The Pharmaceutical Journal
Vol 272 No 7283 p88-89
24 January 2004

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Studying the workforce — why a new academy has just been established

By Peter Noyce

Agenda series

From this month, the school of pharmacy and pharmaceutical sciences at Manchester University has established a unique academic organisation — the Academy for the Study and Development of the Pharmacy Workforce, or “the workforce academy” for short. Its uniqueness stems not only from its focus of activity — the pharmacy workforce — but also its breadth of function. It will undertake research and development on the pharmacy workforce and its performance, and provide learning to maintain competence, and facilitate new NHS service developments.

The new academy is a timely institution nationally and its location in Manchester is natural, given the concentration and convergence of research and learning interests there. The catalyst for its creation was the new regulatory framework for health professionals in UK, and NHS human resources (HR) initiatives in England. These depend on evidence-based descriptions of knowledge and skills of health professionals, and quality-assured learning provision.

“HR in the NHS plan”, outlines four key principles, or “pillars” guiding NHS HR management. One of these is “model careers”, which addresses both learning and regulatory frameworks of health professionals. Related is the “NHS knowledge and skills framework”. This provides a basis for job reconfiguration and skill mix changes and introduces the notion of the “skills escalator”. These policies, alongside “Agenda for change”, are pivotal in determining the shape and nature of the pharmacy workforce in the future National Health Service.

The Royal Pharmaceutical Society has been active on two fronts in ensuring that it is keeping pace with the changing workforce environment of health professionals. A widely drawn Pharmacy Workforce Planning and Policy Group — chaired by the director of the Changing Workforce Programme at the NHS Modernisation Agency — will report later this year.

A range of workforce research activities were first considered at a pharmacy workforce summit at St John’s College, University of Cambridge, in February 2003, and this will be followed by a much larger workforce research conference being organised in May.

The academy will comprise four domains of activity: the well-established national Centre for Pharmacy Postgraduate Education (CPPE) and three related research and development centres. The aims are to:

• Inform and develop learning for the practising pharmacy workforce that is directed at building or maintaining competence to practise and integrated with undergraduate learning, together with that required for advanced practitioner (eg, diploma) or researcher (eg, PhD) status
• Contribute to a knowledge, attitudes and skills map for the pharmacy workforce to inform learning, career and governance frameworks
• Build on recent work on professional careers and autonomy, and earlier developmental and evaluation studies of pharmacy practice, to create an R&D centre for exploring HR and structural factors that enhance or impede innovation and implementation of good practice
• Consolidate the R&D lead that the group already has in pharmacy workforce and skill-mix, and the development of an international profile and research capacity
• Exploit the unique access, resources and networks of the academy to create an academic base for the study of learning in the pharmacy workforce and its relevance to performance

Pharmacy Workforce Studies

Within the workforce landscape, there is a need to describe and explain working levels and patterns, career pathways and mobility of pharmacists and support staff, and to determine how these vary with gender, age, life events and ethnicity. This evidence base is important in informing recruitment and retention strategies within pharmacy.

It is already known that working patterns among pharmacists are unusually flexible, with around half those working in community pharmacy citing their occupational status as “locum” and many GP practice-based pharmacists operating as portfolio workers. Whether this flexibility is due to stress, monotony, disillusionment or convenience is currently unknown, and so attempts at “job enrichment” or otherwise improving the “professional activity” of the pharmacist labour force, lack insight. Almost nothing is known about the two thirds of the pharmacy workforce who are not pharmacists.

The Centre for Pharmacy Workforce Studies will be led by Karen Hassell who holds a five-year NHS Primary Care Career Scientist Award to study the pharmacy workforce. Dr Hassell has been commissioned to make a special study of the locum pharmacy workforce, and has made a significant contribution to the Office of Fair Trading report on community pharmacy. On the basis of the 2002 census of pharmacists she has also published a series of six descriptive articles in The Pharmaceutical Journal during 2003 (see Panel above). She is the recipient of the 2003 Practice Research Award at the British Pharmaceutical Conference.

The launch of the academy has received a welcome boost this month with a £350,000 award to undertake a five-year cohort study of 2004 Great Britain pharmacy graduates, exploring early career and location choices.

Pharmacy Postgraduate Education

The Centre for Pharmacy Postgraduate Education is a Department of Health-funded national centre charged with providing continuing education and vocational training to all pharmacists providing NHS services in England. It has been located in Manchester for the 12 years since its inception. It has a staff of 20 based in the school of pharmacy and pharmaceutical sciences, a national network of 100 part-time tutors and a budget for 2003–04 of £4m. The school at Manchester is unusual in that it also has a long-standing NHS contract to provide learning support to preregistration trainees in the North West. Currently this relates to those employed in hospitals in three strategic health authorities, totalling over 70 trainees.

In 2002–03, the CPPE provided 20,800 workshop places (through 820 workshops) and 26,000 units of open learning material covering 66 products. Its output is directed towards providing learning that:

• Contributes to continuing professional development requirements for pharmacists (and in the future, pharmacy technicians), for continued right to practise
• Underpins NHS policy and service development, eg, supplementary prescribing, local pharmaceutical services

The workforce academy will incorporate the CPPE, which itself is also undergoing a process of modernisation to fit changing demands and expectations within pharmacy and the wider health professional landscape. Its future emphasis will be on “learning and development with a purpose”, rather than on its original continuing education brief.

The CPPE is diversifying on several fronts: its client base, its modes of delivery, and its organisational structure. Although in volume terms, the delivery of learning to individual pharmacists practising in the community will remain its primary client base, learning will also be provided from April 2004 for pharmacy technicians. The CPPE is also already developing programmes that will meet the needs of pharmacists working in other NHS sectors, eg hospitals and prisons.

Delivery formats are tailored flexibly to accommodate different learning needs and styles, with bespoke programmes designed to underpin new service developments, such as repeat dispensing. E-learning is particularly popular with younger pharmacists: this is important given the known barriers to uptake of existing learning materials in this group of pharmacists.¹ E-learning is the format adopted to deliver CPPE’s supplementary prescribing programme.

The IT capability of the CPPE is impressive. This has been driven by three main factors:

• The need to increase scope and capacity of access
• To support the learning and assessment capacity and quality of the CPPE
• To work closely and electronically with the new regulatory authority, the Royal Pharmaceutical Society

It has automated booking and processing systems, including marking, grading and documentation of learning. Each subscriber has access to their individual learning/CPD portfolio. Group interactive learning facilities are also being developed.

The CPPE has recently received commendable and encouraging reports as a developmental organisation under its “Investors in people” status, and for its robust and reliable processes from the University of Manchester learning quality assurance team.

Study of Learning and Performance

In many ways the Centre for Study of Learning and Performance is the keystone of the academy. The relationship between learning and performance is recognised as an under-researched area across the health professions. Most interest has been focused — and this is equally so in pharmacy — on undergraduate education. However the Royal Pharmaceutical Society was far-sighted in commissioning a group in 2002 to consider R&D priorities across all areas of learning of the pharmacy workforce. As professor of pharmacy practice at Manchester, I chaired the group, and the group’s report, “Making pharmacy education fit for the future”, was presented to the Society’s Council in December 2003; it is to be considered by UK heads of pharmacy schools in February. This new initiative is pivotal in supporting the CPPE’s new focus and base for the design and development of its learning portfolio.

Performance directed-learning in pharmacy has come sharply into focus for several reasons:

• The need to map the knowledge, attitudes and skills of the pharmacy workforce for regulatory purposes, and to understand the relationship between learning, development and performance
• The need to profile the skills of various levels of the pharmacy workforce to inform the skill mix agenda in community pharmacy
• The requirement to design learning to fit the pharmacy workforce — and that of other health professions — for new roles (eg, prescribing) and responsibilities (eg, reduction of medication errors) related to medicines use

So far little work has been undertaken on pharmacy technicians and dispensers in community pharmacy. Skill mix in community pharmacy — and related regulatory and quality management issues — is currently a high policy priority for the Department of Health in modernising the management of medicines in primary care. The “practice” group has already published a preliminary report scoping the key aspects of skill mix in community pharmacy and has been commissioned to undertake a comparative study of the responsibilities and training of “pharmacy assistants” in community pharmacy in Denmark, Holland and Sweden, and observational studies in two English primary care trusts.

Innovation in Practice

There is a long tradition of exploring and supporting innovation in pharmacy practice in Manchester. This was first demonstrated by the creation of the Pharmacy Practice Research Resource Centre (1991–96). Since then the group has undertaken a series of feasibility and evaluation studies of pharmaceutical services. The innovative transfer of the management of minor ailments from general practitioners to community pharmacists — first encapsulated in the “Care at the chemist” feasibility study and described in articles in both the BMJ² and The Pharmaceutical Journal³ in 2001 — has been widely adopted by primary care trusts in England and rolled out as the Direct Supply of Medicines Scheme by health boards in Scotland.

Work in the Centre for Innovation and Practice will also be important in shaping the learning delivered by the CPPE. At present the group is currently undertaking work on “new” prescribers, ie, nurses and pharmacists, alongside two projects involving innovation and culture change in community pharmacy:

• The national evaluation of local pharmaceutical services pilots that promote new models of skill mix and remuneration within community pharmacy
• Developing a safety culture in community pharmacy — exploring the identification and reporting of errors and “near misses”

The CPPE is nearing completion of an open learning package for incorporation into accredited programmes for pharmacists to become supplementary prescribers. This year it will develop a learning programme on risk management — in collaboration with the National Patient Safety Agency — to support the reporting and reduction of medication errors in community pharmacy.

References

1. Ward PR, Seston EM, Wilson P, Bagley L. Perceived barriers to participating in continuing education: the views of newly registered community pharmacists. International Journal of Pharmacy Practice 2000;8:217–24

2. Hassell K, Whittington Z, Cantrill J, Bates F, Rogers A, Noyce P. Managing demand: transfer of management of self-limiting conditions from general practice to community pharmacies. BMJ 2001;323;146–7

3. Whittington Z, Cantrill JA, Hassell K, Bates F, Noyce P Community pharmacy management of minor conditions— the “Care at the chemist” scheme. The Pharmaceutical Journal 2001;266:425–8

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