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Consultants
Fluoridation
CPD
The Society
Modernisation
Workforce census
Letters to the Editor
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Consultants
Consistent approach to consultant roles
From Mr D. G. Webb, MRPharmS, and others
We welcome the contribution by Brian Hebron and colleagues (PJ, 30 August,
p261) to the debate on consultant roles for pharmacists. The authors
suggest that the title should apply to a cadre of exceptional individuals
and, in support of this, we have made the case previously for the staged
development of practitioners based on competency progression.1 Since
2002, we have been working with pharmacy managers, primary care trust
leads, regional pharmacy specialists and academic colleagues in London
and South East on a strategy that seeks to recognise three distinct tiers
of practice: general, advanced and consultant. A key element of this
strategy has been the design and validation of two competency frameworks
that can be applied at the general and advanced-to-consultant levels
respectively.
The General Level Framework2 has been subject to a 12-month controlled
evaluation among 104 junior grade pharmacists in 21 NHS trusts in London
and the South East. Interim and final analyses have shown benefits in
terms of the framework’s impact on clinical practice and our initial
findings were presented as a poster at the British Pharmaceutical Conference
in Harrogate.3 At last year’s event in Manchester, we delivered
a session on “clinical directorships, consultant pharmacists and
clinical competencies” and this prompted dialogue with the Guild
of Healthcare Pharmacists, the United Kingdom Clinical Pharmacy Association
and various specialist interest groups (including non-clinical pharmacy
specialties) that subsequently has facilitated work on the advanced and
consultant levels of the practitioner development strategy.
Based on a review of the literature and consensus panel discussions,
an advanced practice competency framework has now been produced. In addition
to the four functions described by Hebron and colleagues, this framework
recognises two further competency clusters. In total, these are: expert
professional practice; building working relationships; leadership; management;
education, training and development; and research and evaluation. To
date, we have invited selected clinical pharmacy specialists to assess
whether high-level practitioners can map their own practice on to the
domains of the framework and to indicate what evidence might be used
to support these self-assessments. This research will help to define
the criteria for differentiating between advanced and consultant practice.
During our discussions, however, it has become apparent that consultant
level practice may not be limited solely to the clinical pharmacy domain,
but could also apply to other pharmaceutical disciplines including, among
others, medicines information, technical services, primary care and community
practice. Indeed some groups have formulated their own competency frameworks
and these could provide the detail to underpin the expert professional
practice cluster as applied to each discipline. There is no doubt that
the publication of “A vision for pharmacy services” and “Agenda
for change” has given additional impetus to our work in this area.
At this stage, it is important that a consistent approach to developing
general, advanced and consultant practice is adopted across the profession.
We have informed both the Department of Health and the Royal Pharmaceutical
Society on progress, responded to the Society’s consultation on “Competencies
of the future pharmacy workforce” and are looking now to engage
more fully with community pharmacy. We would welcome collaboration with
individuals and organisations that have investigated, or are considering,
issues in higher-level practice. The strategy, however, will not be meaningful
if it becomes divorced from workforce planning and there is a clear need
to establish the numbers of practitioners required at each level, the
appropriate models of service delivery and the role of pharmacy support
staff in those models.
David Webb
Director of Clinical Pharmacy
Graham Davies
Associate Director of Clinical Pharmacy
Duncan McRobbie
Pharmacy CHD Adviser
London, Eastern and South East Specialist Pharmacy Services
Ian Bates
Head of Educational Development
School of Pharmacy, University of London
Sotiris Antoniou
Principal Pharmacist
Naomi Meadows
Clinical Pharmacist
Barts and The London NHS Trust
Julia Wright
Head of Clinical Pharmacy
Southampton University Hospitals NHS Trust
John Quinn
Chief Pharmacist
South Bucks NHS Trust
References
1. Davies JG, Webb DG, McRobbie D, Bates I. A competency-based approach
to fitness for practice. Pharm J 2002;268:104–6 (PDF
60K)
2. McRobbie D, Webb DG, Bates I, Wright J, Davies JG. Assessment of clinical
competence: designing a competence grid for junior pharmacists. Pharm
Educ 2001;1:67–76.
3. Webb DG, Davies JG, Bates IP, McRobbie D, Antoniou S, Wright J, Quinn
J. Competency framework improves the clinical practice of junior hospital
pharmacists: interim results of the south of England trial. Int J Pharm
Pract 2003;11(Suppl):R91 (PDF 45K)
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