How PDGs can help deliver the pharmacy “vision”
Pharmacy development groups (PDGs) can help deliver the Department of Health's vision for pharmacy, according to speakers at the Royal Pharmaceutical Society's fifth conference on pharmacy development groups, held on 20 November 2003.
The aim of the conference was to promote an understanding of the importance
of “A vision for pharmacy in the new NHS”, the DoH consultation
document, for patients, professionals and the National Health Service
and how pharmacists can collaborate in delivering “the vision”.
Expanding roles
“The Society welcomes ‘the vision’, with its emphasis
on expanding roles for pharmacists,” said Alison Ewing, Vice-President
of the Royal Pharmaceutical Society. “Implementing these roles
will place pharmacy at the centre of health care in the UK.” She
went on to add that the Society has ongoing concerns regarding some of
the detail
of the new roles.
First, she said, is the issue of resources. Such a ground-breaking vision
necessitates the provision of adequate staff, an appropriate environment
and funding.
Secondly, patient information needs to be shared. In the world of collaborative
working, patients and other health professionals must understand and
accept why there is a need to share information.
Thirdly, community pharmacy is still not fully integrated into the primary
health care team. Recent research from the Royal College of General Practitioners
has revealed that general practitioners still tend to view pharmacists
as shopkeepers. This highlights the need for pharmacists to communicate
better with GPs to inform them about their skills and knowledge and how
this can contribute to patient care.
Fourthly, the Society believes that primary care trusts (PCTs) should
have access to high quality pharmaceutical advice, not only at board
level, but also at the professional executive committee (PEC) level.
However, fewer than half of all PCTs have appointed a pharmacist to their
PEC. This is a pity, as those pharmacists who have been appointed to
PECs have made an enormous contribution.
In short, lack of pharmacist integration into the primary care team is
still a key issue. Connection of pharmacists to the NHSnet (announced
in July 2003 by Professor Sir John Pattison, director of research and
development at the DoH) will do much to enhance integration. However,
it seems that connection will happen only when concerns about security
and confidentiality have been ironed out. While there are legitimate
reasons for protecting sensitive patient data, this project must be pushed
forward with the utmost urgency. Without access to patient records, the
electronic transmission of prescriptions, repeat prescribing and medication
reviews will fall by the wayside, Ms Ewing said.
Heather Gray, chief pharmacist, South East Hertfordshire PCT, and project
director, medicines management, pharmacy and prescribing significant
issues groups, described the role of the National Primary and Care Trust
(NatPaCT) development programme and the way in which pharmacists and
PDGs can use the support it provides.
One example of this support is the NatPaCT
competency framework, which
is a self-assessment and support tool to help PCTs. The framework covers
issues such as organisational maturity, service provision, securing service
delivery, partnership, public health, community, patient and public involvement,
medicines management, pharmacy and prescribing and clinical quality.
The framework is
built around several competency domains, and each domain has a number
of competencies. For each competency there are competency
statements, and for each statement there are associated examples of evidence. “Significant issues groups” have
been formed to develop more advanced competencies.
Ms Gray recommended that PDGs should use the competency framework to
work collaboratively with pharmacy colleagues in the PCT and the PEC.
The aim is to identify areas of risk and good practice within the PCT
and nine domains can be used to identify gaps within the PCT agenda.
Opportunities for pharmacy to fill these gaps can then be discussed with
colleagues and a strategy and work programme for the PCT developed.
The competency framework gives no practical guidance, so it is important
to make use of tools and examples of good practice, which are available
from various organisations (eg, the National Pharmaceutical Association,
the Pharmaceutical Services Negotiating Committee, the National Prescribing
Centre and the Society). Relationship problems
Brian Curwain, chief pharmacist and head of primary care, New Forest
PCT, emphasised the importance for pharmacists of getting relationships
right — at both PCT and PEC level. PECs are not functioning well
in many places, mainly because of conflicts between management and
professional members. One difficulty is that professional members (eg,
pharmacists, dentists, opticians) may not be supported managerially.
Professional members must also learn to take on board the PCT agenda
and become PCT people. They should bring information as to what their
profession can contribute, but — a word of warning — they
should not just act in their own group’s interest.
Mike King, head of professional development, Pharmaceutical Services
Negotiating Committee, emphasised the importance of getting relationships
right. Clearly, the future for pharmacy rests on the new contract, but
this does not obviate the need for pharmacists in PCTs, PDGs, LPCs and
PECs to work collaboratively. There must be no in-fighting. All must
work together to promote pharmacy, develop pharmacy services, a pharmacy
strategy and a local delivery plan.
PDGs should not forget hospital pharmacists, Ms Ewing emphasised. So
many of the issues of current concern in the community — skill
mix, use of technicians, expansion of clinical roles, medicines management
and information technology — have been pioneered in secondary care.
Hospital pharmacists have much relevant experience to bring to pharmacy
development in the community. Medication issues around discharge are
of concern to all pharmacists, making collaborative working in this area
essential. Perhaps it is also time to stop thinking in terms of discharge
from hospital, but more as readmission to the community. Being in hospital
is the abnormal event in a person’s life and returning to the community
is the route back to normality. Public health role
Miriam Armstrong, chief executive of PharmacyHealthLink, reminded the
audience that “the vision” recognises pharmacists’ role
in public health. As people who spend a large proportion of their job
engaging with and providing health interventions to individuals, groups
and communities, all pharmacists can be described as public health
practitioners. Ten key generic public health practitioner competencies
have been identified by Skills for Health (www.skillsforhealth.org.uk)
in the national consultation commissioned by the four UK health departments
and the education regulatory authorities. Ranging from surveillance
and assessment of the population’s health and well-being and
promoting and protecting health to developing health programmes, reducing
inequalities, policy and strategy and quality and risk management,
these competencies describe skills and ways of working. Pharmacists
can use them as a framework for their public health activities.
In a presentation about continuing professional development, Fred Ayling,
CPD officer for the Society, said that pharmacists had several concerns
in relation to CPD, including time, what and how to document and the
type of evidence required. PDGs can encourage pharmacists in their CPD
by showing leadership, getting pharmacists to make a start on their CPD
records (perhaps on-line; see www.uptodate.org.uk),
creating an environment where CPD can be shared and providing help with
reflection.
Summing up the day, Anne Adams, the Society’s project manager for
PDGs, emphasised the importance of communication — talking to people
inside and outside the profession and to every pharmacist in the locality. “PDGs
are an important vehicle for delivering the vision. Local leadership
is vital: not everything can be done centrally.”
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