Role for pharmacists in the National Care Standards
Commission
The Care Standards Act 2000 is a landmark piece of
legislation with two main aims: improving the quality of care services
and protecting vulnerable people who use these services, according to
Trish Davies, project manager for national minimum standards of the National
Care Standards Commission (NCSC) implementation team. She explained that
the Act sets up a new body for health and social care that is to regulate
services and agencies in England against a set of national minimum standards.
(The commission is working closely with Wales to the same timetable, but
Scotland and Northern Ireland are working to their own agenda.)
In March this year the first set of national minimum
standards were published and set the standards for Care Homes for Older
People. Under these standards, from April 2002, establishments such as
independent hospitals and clinics will be regulated and inspected using
new regulations and national minimum standards. Hospices and homes providing
palliative care will also be included in this and in time these regulations
would be linked with the Misuse of Drugs Act 1971 covering the use of
Controlled Drugs in such settings. Agencies such as domiciliary care,
nursing and medical agencies will be regulated for the first time and
medication issues will be part of the new regulations for domiciliary
care agencies.
Health authorities have been working with the NCSC
to map local services and identify agencies that will come under the new
regulations. The NCSC would welcome any information in particular about
additional independent health care services that may be affected.
The NCSC intends to work closely with the Commission
for Health Improvement (CHI). In some areas there may be close collaboration,
eg, NHS-run nursing homes will not be under inspection by the NCSC but
may be visited by the CHI. NHS-run residential homes will, however, be
inspected by the NCSC as the service is not considered a function of the
NHS.
In developing the national minimum standards for
each service there will be an emphasis on the service being appropriate
for the needs of the individuals it is trying to serve. It should be clear
to users what that service can and cannot do, explained Ms Davies.
Looking at the standards for the care of older people,
for example, medication is referred to in four standards. In particular
there are clear expectations for accredited training of staff with respect
to handling of medicines. Ms Davies emphasised that the NCSC is concerned
about the management of medicines in homes with issues such as over-prescribing,
polypharmacy and staff training being key areas for pharmacists.
The NCSC will be a three-tiered structure with headquarters
in Newcastle where it is expected to employ one pharmacist within the
voluntary and independent hospital directorate. Eight regional offices
will report to headquarters with 71 area offices (seven to 11 in each
region) beneath them.
Sian Gordon Brown, project manager for staffing
in the NCSC, urged pharmacists to keep their current pharmacy inspection
roles going.
Pharmaceutical inspection is considered a specialist
role and it is hoped that all pharmacists currently employed full-time
by health authorities in this capacity will transfer to the NCSC from
July this year. Where less than 50 per cent of a pharmacist’s current
job is suitable to transfer to the NCSC, any move is for discussion with
individuals and their current employer. The NCSC is keen to retain existing
expertise and therefore various models of working are being considered
including sessional work, outsourced work, the use of freelance specialists
and service level agreements between the employer of the specialist, and
registration and inspection unit.
As a large number of staff will be employed through
each area office, the Commission is considering basing some staff at home.
It is expected that there will be office space for one pharmacist in each
area office with “hot desking” practised by the team of pharmacists undertaking
the work. Mrs Gordon Brown urged pharmacists to speak to local inspection
units for clarification and guidance about employment changes and opportunities,
or alternatively contact the commission directly.
Hazel Somerville, consultant pharmacist for registration
and inspection, described her work as a member of the NCSC working group
involved in its training project. The project has identified a medicines
“top ten” skills and topics that NCSC inspectors will need for basic competency
(see below). The top ten has been accepted by the NCSC and will be incorporated
into the national curriculum for the training of inspectors in development
by the Open University. Mrs Somerville emphasised that there is no room
for complacency among pharmacists that they can just carry on with the
job, but added that if pharmacists are ready then the opportunities are
awesome.
Medicines “top ten” competencies
- Legislation around medicines
- The care home medicine policy
- Definition of a medicine
- Self-administration
- Supply issues
- Storage requirements
- Administration of medicines
- Audit trail for medicines
- Standards of record keeping
- Potential sources of error
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Within the new regulatory framework it is envisaged
that there will be a national award in regulation for all staff involved
in inspection and registration. Chris Johns, of the regulatory and inspection
implementation team, went on to say that this would probably be a postgraduate
diploma. The Open University has been developing the curriculum which
should be available to go out to tender to providers to develop a syllabus
by the end of May.
The first course is expected to run in September
2002 and the awarding body will be the first one that is a multidisciplinary
mix of health and social care, CCETSW (Central Council Education and Training
for Social Workers).
In the meantime current staff are being encouraged
to build up a portfolio of evidence that could lead to a competency-based
assessment used in conjunction with any existing professional competencies
within the individual professional group.
From December 2001, staff in health and local authorities
are expected to undertake an induction/conversion training programme to
be eligible as an inspector for the NCSC in April 2002. Final guidance
will be available at local level advising what this means for individuals.
Mr Johns stressed that the NCSC needs pharmacist
inspectors and not only wants to retain current inspectors engaged in
the process, but wants to encourage pharmacists to work for the commission
where professional development and training will be fundamental to the
Commission’s strategy.
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