|
Tony West is president of the Guild of Healthcare Pharmacists
and Chief Pharmacist, Guy’s & St Thomas’ NHS Foundation
Trust |
As we recover from the excess of another holiday season, this comment
is aimed at those struggling with continuing professional development,
many of whom may have made a new year resolution to use the Society’s
online CPD package.
Following are six developmental needs that pharmacists should consider
adding to their CPD portfolios this year, based on new regulations. While
these are most applicable to those practising in England, the legislation
that will underpin the regulations described below is generally UK-wide.
The Health Bill
First, the Health Bill, which was under debate after its second
reading as Hospital Pharmacist went to press. Like a lot of other legislation
impacting on the NHS, this Bill is an enabler as it provides for Government
to introduce supplementary regulations. Although these regulations are
subject to scrutiny by Parliament, the process is nowhere near as complicated
and time consuming as introducing new primary legislation. There are
potential advantages in that changes can be made to adapt to differing
circumstances, but these have to be balanced against the perceived disadvantage
that Government has the option for greater deregulation.
Every pharmacist should be aware that part three, chapter two of the
Bill provides the enabling legislation altering the supervision requirements
of pharmacies. I will not rehearse the debate within the Pharmaceutical
Journal, just indicate that this will need to be a topic for pharmacists’ CPD
portfolios in 2006.
However, there is a range of other legislative enablers within the Health
Bill. Of most significance is the supervision of the management of Controlled
Drugs, this being found in part three, chapter one. Here the role of
the “accountable officer” is described along with the duty
of co-operation between organisations and powers to enter and inspect.
With the expected guidance from the Department of Health and amendments
to primary legislation that have been consulted on by the Home Office,
it should be a busy year for revisions to medicines policies and training
programmes for all health care staff.
Part one of the Health Bill deals with smoke-free premises, and although
the Health Select Committee blasts the Cabinet for inaction we probably
need to consider the response within our own organisations to assist
smoking cessation for both staff and the patients and carers who use
our services. May I suggest that another CPD entry for the start of 2006
is entitled pharmaceutical public health and that we all resolve to research
what we might be able to deliver in the secondary care environment.
Finally, part two from the Health Bill, which partly deals with prevention
and control of health care associated infections. Chief pharmacists in
acute trusts in England will be faced with the termination of the DoH
funding for antibiotic pharmacists at the end of this financial year.
They may therefore want to add this topic to their CPD portfolio as the
new legislation is not simply about hand washing.
Prescribing rights
So, four entries complete and the fifth could already be causing sleepless
nights — the further extensions to prescribing rights. Although
independent prescribing is broadly welcomed, the real issue will be in
the detail of the guidance that follows and how it is implemented. For
most of us this may be seen as purely a nurse and pharmacist issue, but
in dental hospitals there are implications as dentists will probably
get access to the whole of the British National Formulary when providing
NHS care, subject to the same proviso of practising within their area
of competence.
Openness
From a personal perspective, the topics suggested above are fairly obvious
candidates for developmental needs. Of more interest though is legislation
that may have passed some pharmacists by — the NHS Redress Bill.
This has its roots back in a “call for ideas” from the Chief
Medical Officer in 2001, which was followed by a consultation paper entitled “Making
amends”. The Bill applies only to England and Wales, as Scottish
law is significantly different. It is, once again, enabling legislation
that allows a scheme to be set up under regulations to deal with liabilities
arising out of hospital care provided as part of the NHS.
The key recommendation from “Making amends” was that an NHS
redress scheme should be introduced to provide investigations when things
go wrong, remedial treatment, rehabilitation and care when needed, explanation
and apologies, and financial compensation in certain circumstances. The
key policy drivers for such reform are based around openness, learning
and reducing litigation costs.
There is good evidence that such an approach works1, from the US, where
the Veterans Affairs (VA) require full disclosure to patients. The VA
has some remarkable similarities to the NHS in that it is federally funded
(ie, from taxation) and offers universal health coverage.
The National Patient Safety Agency Safety Matters bulletin (issue two)
references a training tool it has introduced entitled “Being Open”,
which also addresses informing patients of mistakes. The message is clear,
NHS culture relating to human error will need to shift further. The question
of what this means in relation to medicines and pharmacy practice remains.
I believe this is a must for a CPD entry, probably under the “professional
ethics” heading.
These developments should help pharmacists to have a professionally fulfilling
2006. One final thought — although most new year resolutions may
well have been broken by the end of January, the same luxury cannot be
afforded with regulations.
References
1. Kraman SS, Hamm G. Risk management: extreme honesty may be the best
policy. Annals of Internal Medicine 1999;131:963-7 |
Hospital Pharmacist