Wessex region

Workforce and skill mix challenges

Workforce and skill mix issues were the main topics considered at a conference in Southampton on March 18 organised by the Royal Pharmaceutical Society's Wessex region to examine current challenges facing pharmacy

When considering change in one's profession, the most important factor is often what those outside the profession think, according to contributors to the Wessex conference. If they wish to change the way in which pharmaceutical services are delivered, it is impossible to overestimate the importance of thorough consultation with all other stakeholders. For pharmacists, this would include patients, all other health professionals with whom they come into contact, National Health Service organisations and medical practice staff.

When changes are required, it is helpful to answer three questions: where are we now, where do we want to go and how do we get there? Dr ROBERT DEWDNEY (head of the Society's education division), speaking about pharmacy workforce planning, posed these questions and expressed uncertainty as to whether the profession had answers to these vital questions, or at least answers which enjoyed a strong consensus.

Skill mix issues

Speaking on skill mix issues in community pharmacy, JOHN D'ARCY (chief executive, National Pharmaceutical Association) made it clear that while pharmacy's supply role was important, its real value lay not in the supply itself but in the advice and information that went with it. It was clear from the pharmacy programme that the Government wanted to make better use of pharmacists to ensure patients got the best from their medicines through medicine management schemes. Proper remuneration for this role would be a significant issue as the programme appeared to suggest that a medicine management role should be financed at the expense of the dispensing fee. If pharmacists were to take up the wider challenges and extended roles offered in the NHS pharmacy programme, they had to make best use of supporting staff.

Pharmacy dispensary staff were a key resource. Properly trained dispensary staff would allow pharmacists to free themselves from the mechanical aspects of dispensing and allow them to spend more time interfacing with patients.

Dr PAUL RUTTER (senior lecturer in pharmacy practice, University of Portsmouth) reported on a research study indicating that community pharmacists currently spent 37 per cent of their time on routine “pulling, licking and sticking” in the dispensary and would like to do less. A pilot study had indicated that training counter staff to work in the dispensary resulted in an increased feeling of job satisfaction.

Practice research of that sort helped to answer some questions of the “where are we now?” type, suggested Dr Rutter.

Hospital pharmacy developments

Developments in hospital pharmacy were described to the conference by JEFF WATLING (pharmacy services management, Portsmouth Hospitals NHS Trust), NICK HUBBARD (chief pharmacist, Winchester and Eastleigh Healthcare NHS Trust) and PAT FRAY (pharmacy technician training manager, Portsmouth Hospitals NHS Trust). The conference heard that changes in hospital pharmacy were paving the way for change in community pharmacy. NHS institutions such as hospitals and primary care trusts had a clearly understood need for risk management and monitoring of service delivery. This culture needed urgently to spread to community pharmacy.

In Winchester Hospital, it had been demonstrated that fewer dispensing errors occurred when qualified checking technicians were used. Pharmacists making the final check were more likely to make mistakes! There was now proper training available for community pharmacy dispensary technicians.

The meeting's chairman, Dr BRIAN CURWAIN (pharmaceutical adviser, New Forest Primary Care Group) suggested that some extended roles now being asked of community pharmacists outside the pharmacy, such as domiciliary visits, could be undertaken by trained assistants. In hospitals, technicians were increasingly involved in medicines management on the wards.

Dropping the final check

A pharmacist's final check of each dispensed prescription item should not be a rigid requirement, conference participants agreed.

Asked to vote on whether proper staff training might allow pharmacists to give up the final check, 62 per cent voted in favour and 38 per cent against. One member pointed out that some of the voters were from hospital pharmacies that had already stopped final checking.

The matter of the final check had been raised in an address by Professor IAN JONES (professor of pharmacy practice, University of Portsmouth). He told the conference that no law required a pharmacist's final check and a professional requirement had been quietly removed from the Society's Code of Ethics some years ago.

Professor Jones said that the profession had to bear in mind the public's desire and the Government's direction for speedy, convenient access to medication. With properly trained staff who understood their own competencies and boundaries, changes in working practices could safely be achieved.

The CHAIRMAN suggested that, if pharmacists clung too tightly to their intimate control of all parts of the dispensing process, they would effectively become technicians presiding over ever more automated dispensing of prepacked medicines. With 80 per cent of prescribing being for repeat medication, pharmaceutical input to the process would increasingly have taken place before the regular monthly prescription arrived at the dispensary. Community pharmacy needed to act wisely if it wished to be the place from which such input was supplied.

GPs receptive to pharmacists' support

In a discussion at the end of the conference, there was a consensus that general medical practitioners had become more receptive to support from pharmacists. They were increasingly aware that this could protect them from therapeutic errors. They were also interested in non-clinical advice from pharmacists.

The meeting also agreed that the arrival of mandatory continuing professional development for pharmacists would need to take account of those who were semi-retired and those returning to practice.
— Contributed.

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