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Miss Ewing is clinical director of pharmacy, the Royal Liverpool and Broadgreen University Hospital NHS Trust and Vice-President of the Royal Pharmaceutical Society |
For decades, to work in hospital as a
pharmacist was to work in the twilight zone of the profession. No one
really knew what went on in the basement departments, except that copious
amounts of disinfectant solutions and
various rather smelly ointments were produced. There were few rules or
regulations and
clinical pharmacy services were only a vague dream. How
different things are today!
Modern departments with high-tech systems for aseptic production and
dispensing are springing up all over the
country. And it would seem that at last there has been a
rising wave of interest in
hospital pharmacy from the powers that be – both those inside and
outside the NHS. In September 2000, the
Government published “
Pharmacy in the future – implementing the NHS plan”. Since
then, in December 2001 we have had the Audit
Commission’s “A spoonful of sugar”, which compared
standards across England and Wales.
Now we have “A vision for pharmacy in the new NHS for England”,
issued by the
Department of Health in July. Perhaps the politicians and civil servants
have, at long last, realised the importance of the high quality medicines
management systems in place in hospitals and what can be learned from
this by other sectors!
As well as implying that
hospital pharmacy has moved up the Government’s agenda, the “vision
document” has some other useful messages. For example, the management
of pharmacy services features strongly in the vision
document, and the support for the progress made to date is reassuring.
The crucial point on management set out in the vision document is that
chief pharmacists (or should I say clinical directors of pharmacy) are
recognised as having a vital role to play at senior management level
within trusts. Every single person in this position must now push for
this wider role, if it has not already been established in their trust.
Those trust chief executives who choose to ignore such moves do so at
their peril, because the next round of the medicines management framework
will expect this to have happened and the benefits to have been realised.
There is also a welcome emphasis on working across the boundaries of
primary and
secondary care, which is to set the baseline for the future
development of pharmaceutical services to the population of each health
economy. This will enable easier implementation of other Government initiatives
such as the national service frameworks. We already have some joint appointments
across both sectors for chief
pharmacist positions and I am sure that we will see many more.
There is no doubt that the rational use of antibiotics
advocated in the vision
document is essential for the future health benefits of the nation. The £12
million that has been made available for
promoting this is most
welcome. However, in reality that figure means around £13 to £18,000
per trust per annum – not enough for a full time post at the desirable
grade! Even so, the focus on this issue emphasises the rising
importance of the appropriate use of medicines in the
Government’s view. We need to ensure that we use the money wisely
and achieve the stated aims.
There is also great emphasis on the expanded use of new technology in
hospital
pharmacy. Having just
implemented a robot system for dispensing, I know the
difficulties involved in securing funding and working with the currently
under-resourced NHS IT departments. The expansion of the NHSnet to community
pharmacy will be of major benefit for the transfer of important information
outside the hospital to improve patient care. Unfortunately, the vision
document does not
indicate what funding will be avilable for this, or for all
hospital pharmacy departments to modernise.
On the other hand, it does indicate that substantial funding will be
accessible for
manufacturing within hospitals. This is welcomed, as we all know how
difficult it can be to obtain from the pharmaceutical industry products
that are
essential for patient care but commercially unattractive.
The focus on achieving an appropriate skill mix is also
welcome. Hospitals have for many years pushed back the barriers for novel
staffing
systems to be introduced. Indeed “technician checking” grew
out of the necessity to expand clinical pharmacist roles in hospitals.
This principle is accepted in the vision document, which takes the issue
further, expanding it outside hospitals into community pharmacy, reviewing
the supervision requirements that currently exist. The registration of
all pharmacy technicians, a principle recognised in the vision document,
will provide a common set of standards for those working in all sectors.
However, the lead will most certainly come from secondary care organisations.
Expansion and development of the technical workforce is vital for continuous
improvement in the quality of patient care.
“Agenda for change” is upon
us and if we believe the vision document, the situation will be that
by “…. changing traditional ways of working ….” we
will reward staff and encourage them to stay in the NHS and improve patient
care. Doctors and dentists have been allowed to opt out of this programme,
but pharmacy is still included.
I will wait and see with
great interest what happens
at the early implementation sites!
There is no doubt that
consultant pharmacists with supplementary or independent prescribing
rights will be of benefit to patient care. Indeed in many cases, introducing
these powers will be formalising
systems that already exist. The recognition of this in the vision document
will give power to chief pharmacists to press for funding for these posts.
The principles set out in the vision document are broadly welcome. Some
of the detail is lacking, but I guess we will have to wait for the consultations
to end to see whether these gaps will be filled. I believe that with
the next round of the “Hospital medicines management
framework” we will see
medicines management as a top priority for trust boards.
Clinical directors of pharmacy (or chief pharmacists as they used to
be known!) will need to make sure that they are ready to rise to the
challenge. |
