Review of NHS Pharmaceutical Care of Patients in the Community in Scotland

Report of an independent review of NHS pharmaceutical care of patients in the community in Scotland, carried out by Dr Hamish Wilson and Professor Nick Barber.

Workforce and Education

66. Future workforce requirements are inextricably linked with the nature of the services that the NHS wishes to see delivered, and we are aware that work is currently underway to take forward a Workforce Development Plan for NHSScotland to support achievement of the 20:20 Vision. In relation to pharmacy, there is currently no central locus for national workforce planning in Scotland, and none of the "controls" which apply to some other clinical professions. Scotland cannot plan in isolation from developments elsewhere in the UK and in Europe, for example, the work being undertaken as part of the Modernising Pharmacy Careers (MPC) programme on education and training. And there has been a significant increase in the number of Schools of Pharmacy in England and Ireland, as well as increases in student intake in the two Scottish Schools. A practical result has been far greater availability of pharmacists to work in permanent posts, and a significantly reduced reliance on locums, bringing the opportunity for greater continuity of patient care.

67. We believe that the experience gained by NHS Education for Scotland (NES) in workforce planning for other clinical professions can usefully be applied to pharmacy, using data collection and trend analysis to lead to better supply and demand forecasting, and capacity planning. While the focus of our review is on community based pharmaceutical care, it is important that the pharmacy workforce of the future is seen as a more integrated whole, with greater flexibility and movement between sectors to take account of the changes in patient care and service delivery.

68. While the undergraduate course in the two Scottish Schools has seen an increase in the clinical and patient related context and content, there is a need for this to be further developed to ensure that graduates are suitably prepared to meet the evolving service and patient care needs of the future. It is important that this encompasses all aspects of clinical care, community and hospital, but with a recognition of where the bulk of pharmaceutical care will be delivered. The opportunity should also be taken to continue to enhance the inter-disciplinary elements in undergraduate education, particularly with medicine, including greater co-operation between Pharmacy and Medical Schools. Learning together builds a strong foundation for more effective working together through greater understanding of and respect for each other's skills and expertise.

69. The Pre-Registration Pharmacist Scheme (PRPS), which is administered and funded by NES, has made good progress in achieving the objective of an appropriate period of cross-sectoral experience for graduates prior to registration, in line with the principles of the MPC proposals, albeit not within a formal integrated academic course. Whatever the final arrangements in Scotland for the five pre-registration years, the mismatch of graduate numbers and funded pre-registration places needs to be addressed. This should take into account the future workforce needs, and the nature of the funding support provided to those in that fifth year. If the PRPS were to continue and be seen as more integrated with the undergraduate course, there would seem to be logic in NES assuming for pharmacy the same role that they perform effectively for some other clinical professions i.e. becoming the employer of pre-registration trainees, quality assuring the training environments for educational purposes, ensuring the right balance of clinical (including inter-disciplinary) experience, and supporting and appraising the tutors.

70. A significant part of formal post graduate training, including the courses in Clinical Pharmacy and the Vocational Training Scheme, is currently focused on hospital based pharmacists, linking to potential career development. Just as there needs to be further work to continue to develop a structured Career Framework in hospital pharmacy, the opportunity should be taken to consider how such a Framework might apply in community pharmacy, based on clinical pharmacy practice, and recognising future CPD and revalidation requirements. This should also take account of the development of community based specialists and the inter-linking with the hospital based pharmacy services, with the increasing complexity of patient care ("hospital at home") in the community and the need for flexible professional input. The continuing benefits of inter-disciplinary learning (with medicine, nursing, social work etc) should be underpinned by more formal arrangements which provide protected learning time for community based pharmacists. This would support the practical implementation of, for example, the Patient Safety Programme in Primary Care, the delivery of services in Care Homes, and effective integration of health and social care for people with multiple needs in the community.

71. The development of pharmaceutical care in the community depends also on the skills and experience of the other members of the pharmacy team, the pharmacy technicians (now registered with GPhC), dispensing assistants and medicines counter assistants. There is a need to develop accredited training for pharmacy technicians in extended roles (e.g. checking of dispensed medicines, medicines review, patient counselling) linked more closely to the education and training of pharmacists, and to ensure that the other pharmacy staff have the relevant skills to support the public health, self-care, and long-term medication needs of patients and their carers.

72. As with other clinical professions, the education and training system for pharmacists and other team members has to recognise the changing nature of NHS services and the opportunity for a more integrated workforce. We recommend that there should be an early review of all aspects of pharmacy workforce and associated education and training, involving Scottish Government, NES, the Schools of Pharmacy, NHS Boards, and the professional groups to plan and take forward an integrated approach which meets the future service needs in Scotland.


Email: Elaine Muirhead

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