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In the 1990s, the Royal Pharmaceutical Society of Great Britain (RPSGB) launched a vision for pharmacy known as ‘pharmacy in a new age’ (PIANA).1 PIANA raised the profile of the profession and demonstrated that pharmacists were not only prepared but also qualified to provide increasing contributions to the wider National Health Service agendas. This programme of development was expanded in the ‘fit for the future’ programme2 which spearheaded improvements in pharmacy education, including: investment in research and development; development of a pharmacy student code of conduct and fitness to practice systems;3 as well as inspiring standards for education and training.4 Along with structural changes to the professional leadership body (RPSGB) and regulator (General Pharmaceutical Council (GPhC)) and considering the goals for future practice described in recent government white papers,5 ,6 the profession has reflected upon existing undergraduate course and its ability to deliver competent practitioners who are able to put patients first. Fundamentally, the pharmacy profession is required to be adaptable and flexible, and it must be able to demonstrate the benefit of pharmacy practice on real patient outcomes. Modernising Pharmacy Careers (MPC)7 workstream 1 proposed the integration of the preregistration year for pharmacy undergraduates within the current 4 year degree, extending it to a 5 year course, for all universities in the UK, to facilitate an increasing focus for students on practice based activities and the application of knowledge into practice. MPC is part of ‘Medical Education England’ which will convert to ‘Health Education England’ within the next 12 months. Although this work is led by England, the other three home countries (Scotland, Wales and Northern Ireland) are closely observing and mirroring the developments locally.
A focus on clinical skills—teaching and assessment
In order to increase the focus of pharmacy practice on patients, there has been an increasing emphasis placed on the development and retention of clinical skills within the profession, as well as the development of a holistic approach to patient care. With this shift in focus comes the need to develop appropriate examinations to determine pharmacy student as well as pharmacist performance in the experiential setting.8–10 In order to determine the competence of the future pharmacist in clinical practice, schools of pharmacy have stepped up to the challenge of designing and implementing robust series of assessments to ensure that graduates are equipped with the essential skills and knowledge to deliver safe and effective pharmaceutical care in a wide range of settings. A recent document commissioned by the GPhC ‘The assessment of observed practice; a literature review’,10 found that within healthcare professions, including pharmacy, there is a need for assessments which address a range of professional competencies. The authors recognise that to achieve this, a range of methods are required and suggest; An integrated programme, intertwined with the educational programme.
This approach will support the role of the employer in the teaching of undergraduates, particularly the provision of opportunities to interact and develop patient based skills in a range of practice settings. In the development of a pharmacist, the goal of assessment of clinical competence is to enable pharmacy students and newly qualified pharmacists to demonstrate their competence in clinical pharmacy practice skills—for example, to identify and resolve pharmaceutical care problems in different clinical settings. In order to standardise the definition and assessment of competence across the profession, the Competency Development and Evaluation Group (CoDEG)11 established a framework for general level pharmacists, the General Level Framework (GLF), and the Advanced and Consultant Level Framework (ACLF) for pharmacists further along in their careers. These frameworks have been embedded in hospital pharmacy training across the UK over the past few years. They also represent core standards within postgraduate programmes, such as the diploma/MSc in general pharmacy practice run by the Joint Programs Board (JPB)12 and the vocational training (VT) programme in Northern Ireland led by the Northern Ireland Centre for Postgraduate Learning and Development (NICPLD).13
Competency training programmes support pharmacist education and training through a range of specialities in hospital practice, from aseptic preparation and medicines information to clinical pharmacy. Students complete a portfolio of evidence from each area in which they ‘rotate’, demonstrating their achievement of various competencies, as per the GLF or ACLF. Students complete a variety of other assessments throughout their training, including oral presentations, a mini-clinical examination (CEX), mini-peer assessment tool (PAT) and objective structured clinical examination (OSCE). Other pharmacists complete the traditional certificate, diploma and MSc in clinical pharmacy, either via local teaching or distance learning.
Depending on the specialist or generalist career path that a pharmacist undertakes, a number of further qualifications are available to support future development, such as Qualified Person (QP) training, Masters of Business Administration (MBA) and the Doctor of Practice (DPharm). A DPharm is a postgraduate practice based doctorate, usually completed after an MSc in clinical pharmacy, where credits are awarded for practice based work—for example, case studies on patient's care managed by the doctoral student demonstrating their practice, as well as a research project into an area of their practice. Assessment is via reflective assignments based on practice work completed, evaluated by university academic staff. This course is often undertaken by senior clinical pharmacists (eg, consultant pharmacists). The degree is completed part time over between 4 and 7 years, depending on the candidate and the university. The DPharm differs from the PharmD award which may be the primary undergraduate degree undertaken by a candidate.
Hospital pharmacist banding and qualifications
Although not directly linked to promotion, table 1 displays the agenda for change14 banding when these courses are normally undertaken to support practice. Junior pharmacists start in hospital practice at band 5 for preregistration training, working up from band 6 as entry level pharmacist, through to the most senior pharmacy posts at band 9 (eg, chief pharmacist of a hospital or trust).
Continuing professional development
Alongside the formal training programmes and qualifications described above, all pharmacists in the UK are required, since 2009, to participate in mandatory continuing professional development (CPD) and submit a portfolio annually which is relevant to their practice and which demonstrates their ongoing commitment to continuing education in their chosen generalism or speciality. In the UK, 30 h of CPD is required for every pharmacist on the register of RPSGB and the Pharmaceutical Society of Northern Ireland (PSNI). CPD is intended to focus the relatively widespread continuing education undertaken by many pharmacists. It requires them to identify learning needs prior to undertaking the continuing education, as well as to put the learning into practice, reflecting on its benefit to their personal development or for patients. Assessment of portfolios is undertaken by trained assessors at the RPSGB and PSNI who review a random selection of portfolios each quarter to determine if an appropriate amount of CPD has been submitted and to determine if the learning has been appropriately documented in their portfolio. Unacceptable portfolios are required to be resubmitted in order for the selected pharmacist to remain on the pharmaceutical register. Support is provided to pharmacists to aid their completion of their CPD portfolios if required.
Training networks in the UK
To support a cohesive approach to education and training across the UK, Local Education and Training Boards are developing training networks to plan and design education to support more sophisticated workforce planning and provide patient care closer to home. These networks will work closely with each other as well as their professional colleagues in medicine and nursing. It is a period of great evolution and development within pharmacy across the UK as we are responding to political, social and professional drivers for change. New concepts in healthcare education development are being embraced, including the use of technology, such as virtual patients and healthcare professionals, as used by the UK Clinical Pharmacy Association Haematology and Thrombosis Group15 to support training for pharmacists and other healthcare professionals at ward level. Most importantly, pharmacy is pursuing an ever increasing focus on the patient and pharmaceutical care that all pharmacists can provide.
Footnotes
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.