Hospital Pharmacist
Vol 10 No 1 p2
January 2003

Looking back to the future

By Diane Langleben, BPharm, MRPharmS

It is probably true to say that in the world of pharmacy, major changes or findings rarely have much impact outside the profession. We quietly get on with the things we do best while the public perception remains that of someone hidden away in a back room counting out tablets to transfer from one pot to another.

However, that perception was dealt several blows during the past year. Published at the end of 2001, the Audit Commission's "A spoonful of sugar" report not only sparked off much debate within the profession during 2002, but also led to discussion in the wider community via wide media coverage. The remit of the Audit Commission is to promote the best use of public money by ensuring the proper stewardship of public finances and by helping those responsible for public services to achieve economy, efficiency and effectiveness. In "A spoonful of sugar" the Audit Commission emphasised the importance of medicines management as a significant part of the clinical governance responsibilities of NHS trust boards, and the key role that hospital pharmacists and technicians play in reducing risk. The report states that the importance of the pharmacist's role needs greater recognition outside the profession; this can only be applauded.

At the British Pharmaceutical Conference, held in Manchester in September, David Lammy, Parliamentary Under-Secretary of State for Health, said that hospital pharmacists were at the vanguard of the profession in developing new clinical roles and will be the first pharmacist prescribers. Mr Lammy also referred to "A spoonful of sugar" and how the recommendations within the report has exciting challenges and opportunities for hospital pharmacists. Sessions for hospital pharmacy at the BPC were also dominated by "A spoonful of sugar". In particular, Nick Mapstone, a senior manager at the Audit Commission, stressed that the document should be seen as a pharmacist's charter.

This year's Hospital Pharmacist conference, the most successful to date, brought together pharmacists who discussed many issues arising out of the Audit Commission report. They were not only looking into the future to see how practice should develop, but also showing how practice had been improved at their particular hospitals, well before "A spoonful of sugar" was published.

In November, again with extensive media coverage, pharmacist prescribing was given the green light by the Department of Health. After a period of training, the aim is to have 1,000 pharmacists as supplementary prescribers by the end of 2004. These supplementary prescribers will be able to share responsibility for the management of individual patients under written clinical agreement plans agreed by independent prescribers, supplementary prescribers and patients.

In the same month, the United Kingdom Clinical Pharmacists Association held a highly successful intensive weekend school. Pharmacists and technicians, both community and hospital, shared good practice and I was particularly impressed by the amount of solid research now emerging from the community sector that has improved their practice of pharmacy. Together with good practice in hospital, this will make a positive contribution to seamless patient care across both sectors of the profession.

And finally, in December, we were told that technicians, who are undertaking more and more of the roles traditionally assigned to pharmacists, are to be registered with the Royal Pharmaceutical Society. Hospital Pharmacist has long recognised the important role that well-trained pharmacy technicians play. To start the new year, we have introduced a new section, "Focus on technicians" aimed at technicians, but not exclusively for them. The articles presented there will show how hospital pharmacy technicians are pushing forward their traditional boundaries and making a full contribution to the profession.

Cynics might suggest that both pharmacist prescribing and the extended roles of technicians are due to a trickle-down effect because of a lack of professionals: too few doctors mean that pharmacists have been chosen to take on some of their professional roles, and a serious dearth of pharmacists (15 per cent of pharmacy posts are vacant) has inevitably led to technicians being given more responsibilities. Whether this is true or not, we must grab the opportunities now being made available, first ensuring that those undertaking these new roles, pharmacists and technicians alike, are trained to an appropriate and universal standard.

The year went out with a bang, when the media paid close attention to research carried out by Dr Bryony Dean on medication errors. One of the conclusions drawn from the research is that hospital pharmacists need to establish routine and formal feedback systems for reporting errors. At the Hammersmith Hospitals NHS Trust, pharmacists meet regularly with other health care staff to discuss medication errors that have occurred and to think of ways to stop them happening in the future.

So, I would suggest that 2002 was the "year of pharmacy". We have finally come out of the back room, and through the positive media reports, the public must now be aware of our rightful place as part of the hospital health care team, not only as pill pushers but as advisers who can use our particular expertise for the well-being of patients.

And what of 2003? I have never been a gazer of crystal balls. However, it has to be said that much of what was started in 2002 will inevitably begin to bear fruit during 2003. Throughout "A spoonful of sugar" can be found case studies of good practice showing what can be done to provide a first class medicines management service. For example, the arrangement for medicines management governance and the impact of clinical pharmacy at North Staffordshire Hospitals NHS Trust, the redesign of medicines supply services at Mid-Sussex NHS Trust, identifying future medicines cost pressures at Salford Hospitals, the robotic dispensing system at Wirral Hospital NHS Trust, and the introduction of electronic patient records at Burton on Trent Hospitals and Wirral Hospital NHS Trust. Certainly, these are not the only hospitals which could have been chosen as examples of what the Audit Commission wants all hospitals to achieve. Conversely, 2003 will not be the year when one could pick any hospital pharmacy at random and find that all the Commission's recommendations have been put into practice. Nevertheless, the work has been started and the Government has recognised that urgent action and investment are needed. As the report states: "The risks of not acting are substantial, both in terms of quality of patient care and the costs to the NHS. Maintaining the status quo is not an option."