The Pharmaceutical Journal Vol 267 No 7157 p86
July 21, 2001

Comment

Academia must produce graduates able to practise effectively in a modern NHS

By Soraya Dhillon and Catherine Duggan

Although academic pharmacists may be seen as isolated from the real world, taking an “ivory tower” approach, they are able to view their profession strategically, seeing its place in the wider National Health Service.

The establishment of comprehensive postgraduate education and training programmes, liaison and work in practice and the creation of academic departments of pharmacy in practice, provide academics with insights into practice, ideas and opinions about future developments. Lecturers, clinicians and specialists witness the tensions that inhibit comprehensive pharmaceutical developments, when interacting with pharmacists from various sectors. Having been given the Government’s vision for the NHS and pharmacy,^1,2 we cannot continue to do more of the same and blame poor recruitment and staff shortages, reduced skill-mix and expertise for the shortcomings of the health service. We need to change the way we work, develop partnerships and assist in taking forward the organisation to develop a 21st century health service and pharmacy’s place within it.

The perspective of health care provision in the United Kingdom is of increasing expectations of service delivery and demands for high standards. Delivery of care is difficult to manage in an environment of cost containment, increased patient demand and tougher performance targets, such as reductions in waiting lists and the emergence of more acute hospitals and tertiary centre specialisation.

When the NHS was established in 1948, there was a culture of social responsibility for health, welfare and education for all, which has evolved to one of universal services based on clinical need, shaped around patients and responsive to different populations. However, there has been a downside: the NHS has been famous for poor budget control, irregular standards of care and long waiting times. Recent reforms seek to improve quality, to minimise risk, to reduce inequalities and, now, to foster and develop strong partnerships working across health, social care and local authorities.

Recent developments, such as primary care groups and trusts, have firmly established partnerships and multidisciplinary working. These may well be extended to bring together health and social care in health care trusts. Strategies have been developed to improve quality of care, to develop guidelines and standards for practice and to implement methods of monitoring these standards to ensure the delivery of open and responsive health services, to improve access and to deliver patient-focused care. The NHS is undergoing modernisation to develop a 21st century approach to professional practice.¹ Indeed, a modernisation group has been set up. There are five key issues underpinning the new NHS strategy: partnership, performance, professionals, patient care and prevention.

The mantra is “performance and delivery”. So where are pharmacists placed within the changing NHS culture? Are we being proactive, contributing to the debate, providing evidence of our expertise as medicines managers, highlighting areas where research evidence is scarce and requires investment? Or are we hiding from the debate, scared of change and waiting to react to the opportunities presented?

There is an active promotion of self-care with access to professional services, such as NHS Direct and NHS Direct On-line, and one-stop clinics that provide health advice and multidisciplinary approaches to diagnosis and treatment. There is an expansion in walk-in centres and delivery of intermediate care, pilot schemes evaluating new models of medical services and (soon) pharmacy services, clinics and diagnostics centres, telemedicine, dermatology, diabetes, cardiology, and community phlebotomy and anticoagulant clinics.

Last September, the Plan for Pharmacy was launched.² Pharmacy has been challenged with change on a scale never before prompted by a government. As with the national plan, the emphasis is on improved access to medicines, together with better systems of medicines management to minimise the risks of adverse effects from drugs. Services are to be reshaped to develop new models of working to ensure a competent and “high quality” professional workforce. We are being asked to develop clinical services without health care boundaries. We must face the challenges of new pharmaceuticals and biotechnology products, gene therapy and markers, together with major information technology developments within the profession and society. Professional changes include minimal invasive surgery, increased technology with robotics, eg, central supplies dispensaries and electronics in prescribing and the NHS patient record. All of these responsibilities are ours within the recommendations and guidelines from the National Institute for Clinical Excellence, using financial and economic profiling skills.

This culture of modernisation of the health services has implications for academia. Graduates must be equipped to meet the demands of this professional agenda. What is the place of the challenges of the NHS in pharmacy education? Do the current roles for pharmacists meet the emerging requirements of our profession, to develop health strategy and policy, to manage the entry of pharmaceuticals and technology in the NHS and to develop a research agenda driven by national priorities?

Within pharmacy education we must further develop an understanding of the professional role, recognition of the Code of Ethics, responsibility for medicines management, and appropriate interpersonal skills to work as part of the health team. We must enhance our critical appraisal skills and our analytical approach, and the ability to contribute to health debate and make decisions. Graduates need both depth and breadth of knowledge covering pathology, therapeutics, pharmaceutics and chemistry. We must also ensure the scientific basis of pharmacy is enhanced and is relevant to the sphere of professional practice.

We must ensure that graduates can deliver core skills, that they have a knowledge base to enable them to practise effectively, and that they can link undergraduate education to professional practice and specialise during postgraduate education. If we believe in a culture of continuing professional development, we must now ensure it is relevant and meets the requirements placed upon us as practitioners in a modern and developing NHS. Practice and academia must work together (as in academic departments of pharmacy) to develop strategies that ensure pharmacy graduates are at the forefront of medicines management at policy, practice and patient level.

References

1. Secretary of State for Health. The NHS plan — a plan for investment, a plan for reform. London: Stationery Office; 2000.

2. Department of Health. Pharmacy in the future — implementing the NHS plan: a programme for pharmacy in the National Health Service. London: Stationery Office; 2000.

Dr Dhillon is director of taught postgraduate studies in the centre for practice and policy at the School of Pharmacy, University of London. Dr Duggan is director of the academic department of pharmacy at Barts and the London NHS Trust