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Mr West is clinical director, Guy's and St Thomas' NHS Foundation Trust |
The title for this article is unashamedly stolen from the front cover
of a recent issue of The Pharmaceutical Journal (21 August) announcing
the arrival of Agenda
for Change (AfC) with the advertisement of the
first pharmacy job under these new terms and conditions. Most of the
articles and presentations on AfC to date have concentrated, quite rightly,
on the mechanics of the process. Many, but not all, of the problems with
the job evaluation scheme and national profiles are now behind us and
probably our biggest concern on the basic terms and conditions side,
the emergency duty commitment, has been sidelined for the next four years
as a consequence of the review process. As a result, earnings and other
terms of conditions for pharmacists working in the NHS should improve
significantly, if not immediately then certainly over the next year or
so. All of this provides a real opportunity to reflect and look forward.
In writing this article for Hospital Pharmacist I have been careful to
ensure it is clear which hat I am wearing as none of the following necessarily
reflects views held corporately by the Guild of Healthcare Pharmacists.
The sentence that would naturally follow the title to this commentary
generally goes something like: “This service terminates here”.
AfC probably terminates, in my opinion, two aspects of hospital pharmacy.
The first of these is our current career path (if readers actually believe
that we have a career path that is obvious and structured when viewed
from a new entrant to our service). The second is our pre-occupation
with collecting bits of paper from higher education institutions that
may have academic rigour but lack any indication of whether the individual
possessing the qualification can deliver. The new NHS is all about delivery,
so anything that fails to address this will almost certainly fall by
the wayside at some stage.
The biggest challenge for pharmacy in the next 12 months, as the rest
of the NHS gets to grips with the technical components of AfC, is to
articulate the future career paths available to pharmacists within
the NHS. This in turn has to be integrated with the work, being led
by the Department of Health, on consultant pharmacists. Opportunities
to frame the future of the profession come around rarely: this is one
such time and the opportunity must be grasped. There is already a “Career
framework for the NHS” published by the Modernisation Agency — we
need to recognise that we will have to work within such a framework
as this includes all staff, even doctors and dentists!
The days are numbered for chief pharmacists to have the scope to adjust
grades of pharmacists or technicians so they can recruit — job
evaluation puts an end to this. We will simply not have E grade pharmacists
with just a few years experience or MTO3 technicians being appointed
18 months post-qualification. If you are lucky enough to be offered a
band 8a pharmacist post or a band 5 pharmacy technician position in the
future, you will already be able to demonstrate your capability to meet
a subset of the skills of the new job. The mechanism for this will, of
course, be the NHS Knowledge and Skills Framework (KSF).
Each post will have two KSF profiles: subset and full. The subset will
be the profile under which the post holder will be assessed within the
first 12 months in the job, the full profile will be what is expected
of a post holder who is meeting all the requirements of that job. Access
to development and training will be determined by what is required to
ensure the post holder fully meets the requirement of the current job.
It will also allow for identification of development needs for the next
job, ie, the chosen career path.
The subtle changes here should be clear to all. First, it will be the
NHS that drives the development needs of its staff, to maximise both
effectiveness and efficiency to deliver the NHS Plan. Second, the individual
professional groups within the NHS will need to be clearer about the
step changes in knowledge and skills that are required for different
roles. This clarity is required because it both directly impacts upon
job evaluation (posts gain points for what is required of the post rather
than what the post holder might potentially bring to the job) and the
access to resource for development of staff. The less subtle component
will be the part played by the KSF in pay progression once the development
reviews are embedded in a couple of years time.
At this stage, we need to ask ourselves a number of questions:
· Is there any clarity, shared across the
UK, for a career structure for pharmacy
services within the managed service component of the NHS?
· Is there a clear lead being given by any authoritative pharmacy organisation
that assures we have a consensus on knowledge and skills requirements,
and that this is uniformly applied across the UK?
· Is the NHS firmly in
control in terms of
specifying what it wants from providers of staff
development, whether they are internal or external to the NHS itself,
and how it
performance manages them?
Anyone reading this who could answer yes to any of these questions would,
in my view, demonstrate clear delusional tendencies!
There is much to do — the work on the consultant pharmacist role
will give a clear enough indication of whether we are a profession intent
on “up-titling” to deal with workforce problems in the short
term or one that might be willing to at least try and move along a common
path, to address medium and longer term issues. What is needed at this
time is some inspirational leadership and radical thinking — given
the number of largely independent pharmacy organisations that exist currently,
where do we find this? |
Hospital Pharmacist