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Over the past 20 years within the hospital sector, pharmacists have successfully demonstrated that they are the experts on medicines and that they can add value to services provided by other health care professionals. With the current drive to move health care services from hospitals into the community, the profession must seize the opportunity to replicate the success of hospital pharmacists and build sufficient capacity to deliver quality clinical pharmacy services in the community. Such services comprise
strategic advice to the newly formed practice-based commissioning groups,
operational support to GP practices, and advanced and enhanced services
within the national community
pharmacy contract.
Currently, however, there is only a small number of pharmacists delivering
quality clinical pharmacy services in the community.
Anecdotal evidence exists of barriers to delivery of medicines use reviews
(MURs) by community pharmacists, despite accreditation, that relate to
unmet training needs and a lack, or perceived lack, of skills. Additionally,
anecdotal evidence also exists of complaints from GPs about the quality
of MURs, including the limited value of them and that community pharmacist
recommendations are not evidence-based and conflict with advice from
local primary care trust prescribing
advisers.
Since 1997, the Pharmaceutical Resource Network has been commissioned
to train over 600 health care professionals in 19 primary care organisations
to support medicines-related service developments. We have designed and
delivered bespoke uniprofessional and multidisciplinary workshop programmes
that are specifically focused on the practical application of knowledge
and skills in the workplace.
From our experience of training community-based pharmacists, we have
identified that they need to undergo a massive and swift change in mindset
in order to build on the success of hospital colleagues and gain widespread
recognition as being “the experts on medicines” within the
primary health care team.
This needs to be addressed both within the training environment and on
an ongoing basis within the workplace, to provide hands on support to
isolated community pharmacists developing new and changing professional
services.
In an earlier Broad
spectrum article (PJ, 18 June 2005, p758), one of
us (SS) argued that appropriate training content, robust assessment of
competence and a mechanism for ongoing support for pharmacist practitioners
are all crucial to ensure successful patient outcomes from medication
review. We believe that the same is true to ensure the success of MUR
services and other clinical services delivered by pharmacists in the
community. Hence, reform of pharmacy postgraduate education for community
based pharmacists needs to address the content of
training, assessment of competence and support networks for community-based
pharmacy practitioners.
Content of training
• Content needs to be determined by the competencies required for service
provision.
• Training programmes need to be co-ordinated so that they cover
all of the competencies required to deliver individual professional services.
• Training programmes need to focus on the practical application of
knowledge and skills in the workplace.
• Training materials must be developed and delivered primarily by
leading-edge pharmacist practitioners who also have additional expertise
in training
and a working knowledge of primary care. However, this has implications
for accreditation of postgraduate education because such providers
are often not affiliated with higher education institutes.
• Training materials must be evidence-based and updated before every
face-to-face
delivery.
Assessment of competence
• Written and verbal communication skills underpin competence and should
be an integral part of competence assessment for clinical practitioners.
• Assessment of competence should include input from service users,
including patients and other health care professionals.
• The Objective Structured Clinical Examination should be adapted for
use and incorporated more widely into accreditation processes for practitioners
to demonstrate their ability to deliver evidence based practice.
Support networks for community based pharmacy practitioners
• There is an urgent need to establish local clinical pharmacy networks
to stimulate and support new service delivery in the community and
to facilitate sharing of best practice and problem-based learning.
• Such networks should be led by dynamic, motivating, expert practitioners
who can act as role models and facilitate professional development.
• There is an urgent need to provide shadowing and coaching opportunities
to support isolated practitioners in delivering new professional services.
The success of hospital pharmacists has been underpinned by a career
structure and an integrated programme of applied professional development
in a supported environment. It is imperative that postgraduate education
for community-based pharmacists replicates this in order to deliver practitioners
who can demonstrate that they are truly “the experts on medicines” within
the primary health care team.
Based on Pharmaceutical Resource Network’s experiences of training
hundreds of health care professionals, mainly community pharmacists with
unmet training needs, we believe that substantial and rapid reform of
postgraduate education for community-based pharmacists is required to
achieve the necessary change in the profession. Community-based pharmacists
need to be confident and competent to deliver clinical services that
meet the needs of the local population. Supporting them to reach their
potential in the current NHS environment requires more than just traditional
education and training activities.
In our experience, robust assessment of competence and hands-on support
in the workplace give pharmacists the confidence to implement what they
have learnt, and establish and maintain new clinical services. However,
the current arrangements for funding community pharmacist postgraduate
education in England leave little room for diversity in meeting pharmacists’ development
needs to deliver locally commissioned services. Perhaps it is time for
a rethink. |
The
Pharmaceutical Journal