British Oncology Pharmacy Association
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The British Oncology Pharmacy Association held its annual symposium in Cardiff from 10 to 12 October. The symposium was attended by over 400 people. Dawn
Connelly (on the staff of The Journal) reports
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Cancer network pharmacists need to publicise their achievements
Mary Maclean: effective promotion of role essential |
Lead
pharmacists have now been appointed in about a quarter of managed clinical
networks (MCNs) for cancer across the United Kingdom, although
when the networks were first formed there was no recognition of the
need for pharmacy leadership, said Mary Maclean, regional cancer care
pharmacist,
West of Scotland Cancer Network.
MCNs are linked groups of health professionals and organisations from
primary, secondary and tertiary care, Ms Maclean explained. The aim
of the networks is to ensure equitable provision of high quality clinical
services. Forty MCNs for cancer have been established throughout the
UK and they are used to develop strategic plans, implement national
policies
and deliver improvements in the care of patients with cancer.
Following publication of the NHS Cancer Plan for England, in which
pharmacy only received a passing mention, the British Oncology Pharmacy
Association
(BOPA) prepared a response to highlight deficiencies in the provision
of oncology pharmacy services in acute care and to propose a way forward.
This was one of the drivers for the establishment of a cancer network
pharmacist role, said Ms Maclean, although she suspects the main driver
was managed entry of new drugs.
Ms Maclean carried out an informal survey of a group of pharmacists
who attended a network meeting this summer. She identified 11 formal
network
pharmacist posts and a further 11 pharmacists with an informal network
role.
She went on to describe the roles and responsibilities of the network
pharmacists surveyed. These include: co-ordinating development to ensure
delivery of high quality oncology services; monitoring and forecasting
for new drugs; standardisation of policies, peer review and audit;
and participation in tumour site-specific groups and MCNs.
In addition she identified various informal network roles. These include
chairing the pharmacy network, advising the lead clinican, and undertaking
drug and therapeutics committee and supporting work.
She then discussed barriers to the progress of the role, which include:
• Free access to expert advice from pharmacists on an ad hoc basis obviating
the need for a formal role
• Too few pharmacists with appropriate skills and experience
• Lack of funding
• Pharmacists’ tendency to underplay responsibilities and accountabilities
• Traditional organisational boundaries
• Lack of focus on services other than acute care services
We have made some progress in the recognition of the need for network
lead pharmacists, said Ms Maclean. However, effective communication and
promotion of the role is essential. She recommended that current post
holders publicise their achievements: “We need to be influencing
key players more effectively ... and we need to raise our profile with
the general public.”
The recently formed Network Pharmacists Group should help UK-wide communication
and collaboration. “We need to work towards formal recognition
of the role at a national and local level,” she said. However,
she warned that pharmacists need to keep patient-focused: “We are
trying to develop this role to improve outcomes for patients, not to
create career opportunities for the profession.”
She finished by presenting her vision of the skills needed to be an ideal
network lead pharmacist. These include:
• Being an innovative and strategic thinker
• Having excellent leadership and partnership skills
• Having a high level of organisational, interpersonal and communication
skills
• Being politically aware
• Being an expert cancer care practitioner
• Having a good research and publications track record
Consultant role must meet modernisation agenda
Should there be consultant grade pharmacists? Should there be controlled
entry to this consultant grade, and who should be the controlling agency?
These were the three questions that Robert McArtney, president, Guild
of Healthcare Pharmacists, and clinical pharmacy specialist for Wales,
Cardiff and the Vale NHS Trust, put to participants at the symposium.
The answers were, in general, “yes”, “yes” and “don’t
know”.
Currently there is no restricted title for consultant pharmacists,
said Mr McArtney. “I am uncomfortable with pharmacists calling themselves
consultants with no control. I think we will have to have the Royal Pharmaceutical
Society and the Pharmaceutical Society of Northern Ireland involved.”
Mr McArtney reminded participants that the Government’s vision
for pharmacy document talks about moving forward with the consultant
role in England. He said that the core functions for allied health professionals
to become consultants are:
• Expert clinical practice
• Professional leadership and consultancy
• Education, training and development
• Practice and service development, research and evaluation
“These functions are not dissimilar to those of an ideal network
pharmacist described by Ms Maclean,” he commented.
His view, and that of the guild, is that consultants should have proven
experience and competence, advanced specialist knowledge, leadership
and vision. They should be involved in educating and training others,
undertake research, development and audit, have a specialised and complex
case load, influence and contribute to practice in the UK and contribute
to the strategic agenda.
This list is not finalised, he emphasised. It is just a way of trying
to take things forward. “The key thing is that the term ‘consultant’ means
something to the public, ie, you know what you are doing, you are there
to protect them and to make sure they get better.” He added that
we need a clearly defined career progression to reach the role of consultant.
In conclusion, Mr McArtney pointed out that the role of consultant has
to meet the modernisation agenda or it will fail. We need to answer the
following key questions: Does the NHS need consultant pharmacists? How
many posts does it need? What value will these posts bring to patient
care?
Development of competency frameworks for
clinical and oncology pharmacists
Two competency frameworks for clinical pharmacists have been developed
by David Webb, director of clinical pharmacy, London and Eastern London,
Eastern and South East (LESE) specialist pharmacy services, and his colleagues.
Mr Webb told participants that the general level framework, aimed at
junior pharmacists, has been piloted on 104 pharmacists in London and
the South East. Analysis of data from the pilot study shows that there
were benefits to the clinical pharmacy service and that it “helped
managers to think about how their services were structured”.
Dr Graham Davies, associate director of clinical pharmacy, LESE specialist
pharmacy services, described the second framework, which is for advanced
and consultant level pharmacists.
The competencies for this framework are grouped under six “clusters”,
namely, expert professional practice, building working relationships,
leadership, management, education and research.
Advanced and consultant level practitioners are differentiated by identifying
three levels of skills: foundation (the majority are generalist practitioners);
excellence (the majority are advanced practitioners, ie, specialists);
and mastery (the majority are consultant practitioners).
These levels were established by sending the competency framework to
a number of high level practitioners in selected specialties and asking
them to map their own practice onto the framework, and to provide evidence
to support their self assessments.
Dr Davies said that a shadow pharmacy board was about to be established
in order to develop mechanisms for accreditation.
He challenged participants “to support the initiative, see the
merit in it and work with us to make sure it is further developed”.
Geoff Saunders: oncology framework is in draft stage |
Geoff Saunders, cancer network pharmacist, Greater Manchester and Cheshire
Cancer Network, talked specifically about competencies for oncology pharmacists.
Various oncology competencies have already been published and the best
aspects have been taken from each of these in order to develop a framework
we can use in practice, said Mr Saunders.
He explained that, like the clinical competencies, each competency statement
is defined at three levels: foundation (essential for any pharmacist
providing care to cancer patients, usually under the guidance of a more
experienced pharmacist); excellence (desirable for any pharmacist practising
in oncology without the lead of a more experienced pharmacist); and mastery
(where a pharmacist is acknowledged to be a specialist in oncology pharmacy
practice).
The framework is divided into behavioural and knowledge-based competencies.
The framework is currently in draft form and can be viewed on the British
Oncology Pharmacy Association website at www.bopa-web.org. Comments should
be sent to Geoff Saunders at geoff@nhs.net.
Mr Saunders advised that it would be useful to consider the following
questions when responding to the consultation:
• Does the framework fully identify all the competencies that oncology
pharmacists need to develop?
• Are the competencies unambiguous?
• Does the framework allow current and future training needs to be identified?
“It’s time to raise your profile”
The time has come to get recognition of the problems you face and to
get something done about them, advised Dr Ian Gibson MP and chairman,
All Party Parliamentary Group on Cancer. “If you do not talk
about what you are good at and what you want to happen you will not
get on the [political] agenda at all,” he said.
“It’s time to raise the stakes — you are not even in
the foothills of engaging the political process,” he told participants. “You
are professionals who have something to give to people suffering from
cancer in this country.”
The work programme for 2003 for the APPG on cancer includes campaigning
for a second cancer plan. “I think the first cancer plan has been
a disaster,” he said. He commented that some of the targets were
completely unrealistic with deadlines that could not be met.
“Your time has come.” he said. “Whether it ends up
as a second cancer plan I can’t promise. All I know is that there
will be lots of activity in the next two years.”
Tim Root, London specialist pharmacist clinical governance and technical
services, Chelsea and Westminster Hospital, asked which issues Dr Gibson
thought pharmacists should campaign on first.
“You have to decide yourself what you think will improve the service
you provide,” said Dr Gibson. He advised that pharmacists should
start in a small way, pick one issue, win the battle and then go on to
bigger
things.
BSA to estimate dose should be abandoned
The use of body surface area (BSA) to calculate dosing should be abandoned
for drugs for which it has been shown to be pointless, eg, cisplatin
and epirubicin, said Dr Max Summerhayes, medical adviser, Roche
Products.
“I find it extraordinary that we continue to do this,” he said, “It
is unscientific, cumbersome and potentially dangerous.”
He examined the evidence for the use of BSA to calculate chemotherapy
doses and found just one paper that reported that BSA could predict the
pharmacokinetics and pharmacodynamics of docetaxel. A lack of a relationship
between BSA and pharmacokinetics and pharmacodynamics was demonstrated
for cisplatin, epirubicin, topotecan and carboplatin. Dr Summerhayes
found no data for all other drugs.
He said that he was surprised that the European Agency for the Evaluation
of Medicinal Products and the Food and Drug Administration have not already
challenged this lack of evidence: “Why they accept this I really
don’t know.”
He concluded that manufacturers and regulators should ensure that BSA
is only used in the development process in the future when it enhances
the accuracy of dosing.
“This is something we can do something about. It would make everyone’s
life easier,” he added.
Predictive oncology
The development of new drugs using predictive techniques is likely
to be critical to successful cancer therapy, said Ian Cree, professor
of histopathology, Translational Oncology Research Centre, Portsmouth.
ATP-based tumour sensitivity assay is one predictive technique that
has already resulted in an improvement in progression free survival
in ovarian
cancer patients. The technique is currently being tested in patients
with carcinoma of unknown primary site, a condition that has a poor prognosis.
BOPA chairman steps down
Denise Blake stood down as chairman of BOPA, a post which she has
held for the past three years.
Tim Root, treasurer, BOPA, and London specialist pharmacist clinical
governance and technical services, Chelsea and Westminster Hospital,
was nominated as new chairman.
“Members need to play a bigger role in BOPA,” he told
participants. |
