Hospital Pharmacist
Vol 9 No 10 p282
November 2002

Integrating academia and practice

By Catherine Duggan, PhD, MRPharmS

At this year's British Pharmaceutical Conference (Manchester, September), there was a focus on leadership and hospital pharmacists. Speaking at a conference session, Dr Peter Lees (national programme director at the Government's new Leadership Centre), said that there is a need to deliver a step change in the calibre of National Health Service leaders and to promote leadership development.¹

During a subsequent conference session, entitled "Clinical directorships, consultant pharmacists and clinical competencies", various ways for delivering the kind of leadership required to modernise the NHS were proposed. The publication of "A spoonful of sugar" has provided hospital pharmacy with ways forward for this branch of the profession. There is a need to move from pharmacists as head of services with a management focus to clinical directors with strategic responsibilities. With consultant positions emerging in other health care professions, the time is right to develop clinical directorship roles for chief pharmacists.^1,2

As we are aware, there is little formal succession planning within the NHS, and a lack of planning for career progression within pharmacy, which limits the emergence of leaders able to take on new roles. The profession is said to be vulnerable because it lacks clear guidance on the ways to achieve various levels of practice.

The need for standardised career ladders and competence-based practice throughout the profession was proposed during the conference session. They should be based on objective measures of competency while allowing excellence to flourish. Various continuing professional development (CPD) programmes exist that provide good training. However, they do not provide consistent competencies, which are needed if competence is to move from a local initiative to a national standard. During the conference session, there was a recommendation for structured career pathways for pharmacists, with a national standard applicable throughout the United Kingdom. If this approach is to work, various agencies and care sectors need to work together, taking a consistent and collaborative approach.

The presenters acknowledged that competency in professional practice is not limited to hospital practitioners but has to be developed across the health care sectors to include community and primary care colleagues. In addition, appropriate measures of accreditation need to be developed to ensure national standards are met. Career progression needs to be based on performance. Accreditation must be appropriate and recognised by representative bodies (eg, the Guild of Healthcare Pharmacists and the UK Clinical Pharmacy Association). However, collaboration does not end there.

Alignment needed

There is a need for academia and practice to become more closely aligned for rigour in the process of accreditation — this has to be on a national rather than a local level. For such integration to be the norm rather than a rarity, good practice should be shared and built upon.

One way to integrate academia and practice is through the establishment of academic practice units that are centres for co-ordinating and integrating both teaching and practice, and research and practice. Many such units integrate practitioners and academics to achieve this aim to varying degrees. Many units have set about excellent ways of integrating academia and practice. Indeed, many trusts have achieved integration without such units being formalised. However, in an endeavour to share good practice and new ideas for collaboration, it seems timely to detail some innovations we have initiated and implemented.

The academic department of pharmacy (ADP) at Barts and the London NHS Trust has been an established link between practice and academia for over a decade.

During this time, the main remit of the ADP has been to integrate science and professionalism. Teaching and research have been linked intrinsically to the School of Pharmacy, University of London, but the ADP has also worked with other colleges and trusts. Various joint appointments and secondments have been established, as in other units, but some are specific to Barts and the London. We have undergraduate and postgraduate clinical lecturer positions, research-practitioner posts, a directorship, and a new outreach officer position.

In order to integrate teaching and practice, the trust has to be a practice base for undergraduates and postgraduates to learn about practice as well as a teaching base for practitioners to learn about teaching. The ADP is central to this development. We have co-ordinated clinical placements for courses run by the university (collaborating with other trusts to achieve this) and have developed a programme whereby junior staff (B and C grade pharmacists) are routinely involved in teaching on the MPharm degree course (for prescription monitoring). More senior staff are involved in the delivery of specialist lectures (eg, pharmacotherapeutics). The approach is systematic and thorough, with lesson plans and learning objectives to ensure that academic standards are maintained with appropriate professional input. We have a joint board set up to ensure standards are maintained and junior staff document their experiences in CPD portfolios.

The other remit of the ADP is to integrate research and practice, which we undertake on two main levels. First, we have an established record of researching and evaluating practice by jointly supervising students from undergraduate to masters to doctorate level with the School of Pharmacy. We have a programme of research projects for students to undertake and have access to local and international Erasmus and masters students. Secondly, we have a responsibility to involve staff in evaluation as part of their routine practice. We now have regular meetings where staff can brainstorm areas of practice to be evaluated and develop collaborations with other staff in pharmacy or elsewhere.

We also maintain records of completed, ongoing and planned evaluations, from audits to full-scale research. Pharmacy staff are supported in managing students from the university in these projects and can undertake the projects themselves while registering for a further degree. All staff and students are encouraged to disseminate their evaluations locally, nationally and (sometimes) internationally.

If we are to develop consistent approaches to measuring competency in practice, together with career progression models and greater integration between science and professionalism, we need to share experiences, approaches and good practice. This will allow pharmacy to develop in line with calls for standardised practice and incorporation of evidence into all aspects of service delivery.