The Pharmaceutical Journal
Vol 268 No 7182 p119
26 January 2002

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“Guide to Clinical Governance” articles

In the third of a series of articles on aspects of clinical governance, Catherine Dewsbury, the Royal Pharmaceutical Society's clinical governance pharmacist, analyses a new Department of Health document on clinical governance in community pharmacy

What needs to be done?

Questions for community pharmacists

What it means for community pharmacy

Clinical governance is defined as: "A framework through which National Health Service organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care, by creating an environment in which excellence in clinical care will flourish." From this month there is no excuse for community pharmacists to say that the NHS is ignoring their role and potential in clinical governance. Throughout England, letterboxes have been rattling to announce the arrival of the Department of Health document "Clinical governance in community pharmacy: guidelines for good practice for the NHS" (see p81).

The document has been written by Professor Alison Blenkinsopp (regional pharmaceutical adviser, West Midlands), Professor Jennifer Tann (University of Birmingham) and Jeannette Howe (deputy chief pharmacist for England). The guidelines have been tested by many individuals and organisations involved in quality and in pharmacy, including the Royal Pharmaceutical Society, the Pharmaceutical Services Negotiating Committee and the National Pharmaceutical Association. The guidelines provide a clear reminder to chief executives of primary care organisations that clinical governance must extend to all NHS activities, including community pharmacy.

The guidelines list initial actions for primary care trusts (or health authorities where PCTs do not yet exist) to carry out by April and elements on which to build an action plan for integrating community pharmacy into wider clinical governance plans in future.

With the Vice-President (Dr Gill Hawksworth) and the head of professional ethics (Helen Darracott), I was involved in preparing the document. The Society supports the objective of clinical governance, and it encourages all pharmacists in the community — whether contractors, superintendents, managers or locums — to participate fully so as to maximise their contribution to the health and safety of patient and the public.

What needs to be done?

There is work for all in this document, with the emphasis on PCTs and community pharmacists and their staff. Chapter 3 of the guidelines acknowledges that PCTs may be at different stages in terms of pharmacy and clinical governance. Some areas have done considerable work, as demonstrated in the numerous examples of good practice. Others have either ignored community pharmacy or have not prioritised it. This is worrying when one considers that about 15 per cent of NHS expenditure is on medicines. The aim for the months until April is to get all PCTs off the starting blocks.

The first steps are to:

1. Identify someone at the PCT who will take the lead on integrating community pharmacy into local clinical governance frameworks

2. Appoint a community pharmacy facilitator for clinical governance

3. Include community pharmacy in PCT clinical governance committees

4. Set up local communication networks

5. Undertake a baseline assessment

6. Provide training on clinical governance and to build on earlier training

7. Ensure that services commissioned locally, whether new services or existing ones such as advice to residential homes, have clinical governance arrangements

8. Include community pharmacy in plans for 2002–03

9. Develop a strategy for implementing community pharmacy clinical governance in a multidisciplinary framework

We know that many community pharmacists have done baseline assessments and are working to establish local networks, and some local facilitators have already visited more than 100 pharmacies. But do not sit back thinking you have nothing else to do. Remember that clinical governance is not a one-off event. We can always improve. Look at the questions in the panel and be honest with yourself and your staff. You might take the opportunity to ask your customers similar questions. Remember that involving patients is an important part of clinical governance.

Where local pharmaceutical committees and PCTs have agreed a strategy for clinical governance in community pharmacy, it should be tested against the guidelines. The guidelines include a whole section (Chapter 4) on formulating a development plan. This offers useful advice on such diverse topics as confidentiality, handling complaints, reporting adverse incidents, continuing professional development, appraisal and poorly performing pharmacists. Much of this is a useful reminder for employers, superintendents and individual pharmacists.

The Society also receives a steady stream of telephone calls from PCT pharmaceutical advisers seeking tips on writing job descriptions for clinical governance facilitators in community pharmacy. This is made easier for all concerned because the guidelines give a sample job description and person specification for this role (Appendix 3).

For those who are new to clinical governance or who want more information on how it fits into the wider health agenda, Chapter 5 sets out "the wider context". This includes an important update on government initiatives, including improving patient safety by minimising medication errors.

Preventing and reducing medication errors is a subject close to the heart of all community pharmacists and their staff. It may be news to many to learn that England's chief pharmaceutical officer, Dr Jim Smith, is working up a plan to tackle the problem of medicine errors with the aim of hitting the Government's target for reducing serious medication errors. This is a tough task but one that the Society must support if pharmacists are to fulfil their role in risk management and protecting patients.

The document's final section (Chapter 6) consists of examples of good practice, demonstrating the contribution community pharmacists and their staff can make to local quality improvements and clinical governance. These are split under three headings: "Delivering clinical and service standards", "Risk assessment and management" and "Continuing professional development".

In many examples the pharmacist is based in the pharmacy. Other examples highlight the work and support available from the Society, the NPA and the College of Pharmacy Practice. Helpfully, there are contact details for those who wish to follow up particular examples. Most importantly, the examples demonstrate that, with imagination, commitment and local co-operation, pharmacists can participate in local schemes to improve quality of pharmacy services, and wider NHS services, for patients and the public. And if others can do it, so can you.