British Oncology Pharmacy Association, 10th annual symposium
Plans to establish faculty of
oncology pharmacy will address accreditation
Other options discussed
The other options put forward for a system of accreditation were:
• Doing nothing — to continue allowing oncology practice
to develop in an unplanned way. The working group did not consider
this a plausible option.
• A BOPA college — the formation of a college with BOPA in
charge of accreditation processes. It was thought that this option
would allow BOPA to have complete control of what happened, but
there would be issues surrounding resources and credibility. This
might not be feasible with the formation a body akin to a royal
college.
• A joint BOPA/university higher education institute — collaborating
with a university to offer postgraduate training and qualifications.
It was thought that, while such a collaboration could be prestigious,
there is no one university leading the way in specialist oncology
pharmacy and the arrangement could lack credibility at a national
level. |
Geoff Saunders, BOPA chairman |
Plans to create a faculty of oncology pharmacy, in collaboration with
the College of Pharmacy Practice, were instigated at the British Oncology
Pharmacy Association annual symposium, held in Glasgow last week.
BOPA’s
accreditation workgroup — set up last year to look at professional
competence in oncology pharmacy — suggested this as the preferred
option to take forward an accreditation system for UK oncology pharmacists.
BOPA members voted in favour of the proposal.
In an overview of the workgroup’s recommendations, Geoff
Saunders,
BOPA chairman, and Macmillan cancer network pharmacist, Greater Manchester
and Cheshire Cancer Network, said that accreditation needs to be applicable
wherever a pharmacist provides a service, whether it be clinical or technical.
“It
has got to be recognised, both within our own profession and also outside
our profession. If we as pharmacists want to convince other health care
practitioners that we are achieving a high level of practice, whatever
accreditation we have has got to be recognisable to them,” he told
participants.
An accreditation system, Mr Saunders said, needs the ability to build
on what work people are already doing, rather than enforce a single path. “We
should be able to make sure that anyone wanting to take part in what
we do as oncology pharmacists feels comfortable that they can bring their
own skills to enhance patient care,” he said. Mr Saunders also
said that the accreditation system will need to be aspirational — to
address how pharmacists can build on their skills to become advanced-level
practitioners and consultant pharmacists for the future.
Pharmacists were asked to consider all of the options put forward (see
Panel), but he emphasised that a faculty structure within the CPP was
the preferred option.
Steve Tomlin, consultant pharmacist, Evelina Children’s Hospital,
London, and membership secretary of the Neonatal and Paediatric Pharmacists
Group, told participants about the founding in 1992 of the Faculty of
Neonatal and Paediatric Pharmacy as a joint venture between the NPPG
and the CCP. He said that there is an assumption that pharmacists working
at a particular level within a particular specialty are working at an
equivalent level as those in another specialty. “What we need now
is a process to ensure that this does happen within the pharmacy profession.
Therefore, starting to join together under one system of assessing competence
is essential to the way forward and the College of Pharmacy Practice
is holding that up and saying ‘we are here to facilitate’,” he
said.
Catherine Duggan, associate director of clinical pharmacy
for development and evaluation, London South East and Eastern, said that
accreditation
is about providing people with a recognised structure to their career
and being recognised for the high-level practice that they are delivering. “We’ve
got to think about the competency agenda, safety for patients and the
fact that the moment you finish your degree is not the last time you
need knowledge,” she pointed out.
Mr Saunders concluded: “What we need is a broad-based,
UK-based, accreditation system … that we are in control of and that
we can
present both to the wider pharmacy community and to the outside world.”
Multidisciplinary care must go further, but safely
Pamela Warrington |
Across the UK, specialist pharmacists are playing their part within the
multidisciplinary team to enable chemotherapy to be given safer, closer
to people’s homes, said Pamela Warrington, deputy chief
pharmaceutical officer, Scottish Executive Health Department, in her welcoming
address.
However,
she said that progress on this front needs to go further and more quickly,
but within the context of safely delivered services.
She said that pharmacists
would have new opportunities in line with new cancer technologies, but
that these opportunities would come with increased expectations and greater
responsibilities.
“Patients
and the public need to be reassured of safety and quality and, on both
counts, that is very much the core business of pharmacists and NHS pharmaceutical
services,” she said.
She went on: “We also need to look at the modernisation
of professional regulation to achieve the level of public confidence that
is required.”
Pharmacy chiefs discuss future of oncology practice
Hospital pharmacists play a major role in the treatment of people with cancer,
said Keith
Ridge, chief pharmaceutical officer at the Department of Health.
Dr Ridge acknowledged that hospital pharmacists’ work ranges “from developing
prescribing policies to operational and technical issues of safe aseptic
dispensing of chemotherapy, trying to deal with ever increasing throughput
by capacity planning”.
He went on: “Many of you practising in hospital will
be familiar with the rapid growth in chemotherapy demand, and expectation
of rapid chemotherapy to patients whether at the bedside or in the
clinic. Many hospital pharmacy departments have had to, rightly, redesign
the way
they work alongside other professional colleagues in order to cope
with new levels of demand and expectation from patients.”
He also spoke
of community pharmacy’s emerging new roles: “Community pharmacy
is at the heart of many smoking cessation services across the UK and is to be
congratulated for delivering a major public health benefit. Smoking cessation,
now combined with the tobacco advertising ban and the ban on smoking in public
places, should help deliver major health gains for the UK population.” He also
drew attention to community pharmacists’ potential public health role in areas
such as excessive sun exposure, alcohol consumption and weight — risk factors
for a number of cancers.
Dr Ridge described a future model for pharmacists in
oncology — that of the “confident carer”. This pharmacist would be “fully engaged,
working with the public, patients and other clinicians, planning and delivering
care to patients with cancer”, he said. “The confident carer pharmacist would
have a thorough understanding of cancer prevention and would look for opportunities
to engage the public and patients in their own health — this would include working
across professional and sector boundaries.”
He described the broader context of
this role as: increasing specialisation of medical colleagues and centralisation
of complex services; the desire to move
services closer to patients, making services more convenient; changing roles
of different staff across the cancer care team, increasing flexibility, where
the focus is on having the skills to do the task rather than job titles; using
hospital beds better and only having patients in hospital when it is absolutely
necessary; and a growing range of targeted but expensive technologies including,
but not exclusively, drugs.
Bill Scott, chief pharmaceutical officer, Scottish
Executive Health Department, told participants that it is the individual practitioner
who in many ways reflects how society feels about the profession. He said that
most people’s view of pharmacy is of community pharmacists, because they do not
have regular contact with hospital pharmacists. “Therefore,” he said, “advancing
our practice in secondary care still leaves us with addressing how we transfer
those skills — and up-skill our colleagues in the community.”
Mr Scott believes
that pharmacists need to see themselves evolving into a research-based profession.
He said that with the advent of consultant pharmacist posts within
Agenda for Change there is an opportunity to get a cohort of high-level researchers
pushing the boundaries of knowledge in the NHS. “There are some very fundamental
questions about patients’ attitudes to medicines and how they can get the best
out of their medicines,” he added.
There could be tremendous opportunities for
the hospital sector to work across
boundaries in primary care, Mr Scott believes. “Is there any reason why someone
in secondary care oncology services cannot spend a session in a community pharmacy
that is engaging in palliative care or some aspect of oral chemotherapy,” he
questioned.
Mr Scott said that a professional body should be there to support
its practitioners, not be a punitive force. “We do hear about the no-blame culture
but, in fact, with medicines [errors] it is very much a blame culture and for
pharmacists it is a criminal offence — and that is something that we are working
to try and address,” he told participants. “If you cannot have a system that
recognises human failure, and does something to support it, people are not going
to admit their mistakes.”
Poster presentation winner looks at CMV
Best poster
The prize for the best poster went to “Impact
of pharmacy support in daycare” by Susanna Daniels and colleagues
from University College Hospital, London. |
A presentation entitled “High-dose aciclovir to prevent cytomegalovirus
(CMV) infection and disease after allogeneic stem cell transplant” was
voted the best poster presentation.
Nick Duncan, haematology pharmacist, Queen Elizabeth Hospital, Birmingham, presented
the research on behalf of co-authors from University Hospital Birmingham NHS
Foundation Trust and the University of Birmingham.
The study aimed to assess the impact of a new policy for aciclovir dosing to
prevent CMV post-stem cell transplant on incidence of CMV infection, incidence
of CMV disease, time to reactivation and patient survival. They also aimed to
investigate risk factors for CMV reactivation after transplant.
They found that aciclovir did not appear to confer any significant benefit in
terms of CMV reactivation post allograft; CMV serostatus and T-cell depletion
impacted on risk of reactivation; and underlying disease appeared to impact on
risk of CMV reactivation.
A closer look at drug technology appraisals
There is no evidence that the Scottish Medicines Consortium is biased against
accepting oncology drugs for use in NHS Scotland, Kenneth Paterson, SMC vice-chairman
told participants in a session on drug technology appraisal processes. He
said that around 34 per cent of all SMC submissions are accepted with no
restrictions, 36 per cent are accepted for restricted use, and some 30 per
cent are rejected by the consortium, and there has been little change in this
over time.
“Acceptance rate for oncology drugs is 67 per cent — the same as
the rest of the drugs we look at,” he said. Mr Paterson pointed out that
there are usually fewer randomised controlled trials of oncology drugs, with
a median
of one trial compared with a median of two trials for non-oncology drugs. However,
he said that follow-up in the trials tends to be longer. “The median
follow-up for [all] drugs that we look at is just 12 weeks. At least in oncology
drugs the median follow-up is a year, which gives us some taste of the actual
benefits of the drug,” he said.
“The average cost per QALY [quality adjusted life year] of the drugs
that we have accepted for cancer is £15,000 as opposed to an average
cost per QALY of accepted drugs of £8,500,” Mr Paterson added.
The SMC assesses all new medicines, all new formulations of existing medicines
and major new indications for existing medicines. Mr Paterson said that the
National Institute for Health and Clinical Excellence does not necessarily
receive bad press for saying no to drugs but rather for not saying anything
about them for a long time.
Karen Samuels, from the Welsh Medicines Partnership, spoke about how the All
Wales Medicines Strategy Group appraises medicines in Wales. She explained
that the AWMSG recommendations are made at a public meeting. The group considers
a preliminary appraisal report put together by the New Medicines Group, as
well as a response from the product’s manufacturer and responses from
patient interest groups. The decision is finalised once it is approved by the
minister for health and social services.
The AWMSG only considers medicines that NICE does not have on its assessment
programme for the next 18 months, she said.
She also drew attention to a recently formed All Wales Cancer Drugs Group,
which liaises with networks of oncologists and oncology pharmacists to find
out which medicines should be prioritised and is involved with horizon scanning
for forthcoming oncology drugs. |
The
Pharmaceutical Journal