Hospital Pharmacist
Vol 10 No 5 p198
May 2003

Review of circulars and official publications
by Alex Bower, MRPharmS

Agenda for change: proposed agreement was issued by the Department of Health (DoH) in March and is available as a PDF file (210K). The document sets out a new pay structure with three pay spines for "doctors and dentists", "nurses and other health professionals" and "other directly employed NHS staff, with the exception of the most senior managers". The latter two pay spines are divided into eight pay bands. Staff will be assimilated into the pay structure at some pilot sites on 1 June this year and national assimilation will be 1 October 2004. A recruitment and retention premium of up to 30 per cent of pay is payable for specific situations. The new scheme will represent a significant change for hospital pharmacy which, in general, has valued its independent pay scale and, traditionally, has guarded against being grouped with other professions.

The "Job evaluation handbook: first edition", also issued in March by the DoH, describes an evaluation scheme based on a points scoring system (maximum of 1,000 points) that matches jobs to pay bands. A range of national job profiles linked to bands is available. Some of the factors that are taken into account together with the maximum points available for each are:

240 points:
Knowledge, training and experience

60 points:
Skills such as those relating to:

• communication and relation- ships, analysis, organisation

• Physical skills

• Responsibility for patient and client care, policy and service, finance and staff, human resources, leadership, training, information, research and development, freedom to act

25 points:
Physical, mental and emotional effort

There is a job profile for a "specialist pharmacist (eg, renal/oncology/section manager)" which has been evaluated with 496–511 points in band 7 and for a "pharmacy technician" which has been evaluated at 216 points in band 3. The 2002/03 pay rates for these posts, as set out in "Agenda for change", are £24,500–£32,300 and £12,450–£14,900 respectively but the current scales that would be considered appropriate for assimilation to these bands is not indicated. The 164-page handbook relates mostly to job profiles. Hospital pharmacists will find pages 1 to 42 to be of interest together with page 132, which is the pharmacist job profile. The document can be accessed as a PDF file (460K).

"Developing NHS Direct : a strategy document for the next three years" was issued in April by the DoH (available here). Further investment is to be provided to enable this service to meet future demand, including out-of-hours services. It is envisaged that NHS Direct will eventually become a means whereby patients will be able to access all parts of the NHS. NHS Direct currently provides a 24-hour nurse-led help and advice telephone service and an internet service (NHS Direct Online). The current level of capacity is six million calls a year. By 2006, it is expected that this will grow to 16 million calls a year. Part of the development process will involve greater use of specialist staff to handle particular calls. Significant expansion of the internet site, including the development of video content, is envisaged. A new NHS Digital service, to start in April 2004, will explore possible health applications of digital television and this will include information on medicines. These exciting and important developments in patient empowerment will have a profound influence on the future delivery of health care. Hospital pharmacists will recognise the potential for pharmaceutical input to these schemes and the potential to enhance the way information about medicines and how they should be administered is provided. There is a need for some long-term strategic thinking on this topic to guide hospital pharmacists in the way that they should be shaping services for the future and engaging in the new developments as they occur. Senior hospital pharmacists may wish to use their influence to ensure that this work is either underway or can be initiated.

"Partnerships for care: Scotland's White Paper" became available in February from the Scottish Office and can be viewed at the Scottish Executive website.

This document recognises that improvements in health can best be done through partnership working between the Scottish Executive, local authorities, the voluntary sector and local communities. It sees patients and national standards as key drivers of change, and front-line staff as leaders of the change process; a "command and control" model is explicitly rejected. The inclination is to distrust structural change as a distraction from the key issues and challenges to be addressed. Education, housing, the environment and employment are all seen as key contributors to aspects that can help improve health. Four particular areas of attention are: the early years, teenage transition, the workplace and communities. The document seeks to ensure that the views of patients, carers and local communities are actively sought and that they are empowered to increase the extent to which they can take control over their own health. There will be a "whole system" approach to the redesign of services to reduce waiting times and end bed blocking. Significant change is envisaged in the services that will be provided in primary care settings in the future. For example, GPs who have acquired specialist expertise or specialists who are based to a greater extent in the community could provide more specialist treatments. Health care teams will work across communities and care settings in a multidisciplinary and multi-partner way. Increasingly, acute services will be delivered in hospitals on a day case basis and in ambulatory and diagnostic centres. New intermediate care and rehabilitation services will be developed. The process in Scotland to dissolve trusts and create single NHS organisations in each area to strengthen corporate working will continue.

The document heralds profound change in the future delivery of health care. The boundaries between primary and secondary care will become blurred and this will impact significantly on hospital pharmacy. A strategic approach is needed to ensure that pharmacy skills are deployed wherever these are appropriate and not confined to within hospital walls.

  * PDF files on PJ Online require Acrobat Reader 4 or later.

Mr Bower is a consultant pharmacist