|  The UK Clinical Pharmacy Association was founded in 1981 by Laurie Goldberg,
district pharmaceutical officer for Salford and Mike Cullen, district
pharmaceutical officer for Derby, but the seeds of its beginnings go
back to the late 1970s. At that time a number of events in the UK prepared
the ground. For example, Malcolm Rowland was appointed professor of pharmacy
at Manchester University, having just returned from the University of
California in San Francisco (a leading centre in clinical pharmacy development),
articles describing clinical pharmacy activities were appearing regularly
in US journals, and a clinical pharmacy teacher-practitioner was appointed
in north west England.
A number of experienced pharmacists were beginning to voice the need
for more patient-oriented activities but in other areas ward pharmacy
appeared to be developing in a supply-oriented direction. Mr Cullen recalls
a consultant physician saying to him: “Pharmacists have a lot of
knowledge but are unable to communicate it, whereas junior doctors tend
to be good communicators but less knowledgeable; if pharmacists learnt
to communicate there would be a real future for them,” which, he
said, made him think a lot about where pharmacists were going.
Against this background, in 1980, a series of workshops was organised
(supported by the then Smith Kline & French vaccines division), that
focused on clinical topics and drew together a band of people who wanted
to change the way pharmacists worked. After three workshops, there was
a strong and growing tide of feeling that a group should be formed that
would allow participants to meet and develop their interests further.
Mr Cullen, now retired, recalls, “None of the established pharmacy
bodies at the time put much emphasis on patient-oriented activity. As
far as Laurie and I were concerned that was pharmacy. We wanted to form
a body of like-minded people to take it forward.”
As a result, an invitation was made to pharmacists, through The Pharmaceutical
Journal, to attend a meeting at Leicester Royal Infirmary one Saturday.
There was considerable scepticism, from some quarters, that pharmacists
would want to give up a Saturday to attend a meeting about clinical pharmacy
but, in the event, the lecture theatre was so full that people had to
sit on the steps. That day, a steering group was elected and a name for
the organisation was agreed: the UK Clinical Pharmacy Association (UKCPA).
From the outset the founding members of UKCPA had strong views about
what they wanted the organisation to do and how they wanted it to work.
Given the low level of interest in patient-oriented activity in pharmacy
in general, members envisaged a self-help group in which experiences
could be shared and skills developed. Moreover, meetings should provide
an environment in which aspiring clinical pharmacists could rub shoulders
with more experienced colleagues and learn from them. They should also
provide a platform to present work where new authors would be welcomed,
encouraged and supported.
One important decision was to run meetings that comprised a series of
workshops, involving interactive, small-group teaching rather than traditional
lectures. This was a format that lent itself to the sharing of experience
that members demanded and has been widely copied since. “Workshops
brought a great sense of fun into learning but they also served to select
good teachers. The workshop format puts the leader under considerable
scrutiny and people whose knowledge was superficial or inadequate would
not put themselves forward”, says Steve Hudson, professor of pharmaceutical
care at the University of Strathclyde.
Another guiding principle was that, as far as possible, practising pharmacists
would be the teachers, rather than members of other professions. This
was seen as the best way to pass on the knowledge and experience that
had been gained. Moreover, there was a great emphasis on learning from
encounters with patients and the case presentation as a teaching vehicle
became increasingly prominent.
Most pharmacists’ experience of professional conferences in the
80s was based on meetings held on university sites where they were accommodated
in halls of residence. From the outset, the UKCPA decided to hold meetings
in hotels to provide more comfort for delegates. In order to make this
possible but also to make meetings affordable Mr Goldberg, now a pharmacy
consultant, had the idea of using hotels in popular tourist locations
out of season. Hotels were keen to have 200 or more pharmacists for a
weekend and excellent rates were negotiated. Thus, the November residential
symposium came into being. The first venue was the Cairn Hotel in Grange-over-Sands,
Cumbria.
Integration
“UKCPA was one of the few organisations that recognised that clinical
pharmacy was practised in both community and hospital settings and it
always encouraged participation from community pharmacists,” Mr
Goldberg recalled. Community pharmacist Gill Hawksworth said: “We
enjoyed the workshops with hospital pharmacists and got a lot out of
them — it helped to develop many of the ideas that fed into the
new [community pharmacy] contract.”
The UKCPA also sought to build a new kind of relationship with the pharmaceutical
industry. In order to do this, a corporate membership category was created.
Corporate members were encouraged to take part in meetings and only corporate
members were allowed to have stands at UKCPA meetings.
In addition, the UKCPA played a part in changing university curricula.
Many members were demanding training for the clinical work that they
wanted to do, and many believed that the universities should provide
the training. However, it was clearly recognised by the leaders of the
association that universities would only introduce clinical topics to
the curriculum once clinical pharmacy was firmly embedded in day-to-day
practice. The UKCPA’s primary role was to be to help its members
to develop their own clinical practice. In time, it reasoned, university
curricula would have to change to reflect the demands of day-to-day practice. A UK style of clinical pharmacy
Founding members of the UKCPA were keen to develop a style of clinical
pharmacy practice unique to the UK. Professor Hudson recalled: “we
were guarded about using the term ‘clinical’ because we
did not want to be see to ape our counterparts in the US.” Two
areas of practice were particularly favoured by the new clinical pharmacists,
namely kinetics (or therapeutic drug monitoring) and parenteral nutrition.
Both represented areas in which the pharmacist had a recognisable and
unique contribution to make. “These were good models that helped
UK pharmacists to develop confidence in their clinical roles,” he
added.
From the beginning, the organisation saw newsletters and conferences
as a way of meeting members’ needs for contacts and information.
The newsletters were launched early on and the first few issues were
concerned with application of pharmacokinetics to practice.
An innovative feature of the regular autumn conference was the introduction
of poster presentations for practice research and developments. This
was seen as a way to help members to share their work in a less formal
and threatening environment compared with the 10-minute scientific presentations
usually made at conferences. Posters had not been a familiar feature
of UK pharmacy meetings and the UKCPA led the way by producing a guide
for aspiring presenters. Dr Hawksworth recalled that UKCPA meetings provided
a good platform for presenting practice research. “You got a lot
of interest, especially about the development of clinical skills in community
practice,” she explained.
At an early stage, a statement on clinical pharmacy was drafted, setting
out the UKCPA’s beliefs about clinical pharmacy in the UK. It was
the first bold step in staking out clinical pharmacy territory and establishing
the organisation as a body that had a view and carried weight. Subsequently
the UKCPA has been consulted regularly by bodies, such as the Department
of Health and the Royal Pharmaceutical Society, and has given input to
key documents, such as the Crown Report.
As the UKCPA grew it remained strongly focused on the provision of services
and opportunities for members. Three initiatives illustrate this commitment.
First, an agreement to supply a number of books published by the American
Society of Hospital Pharmacists (which could not easily be obtained by
individuals in the UK) was negotiated. Second, corporate members were
invited to sponsor awards to support small research projects. For example,
Dr Hawksworth pointed out that work on therapeutic drug monitoring in
community pharmacies that she undertook was partially funded by a UKCPA
award. This work was frequently quoted when prescribing by community
pharmacists was under discussion, she says. Third, a series of practice
guides was published. These were based on the most popular workshops
and were another way of sharing the experience and burgeoning skills
of the clinical pharmacy community.
As the UKCPA matured it became clear that some members were developing
specialist practices in key areas, such as surgery and intensive care.
This prompted the formation of practice interest groups, which at once
provided a focus for individuals working in that specialty and also a
reservoir of expertise for the organisation. Practice interest groups
quickly took on lives of their own, holding their own meetings.
One of the earliest measures that the organisation put in place was a
sound financial management structure. As part of this process, the treasurer,
David Anderson, worked hard to ensure that the charitable status of the
organisation was recognised and agreement
secured from the Inland Revenue that subscriptions would be regarded
as tax-deductible. The future
As the UKCPA grew from a few hundred to more than 2,000 members, it
became clear that committee members could no longer run the organisation
efficiently
in their spare time. Today, the UKCPA has an office and employs a full-time
administrator.
In many ways, recent developments, such as prescribing by pharmacists
and the proposed development of practitioners with special interests,
are the kind of things that the founders of the UKCPA dreamt about. The
UKCPA continues to attract pioneers and innovators as well a broad spectrum
of pharmacists who are simply seeking to improve their own practice.
Importantly, it continues to attract young pharmacists who will carry
the organisation forward. According to the current UKCPA chairman, Duncan
McRobbie: “UKCPA sees itself not only as a leading provider of
education for practitioners but also as a body that leads the way in
ensuring high standards for practice for expert practitioners.”
There can be little doubt that the UKCPA is strongly positioned to support
the ongoing development of clinical pharmacy practice for the foreseeable
future. |
The
Pharmaceutical Journal