The pharmacy odyssey — developing the staff and
the service
The plan for pharmacy in the National Health Service,
published last September, gave pharmacists the chance to fulfil their
professional aspirations. So said Dr JIM SMITH, chief pharmaceutical officer
in the Department of Health.
Delivering the keynote address at the weekend school,
Dr Smith added that the plan offered an opportunity to improve patient
care and the efficiency of the NHS.
Prescribing role
Dr Smith noted that about a quarter of the contents
of the Health and Social Care Bill now before the Parliament related to
pharmacy, including the provision for extending prescribing rights. He
said that although the bill itself would not confer prescribing rights
on anyone, it would lead to legislation giving Health Ministers powers
to designate new groups of prescribers. A new advisory committee, to be
established under the Medicines Act 1968, would advise Health Ministers
on extended prescribing rights. The committee would comprise pharmacists,
as well as doctors and nurses. Dr Smith asserted that when the Health
and Social Care Bill became law, pharmacist prescribing would be given
early consideration.
Medicines management
There had been some concern about the potential
for overlap between the Department of Health's medicines management framework
and the forthcoming study to be carried out by the Audit Commission. Dr
Smith gave the assurance that the Department was working closely with
the Audit Commission to ensure that the two pieces of work were as complementary
as possible. He said that implementation of the Department's framework
by an NHS trust between now and the autumn would stand such a trust in
good stead if it was selected by the Audit Commission for a local audit.
These audits were expected to start in November.
Service quality
Dr Smith acknowledged the effort that had been made
by hospital pharmacists to establish quality management over many years.
He said that as a result of this effort, the overall standard of prescribing
and administration of medicines was high. However, avoidable errors still
occurred: about 1.5 per cent of all hospital inpatients were exposed to
medication errors, of which about a quarter had the potential to be serious.
An area of service quality highlighted by Dr Smith
was unlicensed medicines and specials. There was a need to ensure that
unlicensed medicines used in the NHS were produced to a uniformly high
standard. A risk assessment review of NHS pharmacy manufacturing was soon
to be completed, after which, a document would be published. Dr Smith
said that this document would provide a framework for a long overdue,
co-ordinated national approach to NHS manufacturing.
Concordance
Dr Smith commented on the fact that health professionals
had not been successful in engaging patients as partners in decisions
about their medicines. The result was avoidable ill health and waste.
For example, up to half of patients with chronic diseases, such as hypertension,
did not take their medicines in the proper way. Dr Smith said that better
results could be obtained by getting patients to understand and agree
with their treatment plan. The benefits of concordance to the NHS included
faster and more efficient discharge, higher rates of compliance and a
reduction in waste.
Staffing issues
The Department was aware of the efforts being put
in by hospital pharmacy managers and their staff to maintain service delivery
amid the acute staffing crisis in hospital pharmacy. Dr Smith observed
that some of the solutions that had been devised for alleviating the crisis
had been creative. For the future, Dr Smith said that there was some hope
that the increased number of students in schools of pharmacy would point
to a medium-term rise in the number of pharmacists on the register, once
the profession managed to get past the “fallow year.” However,
new developments in the profession were likely to increase the demand
for pharmacists. Therefore, it was important to expend every effort in
attracting and retaining new pharmacists and pharmacy technicians. Pay
was obviously an important consideration and Dr Smith declared that work
on pay modernisation was presently under way.
Other efforts being made by the Department in promoting
recruitment included a competition in which schools were asked to design
a radio commercial promoting careers in the NHS. There was a specific
award for commercials promoting a scientific or technical career.
Conclusion
If pharmacists were successful in achieving the
targets set out in the pharmacy plan, concluded Dr Smith, it would mean:
- More demand for the services of pharmacists and
more and better trained staff to deliver those services
- Better appreciation by the public and by other
professionals and managers of what pharmacy could contribute
- New opportunities to deploy clinical skills,
matched by a new emphasis on quality and clinical governance
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