The Pharmaceutical Journal
Vol 269 No 7218 p495
5 October 2002

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British Pharmaceutical Conference 2002 summary

Leadership and hospital pharmacists

As at other sessions at the Conference this year, the Audit Commission report, "A spoonful of sugar", if not sweetening proceedings, certainly influenced the two sessions for hospital pharmacists. In her opening remarks, ALISON EWING, clinical director of pharmacy at Royal Liverpool and Broad Green Hospitals NHS Trust, said that the session she was chairing on leadership and hospital pharmacists could not have come at a better time; since the publication of the report, pharmacists were now becoming clinical directors.

Dr PETER LEES, national programme director at the Government's new Leadership Centre, talked about what the centre could offer pharmacists. He began with a quote from Charles Handy's book 'The empty raincoat' — "To wait for leaders to guide us into the future is to be forever disillusioned."

According to Dr Lees, the remit of the centre is to deliver a step change in the calibre of National Health Service leadership and to promote leadership development. He sees himself as a commissioner with a role in supporting the modernisation agenda. He believes that the centre will have pulling power and be able to influence this by linking professional groups and also by linking primary and secondary care.

Dr Lees sees obstacles as challenges and knows that he has to change those trust boards who still care only about money in the short term and those staff who are still content with traditional ways of working.

"What is meant by leadership," asked Dr Lees. "I believe that it is having a vision for the future and working with and through others to achieve improved health services. We do not want bullies, who are often dishonest and hypocritical, taking the glory. The media are moving away from the heroic leader model and seeing people like England football manager Sven Goren Eriksson as ideal leaders who inspire but are modest."

Dr Lees believes that the qualities of leadership are shown by self-belief, integrity, guts and a drive for improvement. "Leaders set the direction: they have a vision, intellectual flexibility and political astuteness. By delivering improved services they are leading change, holding to account, empowering others and influencing strategy. We have a need for competent managers and a longing for great leaders. I don't want to get into a debate about the roles of each; however, managers are necessary but leaders are essential."

The Leadership Centre is to work with and through the strategic health authorities and other networks to identify and encourage leaders in the NHS at all levels, who can create a culture which will value NHS staff. "We must improve the working lives of health care professionals because at the moment they are treated in an appalling way," he said.

Clinical directorships

In a session entitled "Clinical directorships, consultant pharmacists and clinical competencies", DAVID WEBB, Northwick Park Hospital, London, asked if there would be a move from pharmacists as head of services with a management focus to clinical directors with strategic responsibilities.

"NHS modernisation is making a difference. Consultant posts are available for nurses, midwives and health visitors. But one group is missing: pharmacists. We have to meet the challenge." He said that "A spoonful of sugar" has suggested a clinical directorship role for chief pharmacists (Hospital Pharmacist July/August 2002, p182).

Dr GRAHAM DAVIES, University of Brighton, focused on competency issues. He said that there is now a drive for competency with external scrutinising of the performance of health care professionals. "The public now demands competent practitioners and the Government agenda says that they have to be fit for the purpose."

However, according to Dr Davies, there are barriers to competence-based practice, such as, a lack of clarity in exactly what it is that we want practitioners to do and no integrated training strategy. Programmes such as those provided by Centre for Postgraduate Pharmaceutical Education and the College of Pharmacy Practice are fine alone but the competencies that they provide are not aligned. "The challenge is to define expectation and design a competency-based approach to give the learner direction."

Dr Davies emphasised the need to be clear about differences between high-level practitioners and consultant pharmacists and to avoid ending up with more consultant pharmacists than we actually need.

He has developed a rating scale with which to evaluate people. The foundation level rated people as doing things well, the excellence level as doing things better and the mastery level as doing better things. However, the problem was who makes the evaluation and he suggested that there should be a national board to do so.

There was also the issue of maintaining consultant status and he reminded the audience that the General Medical Council reviewed consultants every five years.

Structured training

DUNCAN McROBBIE, Guy's and St Thomas' NHS Trust, went on to describe the pilot Structured Training and Education Programme (STEP) of evaluation in his presentation on competencies for practitioners in training.

It is his view that the pharmacy profession is vulnerable because it does not have clear descriptions of the ways to achieve the foundation level mentioned by Dr Davies. "You cannot expect novices to do the tasks they have been given because that puts the patients at risk."

The STEP scheme is a competency matrix that looks at the behaviour expected of pharmacists. A a quantitative evaluation of 27 basic grade pharmacists at eight trusts over a 12-week period compared those pharmacists taking part with four basic grade pharmacists at one trust who acted as controls. Managers were asked to set standards for such activities as drug provision, drug monitoring and drug history taking. This has not been done before, according to Mr McRobbie. After 12 weeks, there was an improvement in performance of the basic grades at the eight active sites, but no improvement at the control site. The scheme has grids for competencies in clinical practice, problem-solving and in personal areas such as punctuality. The key findings of the pilot are that a competency framework is valid, provides benefits to patients and improves the performance of junior pharmacists in a relatively short time.

Mr WEBB brought the session to a conclusion by suggesting that there had to be a structured career pathway for pharmacists with a national standard applicable throughout the United Kingdom.
— Contributed by Diane Langleben, editor, Hospital Pharmacist.