The Pharmaceutical Journal Vol 267 No 7156 p57-58 July 14, 2001

Articles

“Teaching” primary care trusts — an important development for pharmacy in the future?

Everyone has heard of teaching hospitals. How might the concept of teaching primary care trusts benefit pharmacy in the future? Clive Jackson, director of the National Prescribing Centre, explains

Recent policy documents from the Department of Health, including the NHS plan for England and “Pharmacy in the future”, have set an exciting, and also slightly uncomfortable, modernisation challenge for both the National Health Service and pharmacy. The health care environment is changing both radically and rapidly and will continue to do so for the foreseeable future. In fact, I suspect that, in the months following the recent general election, the pace of reform will quicken in order to ensure that the public will see tangible and beneficial change in their health service within the lifetime of the next parliament. We have, at best, just over three years to embrace the culture of radical reform and maximise the opportunities currently on offer to all professional groups (not just pharmacists) who work for the NHS. So what should we be considering? Fortunately, significant activity is already under way, both within and beyond the main professional bodies and related organisations. For example, the Royal Pharmaceutical Society is engaged in a major programme of work to help ensure an effective professional response, not only to “Pharmacy in the future”, but also to other key changes that we now face. This programme includes: revamping the professional self-regulatory framework the development of an effective continuing professional development (CPD) framework the development of a robust, transparent and fair revalidation system for registered pharmacists the planning for adequate numbers of pharmacists (with the right types of skills) for future work requirements within and beyond the NHS reacting to the impact of extended devolution in the UK (not least regional devolution within England) A need for professional integration and corporateness Each of the above changes is, in itself, important. Put together with the NHS plan initiatives, they form a formidable package of positive professional reform, but with only a limited amount of time given for effective delivery. To succeed, the profession needs to develop a new integrated and corporate culture of change management, linked to robust forward planning to ensure that it gets the most out of these opportunities, while minimising the inevitable threats that will emerge in the coming months and years. If we are to survive and flourish, it is now an essential requirement that we think beyond pharmacy’s current boundaries. On closer inspection of the above changes, one of the recurrent and key emerging requirements for them to become reality is the need for pharmacists and pharmacy technicians to become (and ultimately to be widely accepted as) integral members of the multiprofessional culture delivering managed health and social care services. Learning from previous experience Within secondary care, pharmacists have increasingly been achieving some degree of multidisciplinary integration since the 1980s. However, even here, the successes remain patchy and integration often incomplete. The wider profession can learn much from the good (and not so good) practice that has evolved in hospitals around clinical pharmacy. For any group or body, times of rapid and radical external change are usually also the most appropriate for making significant change internally. It is always better to be part of (and influential in) any major development process, than to try to get “bolted on” to a system once it is fully formed. Pharmacy’s developmental history tends towards the latter approach, often by default, because of lack of sufficient advance strategic information and subsequent timely planning. As a profession, we now urgently need to assess where change is needed, what change is needed and how quickly we can make any agreed change. Reassuringly, a start has already been made in some areas but there are currently many initiatives where steps can (and should) be taken to help truly integrate pharmacy into the multidisciplinary service culture of the NHS. Outside the profession, the Department of Health is co-ordinating and supporting a range of key policy initiatives heralded by the NHS plan for England that could place pharmacy and pharmacists at the centre of health care development for the foreseeable future. These initiatives include: the medicines management services programme based at the National Prescribing Centre the medicines management pilot scheme being led by the Pharmaceutical Services Negotiating Committee the introduction of local pharmaceutical services pilots the “Patient Partnerships in Medicine Taking” (PPMT) programme the roll-out of repeat dispensing services the electronic transfer of prescriptions pilots the development of extended prescribing responsibilities for pharmacists Just another national initiative? Recently, an interesting national initiative has emerged to little fanfare, which, if developed advantageously, might bring important additional benefits for pharmacy. This article aims to bring this initiative, and its potential importance, into sight of the majority of the profession, to stimulate both discussion and possible co-ordinated action, where necessary. The initiative in question is the proposed development of “teaching” primary care trusts (TPCTs). We are all aware of the concept of teaching hospitals and how these organisations are used to develop skills and expertise in a range of professional staff, using a rotational system through specialisms. One could argue about just how successful individual teaching hospitals have been over the past decade, however, this teaching system has served the medical and nursing professions quite well, particularly in terms of more integrated and structured training and development and in fostering a multidisciplinary (albeit partial) culture of learning and specialist service delivery. It is probably also fair to say that this teaching system has favoured pharmacy less well — partly because it was not designed to do so at the outset and partly because of the profession’s natural reticence in stepping outside its own training procedures. So how might TPCTs help the profession as a whole and pharmacists and pharmacy technicians as individuals? First, we need to know what is currently being proposed. What will a TPCT aim to do? According to the latest information from the Department of Health, TPCTs will “provide teaching and clinical opportunities for primary and community care professionals in order to support and improve the delivery of services to the local population... “A TPCT will provide additional posts (GPs, nurses and other clinical posts) that are part-time, hands on and clinically based providing a service to patients, and part-time teaching or academic based. The TPCT will work alongside the local university [and NHS teaching trust — see Panel below] to provide a learning environment for their own organisation and the local health care system. The emphasis will be on providing additional patient care, the development of learning and the sharing of knowledge. “A TPCT will, therefore: provide an alternative and attractive ‘portfolio’ career option for GPs and other primary and community health care professionals increase the number of high quality GPs, nurses and other primary and community care staff, especially in areas which have traditionally found it difficult to recruit develop the skills of health and social care staff use enhanced skills to further develop the provision of primary and community care services provide a learning and resource centre for dissemination of good practice and learning across a local health care system”

What budding TPCTs may need to demonstrate Vision Direct provision of training and development to the TPCT’s own staff and to the wider health community it covers, such training to be additional to that already provided Linkage of activity to the delivery of wider NHS plan targets (could this also be geared towards “Pharmacy in the future” targets?) Ability to act as a resource centre for all PCTs (and remaining primary care groups) across the locality Impact Development of plans to increase the number of “clinicians” locally Creation of new training posts to facilitate a “portfolio” career option Development for all health care staff locally Provision of a teaching resource for “generic” university courses at all levels Development of opportunities to undertake targeted academic research Development of plans to disseminate the findings of relevant research and learning effectively Support Provision of evidence for true partnerships with local universities and NHS teaching trusts Delivery of support for and from relevant workforce confederations Capacity Identification of long-term funding options Availability (or creation) of relevant training facilities Provision of sufficient resources to act as an effective learning and resource centre

TPCT development plans The initial intention is to create 25 to 30 TPCTs by April 2003 — a figure remarkably similar to the proposed number of new strategic health authorities for England that will emerge as part of the NHS plan’s delivery over the next two years. The preferred type of TPCT development will initially consider the coverage of deprived areas (both inner-city and rural). There are already three sites in pilot form, in Bradford, Sunderland and Salford. It is expected that there may be a further six TPCTs by April 2002 and the balance by April 2003. Achievement of TPCT status will involve a detailed application process, and robust criteria to sift future bids are currently being developed by the Department of Health. The granting of TPCT status will ultimately be subject to ministerial approval. Approval criteria will require each TPCT to show both a realistic understanding of, and an ability to deliver in, specified areas (see Panel). TPCTs and pharmacy Having now seen the outlines of this initiative, it is not difficult to grasp how all elements of pharmacy could become active participants in TPCT development and delivery. As yet, however, I suspect that the main developmental thinking may understandably have been more around the involvement of the medical and nursing professions. Taking into account the firm policy commitments set out in “Pharmacy in the future”, plus the developments emerging from the new Health and Social Care Act 2001 around extended pharmacist prescribing responsibilities, the time must be right for the profession to consider how to get optimally involved with the new TPCTs. Pharmacy, therefore, needs to be proactive now, in the early developmental stages of TPCTs to ensure full participation with all its potential benefits. Community pharmacy, in particular, could gain considerably from effective inclusion in TPCT work. Pharmacy involvement, if timely and effective, could support benefits such as: better links with (and more practical input into) undergraduate pharmacy degree courses and formal pharmacy technician training programmes more targeted and effective pharmacy preregistration training across primary and community care developmental career opportunities for pharmacists and technicians around new and existing roles within strategic health authorities, PCTs and community pharmacy (eg, specialists in pharmaceutical public health, medicines management services, nursing and residential home services, community care services, technician-based supply services) improved manpower planning, especially for newer service requirements, plus more effective accession planning around key strategic posts for pharmacy within primary and community care more targeted and personally relevant approaches to CPD, with facilitation of the imminent requirement for regular assessment and revalidation to remain on the professional register development of improved services and skills across the interface between primary and secondary care better targeted postgraduate qualification courses with practice-based placements within the relevant health care environments a clear focus for the development of teacher/practitioner posts within primary and community care more informed academic research with clear portals to the health service for carrying out high quality health and social care research involving pharmaceutical care truly multidisciplinary professional development and training, encouraging an environment where pharmacy is ultimately perceived implicitly to be part of the team delivering managed health and social care Next steps? With pharmacy facing a huge and rapid requirement for change, it would not be surprising if relatively low-key launches of initiatives such as TPCTs slipped by unnoticed until they were well advanced in their development. However, the profession needs to learn the lessons of the past and be proactive in getting involved during the developmental stages of potentially significant policy initiatives. It would seem that TPCTs might be one such significant initiative. Time will tell. One thing is for sure, if the profession is not able to be proactive, timely and corporate in helping to shape the development of TPCTs then these organisations almost certainly will not deliver the full range of benefits to pharmacists and technicians they potentially could offer. TPCT development, if managed correctly, could help the formal integration of pharmacy into the multidisciplinary and managed service delivery culture within the evolving NHS — an objective that is crucial to the long-term survival and prosperity of the profession. Pharmacists who are interested in getting involved with some preliminary thinking around the possible benefits of TPCTs for pharmacy and how effective input (if required) could be developed, are invited to contact me by email (clive.jackson@liverpool-ha.nhs.uk).

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