AAH Pharmaceuticals
Think like a responsible pharmacist now
Colette McCreedy: individuals will know if they have enough experience
to be the responsible pharmacist |
If pharmacy is going to deliver clinical services and the wider role
it has been asking for, it is absolutely vital that it gets to grips
with the issues surrounding the responsible pharmacist as soon as possible.
So
said Colette McCreedy, chief pharmacist and director of pharmacy at the
National Pharmacy Association, at the AAH Pharmaceuticals convention
in Cape Town, South Africa, last week.
She told participants that if pharmacy does not focus in on the responsible
pharmacist legislation there could be great difficulty in delivering
what is needed in the future.
“We don’t have any definite details about how the responsible pharmacist
is going to pan out. We have some legislation already in the Health Act,
but we don’t have the details.” She added that discussions
about supervision have not really gone beyond the concept stage and that
the consultation on supervision is pending.
Nevertheless, Mrs McCreedy
believes that what has been proposed for the responsible pharmacist will
fundamentally change the way pharmacy is practised in future.
She explained that, within the Health Act, there is now a statutory duty
on pharmacists to ensure the safe and effective running of the pharmacy.
She described how this is different to what is currently required: “This
duty looks at the whole of pharmacy services. It is not just focusing
on the supply of medicines, whether over the counter or on prescription.
It is recognising that pharmacy is moving on. Pharmacists aren’t
just there to supervise and control the supply of medicines. It is about
the whole safe and effective running of the pharmacy.”
Mrs McCreedy said that this statutory duty would include making sure
that appropriate standard operating procedures are in place — that
they are both established and maintained and that they are reviewed often.
She
added: “There is no point having a standard operating procedure
that is not working safely and effectively in practice. And part of that
is making sure that the staff mix is right in the pharmacy so that they
can work within those standard operating procedures.”
Another pertinent point, she said, is that there would be a record kept
of who the responsible pharmacist is at any given time in the pharmacy.
Pharmacists would be required to sign in when they are taking responsibility
and sign out when they are relinquishing it. “That is going to
focus pharmacists’ minds much more — they’re signing
up to those responsibilities.”
Mrs McCreedy said that it was difficult to pass judgement on the issues
surrounding absence of the responsible pharmacist from the pharmacy for
periods of time until the outcome of the consultation on pharmacy supervision
is known. She added that there is an overall view that one pharmacist
should be responsible for just one pharmacy at any given time.
In terms
of whether pharmacists will need additional qualifications — or
a certain level of experience — to act as the responsible pharmacist,
Mrs McCreedy believes such decision should be left to the profession
and not be put in legislation.
“How do you know when you have enough experience to be a responsible pharmacist,” she
asked. “The individual pharmacist will know if they are capable
or not — perhaps in consultation with their superintendent. You
would not as a pharmacist under your ethical obligations undertake any
role that you did not feel you were capable of doing.”
Mrs McCreedy said that there are significant risks in developing models
that will result in the pharmacist not being so freely available in the
pharmacy. She stressed that the accessibility of the pharmacist is one
of the things the profession has been promoting and selling. “If
we leave the pharmacy completely then somebody else is going to come
in and take our place,” she stated.
“Personal control is going to be replaced by the concept of the
responsible pharmacy,” she made clear to participants. “You
need to start thinking about how this is going to affect your pharmacy
business and
your operations and what changes you feel need to be put into place in
your pharmacy. … You need to weigh up the impact of these changes
on your present service against the potential for expanding your services
by taking advantage of greater freedom.”
She finished by advising participants that there is no need to wait for
changes in legislation: “Start thinking like a responsible pharmacist
now.”
White Paper offers great potential for pharmacy
Mark James led the business sessions |
The pharmacy White Paper offers great potential rewards for the profession
as part of healthcare delivery across the UK, AAH’s Mark James
said at his first convention as group managing director.
He said that the White Paper was a comprehensive review containing many
of the elements for which pharmacy has been arguing for some time.
However,
the paper says that certain services should be provided by pharmacy,
not that they definitely would, Mr James pointed out, adding that the
paper “does seem to be fairly quiet” on the issue of funding.
He went on: “The financial situation in pharmacy has probably never
been more precarious and certainly never more unpredictable. However,
the White Paper explicitly states that rewards in time will be better
directed at those pharmacies that fully embrace the direction of change
and that invest in staff and infrastructure to support high quality services.
I think that’s a laudable end.
“I just hope the timescales taken
to develop that will not be so long that, by the time it’s there,
there will be no money left in pharmacy to invest.”
Consider what training is needed for new roles
Pharmacists need to take responsibility for the professional element
of their work as well as business and service delivery, National Prescribing
Centre chief executive Clive Jackson told participants.
He also suggested that pharmacists might need to be more involved in
what is happening with the future of the Royal Pharmaceutical Society
than they might feel they currently need to be. He went on to describe
some of the issues looked at in the Clarke Inquiry’s report into
the new professional body.
“I think the future of pharmacy is very positive now,” he said, “but
it is not going to be handed to us on a plate. We clearly do need to
make sure we are managing our own profession to allow us to get there.”
Mr Jackson said that the more pharmacists move into clinical roles the
greater the range of skills they will need over and above what they already
have. “That requires a different educational approach than we currently
have. And if we think about the potential time it takes to change any
educational approach in pharmacy then we need to be thinking about this
sooner rather than later.
“The Society at the moment sets the curriculum,
the curriculum then defines what schools of pharmacy do, they then have
to change, and then it takes it five years before a pharmacist emerges
with that new skill set. So even if we started today there would be a
lag of probably seven years.”
He said that there is therefore an
issue of training current pharmacists as well as making sure that the
pharmacists of the future are appropriately educated.
Mr Jackson added: “If we move more into the clinical role then
we’ll have to get our minds round the fact that we will be working
closer to patients … and we will have to be comfortable with that.”
He asked: “What can we achieve with limited additional training
and support? And what actually requires wider training and development
and fundamental reform of undergraduate and preregistration [education]
and continuing professional development?”
David Colin-Thomé, national director for primary care at the Department
of Health’s commissioning and system management directorate, spoke
about the commissioning process. He said that commissioners were in a
difficult position because “all the power, status and often the
technical knowledge resides with the providers”.
He added that
many providers are not always objective in the use of resources. He said
that the Government is keen to improve the skills of people involved
in the “world class commissioning” process.
“If you don’t perform you’re out”
It is important for pharmacists to better understand what the commissioning
cycle involves, Mike Holden, chief officer of Hampshire and Isle of
Wight Pharmaceutical Committee, told participants.
He said that pharmacists often suggest they can provide services that
do not meet a local need, and that there is no reason why commissioners
would wish to invest in such services. “Understanding the local
health economy, understanding the strategies of our primary care trusts
and our local health authorities, is very important. If you don’t
do that you will never get a service commissioned — or you shouldn’t.”
He also highlighted the need for pharmacy to “be at the table when
it comes to service redesign”. He said that this is more than just
changing the model of who provides a service, it is about making the
service better for the patient.
He stressed the importance of ensuring that pharmacy can performance
manage the services it provides. “Unless you put performance management
in to get quality outcomes then you will not get recommissioned.”
Mr Holden added: “There is a very clear warning within the White
Paper around poor performance — if you don’t perform then
you’re out.”
Inpatient service improves in NI
Northern Ireland’s integrated medicines management (IMM) programme
has improved safety and reduced medicines wastage in secondary care,
said Sheelin McKeagney, a pharmacist who represents the views of community
pharmacy on the NI Pharmaceutical Services Improvement Programme.
The IMM programme involves hospital pharmacist input in contacting a
patient’s GP or community pharmacist when the patient is admitted
to hospital to ensure an accurate drug history is obtained. The patient’s
own medicines are then used in hospital, and the pharmacist ensures the
patient is properly educated on discharge. Communication with primary
care when the patient leaves hospital is also key, Mr McKeagney pointed
out.
He said that implementation of the programme reduced the average length
of stay in hospital by two days and readmission rates by 20 per cent,
and lengthened the time to readmission by over 20 days on average. Use
of patients’ own drugs produced a saving of some £13.30 per
patient and an estimated 1,000 errors per ward per year were now being
prevented.
“For every pound invested in this service at least £4.80 has been
returned. … This is a win-win for commissioners,” he said.
Summary of business sessions
Mark James summarised some of the key issues identified
in the business programme:
• Commissioning is crucial and pharmacy is going to have to get
much better at playing the commissioning game.
• Patient choice is not so much about the patient having a choice
of location for treatment, rather it is about the patient choosing
how they want to be treated.
• Prevention of illness is talked about a lot but the challenge
lies in convincing people who do not feel unwell to play a role
in preventing future illness developing.
• It could be seven years before pharmacy graduates have the skills
to support new roles — existing pharmacists will need to
ensure they update their skills to provide services in the interim.
• There is a need for pharmacy to measure health outcomes to prove
that its services are making a difference.
• The pharmacy White Paper signals a shift in focus from dispensing
to clinical services. Reward will go to pharmacists who embrace
the changes set out in the paper and provide high quality services
to improve patient outcomes.
• Access to clinical records is necessary for pharmacists to engage
fully with many of the new roles envisaged.
• More work needs to be done to establish effective interprofessional
working at a local level — GP and pharmacist co-operation
will benefit both groups, as well as the patient.
• Pharmacists have the location, tools and ability within their
communities to identify what local health needs are. However, to
benefit from this information they need to be part of an integrated
healthcare plan in the local area.
• Engaging with the local pharmaceutical committee is important
so that pharmacy is able to speak with one voice locally.
• To get the most from over-the-counter business pharmacies need
to focus on giving appropriate advice and asking the right kinds
of questions, because advice is one of the main incentives for
people to go to their local pharmacy for a minor ailment.
• Pharmacists who experience a downturn in income from Category
M cuts should consider whether they can get any tax back from the
excess profits made in the first part of the year.
• The financial climate in pharmacy is getting tougher but there
is still money to be made in the provision of new clinical services. |
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The
Pharmaceutical Journal