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Ray Fitzpatrick is clinical director
of pharmacy at Royal Wolverhampton Hospitals NHS Trust and chair
of the Hospital Pharmacists Group committee of the Royal Pharmaceutical
Society
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At this time of year we tend to reflect on the year gone by as well as looking to the future.
This year started rather inauspiciously for hospitals when the Health
Secretary announced that all trusts would be in financial balance by
the end of March 2007. For trusts already struggling financially, this
set alarm bells ringing. For hospital pharmacy departments, cost improvement
plans meant, at best, a freeze on developments, or, at worst, cuts in
resources. Even trusts that were financially stable at the end of 2005
did not escape, since the increasing application of Payment by Results
signalled a further financial challenge.
The threat to hospital pharmacy is obvious, since clinical support services
are an easy target when it comes to cutting budgets. So, too, is the
medicines budget where cutting costs may reduce the need for staff redundancies.
However, with this threat comes the opportunity for pharmacists to use
their clinical skills to help reduce medicines expenditure without compromising
clinical care. This is not an easy task, but when performed successfully
it raises the profile of the pharmacy department both with clinical teams
and at management level.
The state of NHS finances has had implications beyond our individual
hospitals. There are now fewer pharmaceutical advisers in the new strategic
health authorities, and a reduction in hospital pre-registration training
places across the NHS. The implications of these changes will be far
reaching.
Whilst all this has been going on Agenda for Change (AfC) is continuing
to be implemented at a slow pace, with many staff still uncertain about
how their job will be graded. Although the reduction in working hours
for hospital pharmacists that comes with AfC is long overdue, it adds
to the financial challenge for many departments.
Publications
The results of the Healthcare Commission’s medicines management
audit were published this summer. Most hospital pharmacists agree that
this piece of work was not perfect, but as Alison Ewing pointed out in
a recent issue of Hospital Pharmacist, it was a good start.1 It is now
the responsibility of trust chief pharmacists to ensure the right messages
are taken from their own hospital’s report. The national report
is due to be published at the end of this year, bringing with it another
opportunity to raise the profile of hospital pharmacy within our organisations,
and the wider health community. It is good to see the Hospital Pharmacist journal doing its bit by making this the central theme of its
conference in February.
Two other important documents issued this year offer further opportunity
for hospital pharmacists to expand their influence in medicines management.
First is the Department of Health guidance on safer management of Controlled
Drugs, which not only heralded the role of the “accountable officer” within
trusts, but paved the way for chief pharmacists to undertake this role.
Further guidance on handling CDs in hospital is expected early next year.
Second, there was the change in primary legislation to allow pharmacists
to become independent prescribers. The slow uptake of supplementary prescribing
by hospital pharmacists has been attributed to the fact that it is more
applicable to chronic disease management than acute hospital care. With
independent prescribing there can be no such excuse. Here is our opportunity
to improve prescribing directly, and cement our role at the centre of
medicines management.
The HPG
2006 has been a challenging year for the Hospital Pharmacist Group (HPG)
committee of the Royal Pharmaceutical Society. In addition to the usual
tasks of responding to consultation documents, the HPG has had input
into workstreams such as the definition of “practising”,
and the development of standards for prescribers (work still in progress).
We have also attempted to engage with the Healthcare Commission in the
report stemming from the medicines management audit.
The HPG has been proactive in producing a briefing document for parliamentarians,
which is the first time MPs have been given information about a range
of issues specific to hospital pharmacy. We have also produced a response
to the All Party Pharmacy Group inquiry into the future of pharmacy.
Another important piece of work was the review of the HPG terms of reference
and membership to reflect the changes in the Society following establishment
of the national pharmacy boards. This review was instigated by the HPG
in order that we remain fit for purpose in the new environment. We have
used the opportunity to create a forum within the Society for key stakeholder
groups to come together and provide a unified credible voice for hospital
pharmacy.2
The future
Looking forward, it is likely that next year will bring yet more change.
Practice-based commissioning is with us now, although nobody yet seems
clear about what it means in reality. It represents another potential
threat to hospital pharmacy if there is major movement of clinical services
into primary care. However, there will also be opportunities, since the
philosophy is still one of joint working.
Sharing experiences and new practices is vital if we are to learn from
successes (and mistakes), and this journal provides a forum to do this.
If hospital pharmacy services are to develop in this sea of uncertainty,
then we need to evolve with the changing environment, we cannot stand
still. As the US commander George Paton once said: “In a fast-moving
battlefield, if you dig a fox hole, you will be digging your own grave”.
References
1. Ewing AB. A
good starting point — for medicines management
arrangements. Hospital Pharmacist 2006;13:306
2. Hospital Pharmacist Group Committee, Hospital Pharmacist Newsletter,
The Pharmaceutical Journal 2006;277:Supplement (PDF 290K)
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Hospital Pharmacist