|  With the Government’s emphasis on moving specialist services
from secondary to primary care, a new role for practitioners with specialist
interests has emerged. Guidelines for GPs, nurses, dentists, allied health
professionals and practice managers have already been published by the
Department of Health. Last week, a national
framework and guidance to
support the establishment of pharmacists with special interests was launched
(PJ, 9 September, p299).
A pharmacist with a special interest (PhwSI) is defined as: “Someone
who supplements their core generalist role by delivering an additional,
high-quality service to meet the needs of patients. Working principally
in the community, they deliver a clinical service beyond the scope of
their core professional role or may undertake advanced interventions
not normally undertaken by their peers. They will have demonstrated appropriate
skills and competencies to deliver those services without direct supervision.”
It is not a requirement for PhwSIs to be prescribers but this may enhance
the scope of the role in practice, the framework says.
For a pharmacist who would like to become a PhwSI, the first step is
to find out from local commissioners whether they intend to commission
specific services through PhwSIs as part of service redesign, says Beth
Taylor, national development lead for PhwSI at NHS Primary Care Contracting
and a member of the PhwSI advisory group.
If services are to be commissioned in this way pharmacists can then gain
accreditation by demonstrating competencies in line with the national
framework and undergoing a local accreditation process. Full details
of the accreditation process will be revealed in further guidance expected
later this year. The current system for accrediting GPs with special
interests has been reviewed and pharmacists and GPs will in future share
the same local accreditation system.
Mrs Taylor explains that PhwSIs must be delivering care direct to patients. “It
is not appropriate for pharmacists with a purely leadership role to become
PhwSIs,” she says. Practitioners with special interests must also
maintain a core generalist role.
Clinical networks
For hospital pharmacists who are already providing a specialist service,
for example from an outpatient department, the PhwSI route is optional.
Mrs Taylor explains that the PhwSI model has been developed as a quality
assurance mechanism for practitioners who work more autonomously. “The
idea behind it is that it will make it easier for the commissioners
to commission these services,” she says.
However, hospital practitioners should become involved in the development
of specialist services in the community. Mrs Taylor would like to see
clinical networks developing in which clinical pharmacists and doctors
practising in hospitals at an advanced level work with and support pharmacists
and others working at a special interest level in primary care.
Mrs Taylor suggests that it would be useful for pharmacists who wish
to become PhwSIs to find out whether commissioners in their local health
economy have already commissioned services from practitioners with special
interests.
There are particular areas, like diabetes, dermatology and sexual health,
where it is expected there will be substantial movement of services into
primary care. “Those probably present the best opportunities for
pharmacists,” Mrs Taylor advises. They are also the sort of opportunities
where funding is more likely to be available and where there will be
local support from GPs and others, she says. Competency framework
The document contains a generic competency framework, which takes an
approach similar to that used for the establishment of consultant pharmacists
in secondary care.
The framework lists two levels of competence — practitioner and
pharmacist with a special interest — and six domains. It is intended
to help accreditation panels to distinguish between the two roles. PhwSIs
must be able to demonstrate all competencies in two clusters (expert
professional practice and building working relationships) and the majority
of competencies in a further two clusters (leadership and management).
The two remaining clusters — training and development and research
and evaluation — are optional. Experience
“We would expect that pharmacists that might aspire to this are
already practising in [a specialist] area and may have done some additional
training,” explains
Mrs Taylor. This training may be sufficient or more training may be necessary
to meet the competencies. However, Mrs Taylor predicts that training
alone is unlikely to be what is needed to demonstrate competency. “You
are almost certainly going to need to demonstrate local experiential
learning, such as doing some sessions with a specialist and seeing how
certain services are operated,” she says.
The national framework and a step-by-step guide for practitioners who
are considering becoming PhwSIs is available on the NHS
PCC website.
The first PhwSIs are likely to be accredited in 2007.
Established and emerging service models
The national framework gives details of several
established and emerging service models similar to PhwSI. The
examples listed cover
diabetes, substance misuse, anticoagulation, Parkinson’s
disease, medicines management for older people, pain management,
sexual health and mental health.
A pharmacy service for substance misusers in Northern Lincolnshire
illustrates how a PhwSI could provide both a direct patient service
and act as a central resource to support a clinical network of
pharmacy providers. Tim Cottingham, proprietor of Cottingham Pharmacy,
Grimsby, co-ordinates a drug misuse service provided by 43 pharmacies
in the area. He has undertaken the Royal College of General Practitioners
part 2 certificate in the management of drug misuse and provides
telephone support and one-to-one training to other pharmacy staff.
The service is well integrated with other providers through weekly
meetings with the drug rehabilitation requirements agencies and
a quarterly multi-professional forum with all stakeholders.
Mr Cottingham told The Journal: “Becoming accredited as a
pharmacist with a special interest is top of my agenda for this
year.” He believes that becoming accredited will make it
easier for him to take the service forward because he will be taken
more seriously at primary care trust level. “At the moment
there is nothing that differentiates me from a pharmacist that
has not specialised. Becoming accredited will show commissioners
that I have made a commitment to a particular disease area.”
He plans to extend the initiative to provide a minor ailments service
for drug misusers and their families, which will support the work
of a specialist district nurse who regularly visits the pharmacy
to treat patients. |
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The
Pharmaceutical Journal