeating the project with community and hospital pharmacists in five years' time would produce a measure of success for this element of the Society's work. In the future, it may be valuable to extend the project to elicit the views of the growing body of pharmacists who work within the new NHS structures and settings for the provision of pharmaceutical services.
The Catalyst project provides a rich seam of data whose value is to provide a useful reality-check for the Society's work. As it does not aim to arrive at an endpoint or conclusion, this information does not lend itself to the standard report format familiar from other research methods. However, it may be illuminating to draw on examples of problems that pharmacists in the hospital and community sectors ranked highly and consider how they may now be tackled through the Society's input into the development of the Government's pharmacy strategy.
Pharmacists said: "Developing new skills is vital but we need the time and resources to do so effectively. Where developments are being made it relies too much on individual efforts.
Pharmacists said: "We can provide an even better service for our colleagues (whether consultants, nurses, junior doctors or hospital management) as well as for patients, but we are constrained by factors such as staff shortages.
Pharmacists said: "We need to improve communications between ourselves so that we share knowledge more effectively.
Pharmacists said: "Pharmacy needs greater visibility in the NHS debate and hospital pharmacy issues need closer observation and representation.
Pharmacists said: "There appear to be imbalances between the remuneration of pharmacists working in hospitals and those in the community. In addition we are concerned about consistency of roles and grading across hospitals.
Pharmacists said: "The need to resolve staff shortages is well known and we need to know the action that is being taken and how will it affect the issues we have raised.
The way ahead The Government's pharmacy strategy acknowledges recruitment and retention of pharmacy staff as issues that must be tackled and sets out a programme of work for addressing them. The Society and other bodies representing hospital pharmacy will be closely involved in discussions and implementation of the work in these areas.
The pharmacy strategy sees the need to build on hospital pharmacy's good track record of making best use of appropriately trained support staff across all pharmacy sectors. As this work is taken forward by the new chief pharmaceutical officer for England, the Society will want to play its part. An NHS toolkit, "Improving working lives, is to be developed by April, 2001, and will outline best practice in using the skills of pharmacists and their support staff.
The Society and hospital pharmacy organisations have long been pressing the Government to address the issues of recruitment and retention of hospital pharmacists. Now, the Government's announcement of 500 more hospital pharmacy preregistration places is a welcome development, as is the announcement of plans to modernise pay structures and to reward clinical as well as managerial progression. The development of a range of incentives will include support for lifelong learning and opportunities to develop leadership skills.
The Society's workforce planning group has recently been given a wider remit to produce a clearer perspective over the issues of workforce within this and other sectors. The Government endorses the importance of this work and the Society will be opening discussions on how best to analyse and predict workforce supply across all sectors.
The NHS plan announced significant development in the core curriculum for all professions, including a new emphasis on common training in communications. Through its work in setting standards for undergraduate and preregistration training, the Society will ensure that pharmacy keeps pace with the other professions.
Pharmacists said: "There are some significant opportunities within information technology that we must capitalise upon.
The way ahead Developments in both computer and communication technologies offer significant opportunities for the profession. Of particular importance are the benefits of cheaper and faster communications and the ability to reliably share and process health data with confidence and with the protection of security systems to protect the patient's interests. Development of electronic data sources continues apace and this will facilitate pharmacists' access to high quality and up-to-date reference information underpinning their professional training.
The Society is already involved in the Government's programme to develop IT in primary care. To underpin the Government's stategy to develop medicines management throughout the NHS, the NHS Executive regions will be rolling out a performance management framework specifically for hospitals. The Society will be involved in this work, which will include the development and use of modern IT to foster better communications between hospitals, GPs and community pharmacists as well as the use of automative technology to free hospital pharmacists' time to focus on clinical care.
Pharmacists said: "There are opportunities such as the waste of drugs that pharmacists are uniquely placed to resolve. We need to be seen as the people to do so and empowered to develop the programmes.
The way ahead The Society has a long-held view that pharmacists are in a key position to help reduce the unacceptable waste of NHS medicines. Reducing waste is a specific aim of the plans within the pharmacy strategy to develop repeat dispensing through pharmacies by 2004. However, the causes of waste are deep-seated and manifold and any effective strategy to tackle them must work across the therapeutic partnership. The development of medicines management throughout the NHS will address many of the key factors that lead to medicines being prescribed and not used.
The Society's multidisciplinary work on concordance looks at why patients do not use their medicines properly or at all, which has a clear impact on the quantity of medicines that is wasted. Now, the Government has committed itself to integrating the concordance principle of partnership in medicines-taking into the NHS at all levels.
Pharmacists said: "There are simple things such as problems with leaflets in boxes and disassembling patient packs, which should not occur, but for which we should be finding solutions.
The way ahead The Society has been open about its concerns that the stalling of the patient pack initiative has created serious practical difficulties, making it harder to provide the best pharmaceutical service to patients. The Society will continue to work for rational, workable solutions to these problems.
By 2004, every primary care group or trust will have schemes that provide medicines management services to the community. The Society will be represented on the action team that is being established within the NHS Modernisation Agency to take this programme forward. The development and implementation of medicines management will need to be based on rational systems that offer a sensible, practical basis for professionals to provide optimal patient care.
Pharmacists said: "As proprietors we are naturally concerned at the current mechanisms for remuneration. We recognise the need to invest time and effort in providing new services and these mechanisms do not support us in doing so.
Pharmacists said: "As employees our remuneration concerns cannot be separated from the need to develop new skills and services, but we must not compromise our professional approach nor take on an exhausting workload.
The way ahead "Building the future "recognised that the current pharmacy remuneration arrangements do not foster the positive development of pharmacy services. While the Society's Council has no intention of seeking to involve itself in the negotiation of the community pharmacy contract, it does, however, recognise that alternative frameworks would better support the pharmacy service of the future.
The Government's strategy recognises that current funding arrangements are indeed a barrier to progress and therefore makes a commitment to modernise the way that NHS community pharmacy services are organised and funded. The community pharmacy contract and terms of service will be changed to promote and reward high quality services rather than solely prescription volume. A legal framework will be put in place to allow health authorities to pilot new ways of contracting for pharmacy services that are tailored to meet local needs with individual pharmacists as well as pharmacy owners. Pharmacies are to be given incentives and rewards for providing the best range and quality of services. The Society will continue to play its role in ensuring that the public benefits from a high standard of services provided by pharmacists within the new arrangements.
Pharmacists said: "We need to develop a single coherent voice for pharmacy to ensure we make an effective contribution to the debate within the health service.
The way ahead A good deal of public and political awareness activity is undertaken collaboratively between organisations within pharmacy. It is clearly desirable for pharmacists' organisations to speak as one where possible and appropriate. However, there will be inevitably and quite properly different viewpoints within pharmacy based on different perspectives about key issues. Where viewpoints vary, it is important to identify, understand and respect the reasons for differences of approach.
The Pharmacy in a New Age consultation sent the Council a clear and consistent message: that what the members want is a coherent voice for pharmacy to create a better advocate for the profession. The Council took a decision to reorganise its workload and the structure of the staffing of the Society in order to be able to focus on the issues that matter and to communicate its policies more effectively. The establishment of a policy support function has created a horizon-scanning capacity to inform the Council's thinking and decision-making on policy matters. Membership and communications activities have been drawn together into a new public affairs directorate to enable a more focused use of resources and to create new infrastructure for external networking.
As a result, there has been a much more focused approach to ensuring that ministers, civil servants and other key people in the decision-making chain are regularly made aware of the Society's views and the profession's issues. In England, Scotland and Wales, the Society now pursues proactive political contact programmes to help progress awareness of pharmacy in those countries. The Society is working more closely than ever before with the other pharmacy bodies to promote external awareness of pharmacy taking the pharmacy message to politicians, the public and other health organisations and audiences. At Westminster, along with other organisations representing pharmacy, the Society has helped established the All Party Pharmacy Group in Parliament. Under the chairmanship of Dr Howard Stoate, MP, the group has successfully raised the profile of a number of pharmacy issues with parliamentarians in both houses. It is to be hoped that this joint approach can develop into further areas of communication and networking activity.
The Catalyst project has provided the Society with a wealth of knowledge about its members' practical, day-to-day concerns. This information is already being used in the planning and preparation work that has underpinned the evolution of Pharmacy in a New Age. Publication of the Government's strategy for pharmacy marks the end of the first chapter in what will be a challenging and exciting process of change.
The information generated by the Catalyst project will continue to be used as a touchstone for the Council and staff as the Society embarks upon the implementation phase of the pharmacy strategy. We thank those pharmacists who participated in the project and hope that there will be a measure of satisfaction that many of the problems identified are now being addressed.