A case for specialisms in pharmacy
The National Health Service is now an uncomfortable
environment for health professionals to work. This was the view expressed
by Clive Jackson, director of the National Prescribing Centre.
Mr Jackson said that the NHS has become uncomfortable
due to increased workload in the face of limited professional resources,
new and complex health care technologies and interventions, increased
media interest in problems with health care, an increasingly litigious
society, poor performance from a minority of professionals, and better
informed (and thus more demanding) patients.
In response to this uncomfortable environment, the
Government has, among other things, issued national guidance (in the form
of National Institute for Clinical Excellence guidelines and National
Service Frameworks), developed quality initiatives (clinical governance)
and introduced legal instruments (Health Act 1999, Health and Social Care
Act 2001). Professional bodies have also had to make changes, such as
improving disciplinary procedures and attempting to introduce re-validation
at regular intervals.
For pharmacists, the issues that are likely to be
of concern are:
- Definition of competencies. Questions that need to be answered include:
What are core competencies? Would the achievement of core competencies
allow a pharmacist to practise in specialist areas? Could those with
specialist competencies undertake tasks requiring the core competencies?
How would definition of competencies affect professional flexibility,
that is, the ability to move from one area of practice to another?
- Validation and re-validation processes. These are
necessary in order to assure the Government and members of the public
of professional competence
- Maintaining competencies. A distinction has to
be made between continuing education (CE) and continuing professional
development (CPD). Monitoring CE and CPD is essential but would require
some time commitment
In addressing the issue of competence, Mr Jackson
said that it would be necessary to consider who would produce the competencies
and how they would be produced. One option for the pharmacy profession
is to consider setting up a faculty for each specialty. Mr Jackson said
that specialist pharmacy faculties, similar to the specialist colleges
that exist in the medical profession, would be highly influential with
the Government. He said that, in the medical profession, the Royal colleges
provide a professional framework for the various specialties. A collegiate
system also provides recognition for members both within and outside the
profession, as the qualifications would be indicative of the attainment
of a certain level of competence (such as membership of the Royal College
of General Practitioners, or MRCGP, for GPs).
The establishment of colleges would provide an alternative
to a situation where the Society has to produce competencies for the “core”
competencies, as well as specialist competencies. Mr Jackson said that,
in practical terms, it would be difficult for the Society to accomplish
this task as it would require extra manpower and other resources. In addition,
undertaking the task could distract the Society from other issues.
Mr Jackson recognised that there are not as many
pharmacists as there are medical practitioners. Consequently, the number
of pharmacists in each specialty would be quite few and the large number
of specialties could lead to fragmentation in the profession. He therefore
proposed that a number of faculties could be established under an umbrella
organisation, such as the recently formed faculty of prescribing and medicines
management under the College of Pharmacy Practice. This would avoid duplication
of efforts and administration.
Other benefits of the faculty system are that the
faculties could provide opportunities for professional networking and
peer support, accredit relevant training for members, disseminate good
practice and aid in the re-validation exercise.
Answering a question from the floor, Mr Jackson
said that the extent to which various aspects of pharmacy practice could
be specialised is open to debate but that, for logistical reasons, a faculty
would need to have at least 200 members. There is also the effect of specialisation
on registration status. For example, would specialisation mean that specialists
could only be conditionally registered. Mr Jackson said that issues such
as this had to be addressed.
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