| Preregistration training is becoming increasingly diverse. More preregistration
trainees than ever are spending time in two sectors, gaining a broader
experience
before they qualify.
From 2005/06, it will be mandatory for all preregistration trainees to
have some experience in both hospital and community pharmacy (subject
to Council’s final decision). The minimum is two weeks’ experience
but some preregistration trainees will spend longer in the other sector.
Cross-sector placements are not new: local arrangements for such placements
have
existed for many years. The problem was that the opportunity was not
open to everyone. Making the concept mandatory will address this issue.
Ian Manovel, preregistration training
manager for London, Hertfordshire and Essex Pharmacy Education and Training
(which covers all NHS organisations in the region), is pleased that the
Society plans to make cross-sector training mandatory. “It provides
preregistration trainees with an insight into other areas of the profession,” he
comments.
When the idea of a compulsory cross-sector placement was first mooted,
it was proposed that the preregistration trainee would spend six weeks
in the
second sector. Although the minimum requirement has been shortened to
two weeks, a longer experience is not precluded. At the moment longer
placements seem unlikely since
finding all preregistration trainees a two-week experience has been challenging.
Organising the exchanges is a massive
undertaking. To assist with this, the Society has appointed three facilitators
within the past 18 months. They are Sian Hunger for Wales, south west
England and the Midlands, Sarah Purdy for south east England and the
south coast and Liz Horncastle for the north of England. A facilitator
for Scotland has yet to be appointed. “We collate information about
community preregistration places, liaise with the NHS preregistration
training managers about the hospital places and then try to assist in
placing all the trainees,” explains Mrs Hunger.
Of the preregistration trainees taking their examination this week, 90
per cent of UK graduates have had a cross-sector experience. “We
are aiming for 100 per cent for next year’s cohort before it becomes
compulsory the following year,” says Mrs Hunger.
“Most of the trainees have enjoyed seeing a different side of pharmacy.
Even for those who have decided which sector they want to work in, two
weeks out is valuable. It helps with joining up working between primary
and secondary care through greater understanding,” says Ms Horncastle.
A few trainees have even decided to change their career path as a result
of their cross-sector placement.
In Scotland, it is hoped that four weeks of cross-sector experience will
eventually
become the norm. Rose Marie Parr, director of pharmacy at NHS Education
for Scotland, comments: “We have got considerable evidence from
pilots of cross-sector placements that show that four weeks’ cross-sector
experience is optimal for both the service and the student.”
The biggest problem in organising cross-sector placements is that the
number of preregistration places in hospital pharmacy is far smaller
than the number of community pharmacy preregistration trainees. “There
are simply more community trainees than hospital places,” says
Mrs Hunger. “In some parts of the UK the ratio is three community
trainees per one hospital trainee and in some cities this ratio reaches
seven to one.” This mismatch is certainly a problem in Scotland. “It
means that so far, we are managing to arrange cross-sector experience
for between 60 and 70 per cent of preregistration trainees but not all,” says
Ms Parr.
How can this be overcome? “Some hospitals have been taking extra
trainees compared with the number they send out for community experience.
This sort of goodwill has been fantastic,” says Mrs Hunger. Other
preregistration trainees are travelling to different areas of the country
where the demand on hospital places is less. Another possibility is the
involvement of private hospitals, such as BUPA (see Panel).
Case study: Cross-sector training in BUPA hospitals
BUPA hospitals started to offer two-week cross-sector placements
this year. Altogether, 17 preregistration trainees were placed in
nine BUPA hospitals. The number will be increased next year to 20
places in 11 hospitals.
Elizabeth Read, superintendent pharmacist at BUPA hospitals, explains
that there is a shortage of cross-sector placements in NHS hospitals
and this was something that BUPA could help to address. “It
is also a way to raise awareness about the independent hospital sector,
a relatively unknown area to many pharmacists.”
Working with the preregistration training facilitators at the Society,
Ms Read developed an in-house training programme for the cross-sector
placements. “It is an integrated ‘whole-hospital’ experience.
The focus is on medicines and clinical ward rounds but it offers
more than hospital pharmacy itself. For example, the preregistration
trainees spend half-days in theatre with anaesthetists and on wards
with oncology nurses,” she explains.“The feedback from
students has been superb. Several said that they would like it to
be extended to four weeks and this is something that we will look
at in the future,” she says. Another possibility being explored
is offering a six-month placement. “Some of our hospitals are
relatively small and many concentrate on providing elective surgery
and oncology services so this might limit the experience we could
offer,” she adds.
Sameea Nisar is one of the preregistration trainees who spent two
weeks on the BUPA programme this year in Leeds. “I gained an
excellent insight into how the different departments within the hospital
work as well as how the hospital interacts with the community when
patients are discharged.” |
There is also
another issue: funding. At the moment, the preregistration trainee’s
main employer continues to pay them throughout their cross-sector experience.
No money is exchanged between the two employers.
However, if the demand for cross-sector placements in hospitals continues,
there is speculation that hospitals will have to be paid to take on community
preregistration trainees.
Lesley Brown, preregistration tutor at Queen’s Hospital, Burton
Hospitals NHS Trust, comments that funding would be useful. “It
would allow me to fund additional pharmacist cover for the time that
I, and other pharmacists, spend training the cross-sector preregistration
trainees,” she comments.
Another suggestion is to include the experience that undergraduates get
during their summer vacations. “The Society could look at accrediting
vacation training so that it counts towards the requirement for cross-sector
experience,” suggests Ms Parr.
This seems unlikely. “We have discussed this issue in great depth
and, at the moment, the Society will not consider accepting vacation
experience towards the cross-sector training,” explains Mrs Hunger. Split training
In addition to cross-sector exchanges, a small fraction of preregistration
trainees get a more in-depth perspective on two sectors by splitting
their training into two six-month placements. This type of split has
been around for a long time for preregistration placements in industry,
but different combinations are now being introduced.
The numbers are still small: of the trainees who are just completing
their training, 22 undertook split placements. Official figures from
the Society show that nine placements were split between hospital and
community pharmacy, 12 between industry and hospital, and one between
hospital and a primary care trust. These figures do not include students
at the University of Bradford, who undertake a sandwich course of two
separate six-month preregistration placements.
Victoria Silkstone, placement tutor at the University of Bradford, says: “We
endeavour to place all the students on the sandwich course in hospital
pharmacy for one six-month placement and community pharmacy for the other
placement. Occasionally the odd student wants to do both placements in
the same sector.” She comments: “Exposure to two sectors
has definitely been beneficial for our students. Not only does it help
with career choice but it also helps with the preregistration exam since
they find it easier to answer questions about both community and hospital
practice.”
Southwark PCT is the only PCT that
offered a preregistration place last year as part of a year-long programme.
Six months at the PCT was paired with six months in hospital pharmacy
at Guy’s and St Thomas’s Hospital NHS Trust in London.
Someone who has experienced preregistration training in a PCT is Sinead
McArdle. Her placement was at Kensington and Chelsea PCT and St Charles’ Hospital
in London. “The PCT was able to introduce me to the work of the
prescribing advice team, the community pharmacy development team and
the community health services pharmacy,” she says. “My experiences
within the PCT enabled me to consider more than just the clinical aspect
of pharmacy. Working within a PCT instilled a broad appreciation of health
care and hopefully has produced a well-rounded pharmacist.”
The number of split placements could
increase in the future. There are other combinations to be explored,
and there is a possibility of a split programme with academia or veterinary
pharmacy although neither is currently being undertaken.
Another split combination that is to be
re-introduced for two trainees starting this summer involves six months
at the National Pharmaceutical Association and six months in community
pharmacy at Moss Pharmacy. The NPA experience is based at the association’s
information department. “They will be answering a broad range of
enquiries about medicines, law, professional ethics and business. They
will also learn how to abstract journals, run in-house training, prepare
information leaflets and compile information for the NPA website,” explains
Carey Halls, preregistration tutor at the NPA. In addition, the trainees
will spend time finding out how other departments of the NPA work, such
as the training and NHS services development departments.
Rachel Marchant, preregistration co-ordinator at Moss, comments: “We
are also offering a preregistration place this year with Pfizer, the
first split betwen community and industry.
These combinations provide an opportunity for trainees to see different
sectors.”
Case study: Split placement between hospital and community
In Burton on Trent, community pharmacy chain
Dean & Smedley
has teamed up with Burton Hospitals NHS Trust to offer two placements
that are split equally between community and hospital pharmacy.
Mark Brennan, preregistration training
manager for Dean & Smedley, explains that the preregistration
year is split into four three-month periods spent alternately in
community and hospital pharmacy.
Lesley Brown, principal pharmacist and preregistration tutor at Queen’s
hospital, Burton Hospitals NHS Trust, says: “The split placement
helps preregistration trainees to see what happens in the other practice
setting which is useful even if they don’t want to work in
that setting again.”
Mr Brennan stresses that key to the programme is the integrated approach
between the two sectors. The two tutors meet at the end of each three-month
period. “This is vital in terms of signing off competencies,
identifying what has been covered in the three-month placement and
what is still to be done,” he says. In addition, the preregistration
trainees on the split placement meet on at least a monthly basis.
Dean & Smedley offers two additional preregistration places based
in community pharmacy that include a three-week cross-sector experience
in the hospital and these preregistration trainees join their colleagues
on the split programme at the “learning set” meetings
one afternoon a month for shared study.
“The split placement provides a good breadth of experience. Three
weeks is sufficient to ensure the person knows how the other sector
works but the six month programme really ensures a full experience
in both sectors of practice,” Mr Brennan comments.
The concern is that in six months, the preregistration trainee does
not gain sufficient experience of either sector. Not true, say both
tutors. “The second three-month rotation is quite intensive,” says
Mrs Brown. “In a six-month programme some things have to be
covered in less depth. We ensure that all the clinical aspects are
covered but spend less time on areas such as manufacturing compared
with the full-year training.” And Mr Brennan points out: “In
actual fact, the 50/50 split gives the preregistration trainees the
best opportunity to meet the competencies.”
Emily Court, one of the two preregistration trainees who are about
to complete the split programme, is positive about her training. “It
has been a really good opportunity to get experience from both sides,” she
says. “I chose the split placement because I didn’t think
that I had enough experience of hospital pharmacy and wanted to gain
more,” she explains. “I have now got a much greater background
for making a decision about which way I want to go in my career.
Although I plan to work in community pharmacy initially I haven’t
ruled out a hospital career further in the future.” Even if
Ms Court remains in community pharmacy, the hospital experience has
given her a greater understanding of why certain decisions which
affect patients in the community are made in hospital. |
Shortages of places
There are certainly concerns at the moment that graduates are facing
a shortage of preregistration places, something that was discussed
at this year’s annual general meeting of the Society in May.
The Society does not believe that saturation point has been reached. “It
is not a problem at the moment. There are always a few people who do
not find places but this is
usually because they apply too late or want to work in an area with particularly
high
demand rather than a general shortage of places,” says Ms Purdy. “Often
students want to stay near to their university putting a demand on pharmacies
in areas near to schools of pharmacy. New schools opening in different
areas of the country may result in pharmacies in those areas offering
preregistration placements for the first time.”
However, in London, Mr Manovel says that he always has a waiting list
for hospital preregistration places: “There are already graduates
who cannot get placements.” He warns: “The situation is going
to get worse as the number of students on pharmacy courses increases.
Not only are there new schools of pharmacy but some existing schools
have been increasing their student numbers by 10 to 20 per cent year
on year for several years now. I believe 20 per cent more preregistration
places will be needed in the future.”
Funding is certainly one part of the problem. “The sum that community
pharmacists are paid to take on a preregistration trainee is negligible
compared with the cost of training,” says Mr Manovel. But he is
not convinced that the answer only comes down to funding. “I have
asked heads of departments at hospitals if they would take on more preregistration
trainees if I could get them more money. The answer is no.”
Another problem is finding enough preregistration tutors to cope with
an increase in the number of placements. This might be a particular issue
in primary care because tutors have had to have worked in their setting
for at least three years, Mr Manovel points out. “So one possibility
is using two or three month rotations in primary care while the main
preregistration tutor is in the hospital.”
Increasing capacity by introducing preregistration training in new settings,
such as at primary care trusts, will certainly boost the number of placements.
But Mr Manovel warns that these ideas are unlikely to result in the 20
per cent increase in capacity he thinks is needed. “Unless
action is taken at a national level we are going to get to a stage where
we have graduates with MPharm degrees who can’t do their preregistration
training. That is going to cause a lot of dissatisfaction.” |
The
Pharmaceutical Journal