Q&A: Rob Duncombe, chair of the RPS Hospital Expert Advisory Group

Rob Duncombe is an experienced hospital pharmacist and chief of pharmacy in the NHS. He has been serving as the director of pharmacy at The Christie NHS Foundation Trust since 2012.

What is your professional background?

I am currently director of pharmacy at The Christie NHS Foundation Trust in Manchester. I previously worked for seven years as chief pharmacist at the Princess Alexandra hospital in Harlow, Essex.

Several years ago the RPS set up expert advisory groups in order to gain input from specialists in the various sectors of pharmacy. I applied to be on the hospital expert advisory group (HEAG) bringing expertise in oncology and my experience as a chief pharmacist. 

How does the group work?

We meet twice a year, in London. We also communicate virtually via email on an ongoing basis.

A key role of the group is providing support to the RPS in responding to consultations. The RPS receives consultations from many sources and a fair number of these relate to the use of medicines in hospitals. Recently, we have provided advice on storage of medicines in operating theatres; the prescribing of medical gases; and proposed changes by the Nursing and Midwifery Council to their guidance for the nursing and midwifery professions on medicines management. There’s a broad range of hospital pharmacy disciplines in the HEAG, so we have the expertise to be able to review them and support the RPS in responding to them. 

What priorities is HEAG working on at the moment?

We are supporting the RPS to take a leading role in medicines management, both in hospitals and more broadly. An example is our review of the RPS’s ‘The Safe and Secure Handling of Medicines: a team approach’ guidance document. This is a key document, which is widely used across the NHS and beyond to inform and support practice. The last update to the guidance was more than ten years ago and since then there have been a number of technological developments and other changes. As a group we felt that it was very important for the RPS to show leadership in this area.

We’ve established a task and finish group, who are overseeing the update.

Another major focus for us is in the area of workforce planning. It is gratifying that the role of the hospital pharmacist is developing and evolving and pharmacists are becoming ever more integrated into clinical teams, but that inevitably puts pressure on the service. Pharmacy managers are forever trying to strike a balance between service delivery and supporting service development. In particular, as staff take on new roles we need to ensure that we have in place the education and training strategies to ensure that the pharmacists of the future are sufficiently skilled to take over from those currently performing those newer roles. Otherwise, there is a real danger that services are being provided by sole practitioners and when those staff leave it could be impossible to replace them.

We work closely with the RPS to inform future workforce needs. A good recent example has been the development of pharmacists working within GP practices. While pharmacists from all branches of the profession have embarked on this career path, in certain areas of the country a number have been recruited from the hospital sector. 

Will Brexit affect hospital pharmacy?

That is difficult to answer, but as in all areas of healthcare a good number of pharmacists and support staff have been recruited from EU countries. In many cases these staff have been in post for a number of years and make a significant contribution to the pharmacy service. It may also be the case that a greater number of EU staff may be working in those parts of the country that have historically had problems with recruitment and retention of staff. It may be too early to say what the overall impact of Brexit will be on hospital pharmacy, but we certainly would not wish to lose any of the staff who have supported the development of hospital pharmacy services over many years. We also know that the way we deliver clinical pharmacy services in the UK is often in advance of those in other European countries, and when EU pharmacists return home, they take skills and knowledge with them which support the development of services in their home countries. 

What are your main concerns at the moment?

Workforce remains a key concern for me, and how we continue to develop and strengthen hospital pharmacy. Generally, pharmacists working in hospitals are extremely well respected. However, we need to be wary of developing niche roles, which finish when the post-holder leaves, because we have not focused enough attention on succession planning.

Access to resources and funds for education and training are also a concern at present, with ever-increasing reliance on staff to self-fund their training. In the current financial climate, where pay caps have been in place for a number of years, staff are having to make difficult choices about whether they can afford to support periods of further study, which historically have been funded through employer contributions. 

Why should people consider a career in hospital pharmacy?

It’s very diverse, incredibly interesting, and no two days are the same. You get to use your whole range of pharmacy skills, and you interact with large numbers of patients. You make a massive contribution to patient outcomes and safety. And you are recognised on an equal footing with other members of the healthcare team — you are truly valued by everyone you work with. Over the course of my career I have been involved in many projects which have not only improved patient safety, but also supported the medicines optimisation agenda. Most recently, I was involved in the standardisation of chemotherapy dose banding across England, which clearly showed that when a group of pharmacists gets together we can not only innovate but deliver change on a grand scale, extremely rapidly.

Can people join the Hospital Expert Advisory Group? 

We’re always looking for new members — across the whole spectrum of hospital pharmacy. Many members of the group aren’t based in hospitals, but do work within an NHS trust. As a group we recognise that diversity, and for our RPS support and policy work we need it.

It is extremely important that we attract new members to the group, and that we continue to evolve and develop. If people want to contribute to development in hospitals, and support the RPS, they can get in touch with us, by emailing support@rpharms.com. We need to keep our group fresh.