The Pharmaceutical Journal Vol 267 No 7158 p115-116
28 July 2001

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What does the future hold for health authority pharmaceutical advisers?

Pharmaceutical advisers working for English health authorities are anxiously waiting to hear what the change from 99 health authorities to 30 strategic health authorities means for their jobs. Although many are unwilling to be identified, Michael Thompson spoke to them about their future

Pharmaceutical advisers employed by the 99 health authorities in England and the eight regional offices of the National Health Service Executive have been on the edge of their seats this week waiting for a government announcement, which they expected last week, clarifying the impact on their posts of the latest, and now accelerated, reform, of the NHS.

Some are confident that they will have jobs to go to but others are fearful for their future. Whichever camp they fall into, none of them have any clear idea what their new roles will be. One thing is certain — there is no shortage of employment for pharmacists, but whether the opportunities are what pharmaceutical advisers want is quite another matter.

The first announcement of the coming change was made by the Secretary of State for Health, Alan Milburn, at an NHS managers’ conference on April 25. Then he said that the change from 99 health authorities to 30 strategic health authorities would take place by April 2004. Earlier this month he announced it was to be by April 2002.

The function of the new strategic health authorities will be performance management of the NHS. They will take over this role from the eight regional NHS Executive offices, which will disappear.

Each of the 30 such strategic health authorities is likely to have a staff of between 40 and 50 people, one of whom might reasonably be expected to be a pharmaceutical adviser. In addition, some of the current functions of NHS Executive regional offices will move to the government’s Offices of the Regions, where the public health function is expected to reside, and which draw together the work of many different government departments. Most pharmaceutical advisers, both at current health authorities and at the NHS Executive regional offices work within public health departments because what they do is seen as contributing to the good of populations. This means that there should also be jobs for pharmaceutical advisers at these government regional offices.

Many health authority pharmaceutical advisers, and former HA advisers, are already in posts where they can see their future. Some, still employed by HAs, have specific responsibilities to primary care groups and trusts and can probably expect to make the transfer as a result of the reforms; others, over the past year, have already moved from HA employment to PCT employment.

One regional pharmaceutical adviser said: “Obviously health authority pharmaceutical advisers are concerned that their posts will disappear. I expect that there will be plenty of posts available for them to take up. The question is whether they will be the sort of jobs that people will want to take on.”

Those who have chosen to remain at health authorities working on project management and service co-ordination, rather than the analysis of prescribing data with a view to improving prescribing efficiency will probably not want to do that sort of work for PCTs.

Advice role will continue

Jonathan Harris, pharmaceutical adviser at the Trent NHS Executive office commented: “My personal perception is pretty positive. The role that health authority pharmaceutical advisers currently undertake will, by and large, need to be undertaken in the new arrangements. There will be sufficient posts and more to spare.”

Another said: “The rule of thumb will be that wherever you can identify a need for pharmaceutical advice or prescribing management, you can cross out ‘health authority’ under the current arrangements and write in ‘PCT’.” He added that where there were now 99 health authorities, there would soon be 30 strategic health authorities and over 300 primary care trusts.

Mary Tompkins, head of medicines management, North Essex Health Authority, said: “Clearly the sort of skills that are in place in health authorities in the medicines area are in demand. There is a shortage.”

However, she, too, wonders whether the jobs that PCTs will be offering will offer the sort of work that advisers will be looking for. In this, she acknowledges that PCTs are young organisations and that there is little clarity around what the pharmaceutical advice role in PCTs will look like.

Another issue that is likely to arise as PCTs take on many of the roles of health authorities is that of critical mass. There is a strong perception that PCTs will be too small individually to take on many of these activities which will not be in the remit of the new strategic health authorities. This raises the possibility of impromptu arrangements being made between trusts in order achieve the necessary size effectively to manage such matters as pharmacy contracts and area prescribing policies.

“We will probably see PCTs club together on an agency basis,” was the view of one adviser.

Because the new strategic health authorities will take over responsibility for performance management from NHS Executive regional offices it is difficult to accept that their will be no need for pharmaceutical advice at the new level. It is, after all, accepted as necessary at the regional offices.

Reform is nothing new

Robert Lea, pharmaceutical adviser at the NHS Executive’s South East regional office takes the view that reform is nothing new in the NHS and is likely to go on. Pharmacists have survived previous reforms and there is no reason to expect them not to survive this one.

“Reform has been a preoccupation of every government and every political party,” he says. “This is only the latest reform. We’ve managed and responded to this sort of thing before. It’s nothing new, but it can be traumatic for those involved. Health services have to be provided and people will be needed to provide them. Primary care trusts will need substantial amounts of pharmaceutical advice.”

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Michael Thompson is on the staff of The Pharmaceutical Journal