The challenges facing hospital pharmacy in the UK
- Correspondence to D Miller, Pharmacy Department, Sunderland SR4 7TP, UK;
- Received 21 July 2012
- Accepted 23 August 2012
- Published Online First 2 October 2012
Hospital pharmacists are facing a large number of challenges in the next few years in the UK, which will shape the agenda of the Guild of Healthcare Pharmacists (GHP) who provide professional and industrial representation. Some of the changes affect pharmacists in all four home countries of England, Scotland, Wales and Northern Ireland in different ways as we have greater devolution and increasingly what appears to be four health systems. Others have their effect mainly in England, particularly on the industrial front, following the election of a right of centre government. This is a personal and brief view of all of those challenges.
The professional landscape is changing in England. There is a programme of change for education of all health professions under the auspices of Medical Education England (shortly to be reorganised into Health Education England). The programme covering pharmacy is ‘Modernising pharmacy careers’, which has three major workstreams. Workstream 1 deals with undergraduates, following recognition that current education is not delivering sufficiently confident or clinically adept practitioners, there is agreement to move from what has been termed a 4 year scientifically orientated degree with a 1 year apprenticeship to a 5 year integrated degree. The 5 year integrated degree will have with greater multiprofessional training, patient contact and clinical training through teaching the science in a clinical context, increased placements in the workplace, increased clinical academics and improved diagnostic skills to facilitate the move to a greater prescribing and medicines optimisation role. Workstream 2 is still in the early stages as it seeks to address a number of problems, especially as there is little consensus on the solutions. The problems focus around the postgraduate career pathway, especially in community pharmacy and for novice practitioners. It hopes to address the increasing shortage of specialist scientific roles in quality assurance, radiopharmacy and manufacturing and how that links in with healthcare scientists and improving professional leadership and specialist consultant development. Workstream 3 is dealing with the cross linking agenda such as workforce. There has been a 40% increase in pharmacy graduates in the past 5 years. This is due in part to a move to increasing personal rather than state funding in higher education, no centrally imposed limits on pharmacy student intakes (unlike other health professions) and the current excellent employment prospects within the profession.
In developing pharmaceutical practice pharmacy in all four countries is focusing on an agenda of medicines optimisation—utilising the skills of the pharmacist not to merely improve the process of managing medicines but changing the agenda to focus on enhanced outcomes for patients both individually and collectively. As part of this work, GHP has been working with other organisations, including the Royal Pharmaceutical Society, to develop a series of hospital standards. The hospital standards will demonstrate that a hospital service is being provided not at a minimum and safe level, which is controlled by regulation, but at a quality or professionally acceptable level.
The regulatory framework for pharmacy in the UK is also in a major state of change, with an increasing emphasis on a just culture and professional empowerment. One issue that has not been resolved, and remains a barrier, is the issue that single dispensing errors can be prosecuted as a strict liability offence under sections of the UK Medicines Act, with a punishment of up to 2 years in prison. There was a proposal through a House of Lords amendment to introduce a potential defence of due diligence that was opposed by pharmacy professional bodies, including GHP, following legal advice that it could make the situation worse. The potential problem was that a jury could deduce that if all due diligence had been applied, how did the error occur? We have made it clear we have no problems with any prosecutions of individuals for knowingly reckless or negligent actions and continue to work with others to address the problem and protect pharmacists from an unfit legal framework. One legal issue that has been resolved however is the issue of wholesaling. The UK had until recently allowed registered pharmacies to wholesale a small amount of medicines—usually up to 5% of turnover. This was used by some hospitals to support other smaller hospitals without a pharmacy. This concession has now been removed to bring the UK in line with EU Law and we have worked with regulators to ensure that it has been achieved without detrimental effects on patient care or hospital pharmacy practice.
Pharmacy in Great Britain in 2010 had a new regulator, the General Pharmaceutical Council (GPhC). The GPhC is responsible for the registration and practice of pharmacists and registration of premises, but not usually within hospitals. In Northern Ireland a separate regulator, the Pharmaceutical Society of Northern Ireland, also underwent a fundamental change in role. The Government has now commenced a major review of the regulation of all healthcare professionals covered by the existing nine regulatory bodies with 1.4 million registrants. The aim is to bring professional practice under a single piece of legislation, provide greater freedom and autonomy to the regulators, and impose a degree of consistency for registrants. This is a major piece of work, starting with what is the role of a regulator. There is agreement that it is to protect, promote and maintain the safety of the public by ensuring standards for safe and effective practice—which is the current position within pharmacy—but others are seeking to expand the role into a requirement to maintain confidence in the profession itself.
Similar to the medical profession in the UK, the regulator has also commenced a move to require pharmacists to be revalidated in practice. This will probably require, in addition to the current system of continuous professional development, some form of feedback from peers, work colleagues and patients, evidence of work in quality improvements and reflective learning from incidents, complaints and, if you are lucky, compliments. This is to be underpinned by a professional appraisal system and a formal sign off of continuing competence by a responsible officer.
The most potentially contentious future areas in the regulatory and legal framework, particularly for our community pharmacist colleagues, are potential proposals to change the requirements for professional supervision of medicines by pharmacists and a greater role for newly regulated pharmacy technicians in medicines supply. This is intended to allow pharmacists in community practice to be freed to undertake more clinical and patient facing roles. However, there are concerns from these pharmacists that it will just be used by the multinational employers to reduce costs in service delivery and have a detrimental effect on patient safety.
Hospital pharmacists terms and conditions
Finally, like many countries in Europe, the UK is in a period of financial and economic austerity. This has led to a number of proposals to reduce pension benefits and increase personal contributions to pension schemes. These proposals are seen by hospital pharmacists and other professional staff in the National Health Service as unfair, leading to those professionals taking industrial action while maintaining basic emergency services. Hospital pharmacists are in the middle of a 3 year pay freeze. There are now further proposals to amend national terms and conditions to reduce the staff pay bill by over 10%. This will be achieved through reductions in basic pay levels, holidays, sickness benefit and no additional payments for weekends and nights and potentially a move from these national terms and conditions to regionalised (reduced) pay. In England in particular, there is also a drive for more private sector involvement in healthcare; this is particularly seen in the supply of medicines and the entry of major multinational community pharmacy organisations, driven in part by differential tax rates between public and private sector suppliers. This outsourcing of medicine supply is now so prevalent that guidance has been commissioned by members of the Procurement and Distribution Interest Group of the Guild.
It seems Confucius was correct in wishing for a life in uninteresting times.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed