Elections 2018: What is the biggest issue facing pharmacy?

England

Claire Anderson, academic 

All pharmacists are working under pressure with fewer resources as the NHS goes through unprecedented changes. I advocate that every community pharmacy should have a pharmacist present to provide advice and support to the public about medicines and health.

I advocate for integration of clinical care across the profession promoting all pharmacists as clinicians, enhancing the professional standing of all pharmacists and supporting them to demonstrate their expertise.

The RPS is unique in representing all pharmacists from across all sectors and supporting them as they face massive organisational, economic and technological changes. Pharmacy is on the lips of NHS England and the other royal colleges and in the media like never before and we are getting the professional recognition we deserve. However, there is no need for complacency and the English Pharmacy Board (EPB) must build on its successful leadership work to ensure that pharmacists are supported in delivering effective patient care.

While having a national and international leadership role we must also build on our local engagement. Education is the foundation for the profession and educators need to enhance the skills of pharmacists to meet new demands, including revalidation.

I advocate for all pharmacists to be prescribers and for the qualification to be integrated into MPharm and foundation years. Foundation training is currently ad hoc; it should be encouraged across all sectors of pharmacy to improve the adaptability of the workforce. The RPS must become the royal college home of the foundation training programme for the profession, building on our successful work in the Faculty.

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Catherine Armstrong, primary care pharmacist

It depends on which sector as to what seems to be the most important matter, but the most important matter facing the pharmacy profession regardless of sector is ‘workforce’. There are multiple strands to ‘workforce’; again, these depend on which sector you work within.

Workforce pressure is not unique to pharmacy and is certainly not unique to any one sector. The pressures may outwardly appear different but they are still there and affect the daily lives of pharmacists.

Proving the value of the workforce is also not exclusive to pharmacy, nor to any one sector. Ultimately, our profession needs to prove its worth and ensure that wherever there is a medicine, there is a pharmacist.

Working together, not against each other, seems to be a recurring issue for pharmacy and this is something we need to address. The more I talk to pharmacists working in other sectors, the more I realise that we have more in common than we all think. I want us to remove the barriers we’ve created within our profession and celebrate our successes instead of competing against each other. If we could harvest the energy and time we spend in-fighting, just imagine what we could do instead. We need to remember “the whole is greater than the sum of its parts.” The EPB needs to lead by example and show that the right 14 people alongside the support of the RPS staff can achieve the very best for our profession.

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Harry Cotterill, hospital pharmacist

A most pressing issue I have seen for pharmacists is in the community sector, is the issue of having too many tasks and targets preventing pharmacists undertaking clinical work. By this I mean showing patients how to use their inhalers, advising them about the best ways to use their antihypertensive medications, conducting thorough uninterrupted MURs; the things we learned at university but rarely get chance to show the public. I feel this is how young pharmacists become rapidly disenfranchised, as they are alone in their store day after day without the time, freedom for action, or support to use their clinical training.

I would like to see the RPS engage with big pharmacy chains, and outline directly to them that if they were to allow some autonomy for stores targets, and give back dispensers staff time to their stores, then each store could bring in new sources of revenue currently untapped. This can be done by applying to the local clinical commissioning groups (CCGs) to commission locally needed services that GP surgeries do not have the time to do. The RPS should then in tandem help to create guides on how to write service-level propositions. The majority of colleagues I speak to do not have great links to the local CCG or surgeries and I feel this could help improve that and in turn improve a pharmacist’s moral.

Pharmacists want to help patients clinically and any move that helps put patients in their direct care is good for patients, the professionals’ resolve, and the profession as a whole.

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Sultan (Sid) Dajani, community pharmacist

The air of stygian gloom hanging over our members in most sectors has never been worse and the reality is, mistakes and accidents occur when pharmacists are busy, frazzled, under pressure, exhausted and distracted. Safety, care and caution will only come if the front line is protected, funded adequately and is a calm and interesting place to work.

Ineffectively addressing membership needs is a vicious cycle; translating into a profession that’ll struggle to deliver owing to deepening malaise, fermenting discontent and increasing divisions. Causing a perceived irrelevance of the RPS, falling membership, more workplace sweatshops, exclusion from the vernacular of health’s commissioners/policymakers, dangerous funding cuts, poor cross-sector working, under-utilisation of innovation, no collaborative working, inconsistent workforce development and a diluted vision.

Addressing it requires an RPS leadership with a strong, clear, inspiring voice mandated from across all sectors by a dynamic, vibrant, diverse, united and engaged membership which will effectively challenge threats, harness opportunities and deliver the inclusive, ongoing vision.

This will come from formulating policies and resources that invigorate and empower individual members, examples of which I outlined in the piece I wrote for The Pharmaceutical Journal in November 2017 and include a members policy-debating forum and two-way engagement linking social media with a nationwide physical presence.

Getting this right will give us the right tools and political support that’ll reap a range of immense benefits to our members, our profession, our patients, the taxpayer, the NHS, all our stakeholders and whoever we collaboratively work with.

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Jane Devenish, community, cross-profession pharmacist 

Pharmacy is a busy place and I certainly felt spoilt for choice when it came to the most important matters facing us. Medicines shortages are hugely important for patient-facing pharmacists; the Falsified Medicines Directive will profoundly affect the way that pharma-industry and community pharmacy operate; the Carter review is forcing transformational change in hospital, while funding reductions are affecting all and supervision changes create passionate debate.

I think it will turn out to be antimicrobial resistance. Antibiotics have been squandered faster than they can be developed, and this historic healthcare crisis requires the attention and action of all pharmacists. We don’t write most of the prescriptions, but as medicines experts we must be part of the solution. Funding reductions in community pharmacy and extended opening hours in hospital trusts are still having a huge impact on day-to-day activities, with many contractors and trusts genuinely struggling to balance their books and taking logical steps to pare back activities to a minimum. But these are false economies and, if elected, I’d work with the RPS to ensure that pharmacists can be bold and resilient in saving society from a world without effective antibiotics and ensure that stakeholders understand this vision so that they are able to access the resources needed to do so.

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David Gallier-Harris, community pharmacist

The most crucial factor facing the sector is survival. Community pharmacy is under threat from the Department of Health and Social Care with a narrative that pharmacy supplies medicines and that this can be achieved more cost effectively. The effect of this narrative however will be the removal of thousands of accessible healthcare professionals from communities. I don’t believe this is the best thing for patients and thus a counter narrative is needed with new ways of working to maintain the current pharmacy network.

Pharmacy must add more clinical value to its offering. Box-shifting is a thing of the past. We must change. It is crucial that there is a service-based element to pharmacy funding with investment in quality systems. Medicines optimisation should be at the heart of what we do. We need a contract which can grow over time whereby the safe-supply function is maintained but community pharmacists are employed not to shift boxes but to utilize their professional expertise and are integrated into the heart of the NHS.

The role of the RPS is to provide leadership, enable discussion and collaboration, and showcase the value of what we can deliver to the NHS. Be visionary! The organisation must focus its resources and energy on the community sector to achieve this. Part of the solution is integrating community pharmacy into care pathways – something the RPS is uniquely positioned to facilitate. We need an uncomfortable degree of change. The RPS needs to be there, knowing what to do, guiding us all through the storm.

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Thorrun Govind, community pharmacist

The RPS is for every sector, all ages, all backgrounds, all pharmacists. A threat to one is a threat to the profession.

I believe that it is every pharmacist’s right to work in a safe environment in order to improve safety and care for patients. As pharmacists, we are being asked to do more and more with fewer resources.

There are a number of ways to address this:

• We need to ensure that pharmacy is advocated for and the profile of the profession is raised. That pharmacy has a voice and it is listened to. The public and stakeholders need to understand the importance and value of the work that we do.
• Support systems must evolve to cater for the new, exciting opportunities that are opening up for pharmacists and to enable pharmacists to transition.
• The RPS should set out a clear position that pharmacists should not be placed under workplace pressure which adversely affects patient safety. As our professional body the RPS should be advising the GPHC in setting minimum standards. Pharmacists should not be forced to work alone or forced to work without a break.

Finally, we need to ensure that pharmacists who are struggling are not afraid to seek help before workplace pressures overwhelm them, and are supported to do so when they need it. As healthcare professionals, we have to ensure that we look after our own, which in turn safeguards the interests of the patients we all serve.

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Tohidul Islam, community pharmacist

After spending over a year building up The Pharmacist Cooperative social network and having discussed our current situation with so many locums, managers and contractors, I think we have a lot of issues that need to be dealt with simultaneously. Some of the main concerns are unsafe workplace pressure, unrealistic targets for MUR and NMS, the oversupply of pharmacists leading to reduced demand, hence a decrease in pay year on year and an increase in the number of university places for pharmacy degrees.

The problem of workplace pressure is something that impacts both pharmacy team and our patients. It leads to more errors and some of which can be fatal. We have seen on the BBC how low staff levels and increased work pressure has led to three deaths in a short space of time. Do we really want a repeat of that or an increase? I think not. To reduce this we need to ensure the RPS has a greater power in ensuring there is a safe staffing level and that non-pharmacist line managers are held responsible if adequate staffing isn’t given. Superintendents and owners or heads of corporations must also be held liable if staffing levels are not safe.

Unrealistic medicines use review and new medicine service targets can lead to some unnecessary services being carried out, which is highly unethical and wastes NHS money that could be directed to a more critical area. It also puts unnecessary pressure on the pharmacist and the team when they could be doing more important things.

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Hala Jawad, GP practice/community pharmacist

Many members have become disillusioned with the RPS and feel that it no longer represents them. I want to promote the many ways in which members can be supported by the RPS, for example, through local and national representation on important issues, education on current legislation, or clinical updates relevant to continuing professional development, to name just a few.

I am standing for the EPB and, with your vote, will work towards developing a professional body that we can all value. I believe It is important to retain and grow the membership while also focusing on the needs of our members.

I will work hard to ensure the RPS is sustainable and better reflects the interests of its members, so that it is a recognised and respected organisation across all pharmacy and healthcare community sectors.

I strongly believe in collaborative working, especially with the changes that are happening in the pharmacy sector currently. I feel that it is important for pharmacy involvement in healthcare initiatives, as well as in local and national health groups. I believe the RPS should provide better mentor support and encourage more cross sector and multidisciplinary working.

I have extensive expertise in social media, and I feel that it is important for pharmacy to be represented favourably on the social scene; I will ensure that the RPS and EPB are represented in a positive light and are visible to everyone.

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Asim Mirza, practice/community/new roles pharmacist

Decriminalisation of dispensing errors. Although I was pleased to see the amendment to the law that is due soon, I’m still concerned that this only defends a limited scenario. Pharmacists should be aware that they remain at risk of prosecution. The RPS must continue to lobby our parliament to decriminalise inadvertent dispensing errors other than the two scenarios achieved. This will not only create better working conditions for pharmacists, but also safeguard the public by encouraging better reporting of errors.

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Hemant Patel, community pharmacist

“Change is the law of life. And those who look only to the past or present are certain to miss the future.” John F Kennedy

Rapid change in multiple areas (e.g. finance, workforce, technology and government decisions) have an impact on the lives of all pharmacists and then there are sector-specific issues that need to be addressed. The ability to see opportunities when facing the stiffest of changes is necessary.

Despite being recognised and valued, pharmacists still have to face several difficulties and challenges in our profession. Some of these challenges are easy to overcome but others are quite complicated to handle. Major challenges that pharmacists are facing today include:

• Identity as a pharmacist, lack of cohesiveness and low self-confidence as a profession;
• Some say too many pharmacists. I say, ‘great underutilisation of our skills’;
• Changes in the way we practice, adoption of technology and workforce issues;
• Patient-centred multidisciplinary work.

There is no instant solution and no one person will be able to transform the situation. However, I believe that the RPS can utilise the skills of the profession (including the young and the Fellows) to organise a ‘structured big conversation’ about what we want each sector in the profession to look like in 2025 and develop a pathway to that vision. Pharmacy 2025, as a unifying and imaginative output of the ideas from within the profession, can then be used to influence others. Recognition of diversity with a common thread can give us agility and sustainability.

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Stephen Riley, primary care pharmacist

The most important matter affecting the sector is adapting to continuing change and the need for a strong professional leadership body to be a cohesive voice for our profession.

The whole profession is affected. Community pharmacy is reeling from the ongoing pressures of the 2016/2018 funding cuts, and hospital pharmacy is undergoing changes following the Carter Review. There is continuing and significant change following the development and transition into local care organisation (LCO) services will be commissioned at local level. Across the board we have seen significant challenges around workplace pressures, with our autonomy overridden or interfered with by non-pharmacist management. Also, there is no overarching plan to utilise and develop the pharmacy workforce and adapt service delivery to meet current/future patient needs.

I will work to implement/develop the following to address:

• RPS endorsement of the Safer Pharmacies Charter to support pharmacists and teams to safely and effectively deliver services with better working environments;
• Practical toolkits and leadership support for pharmacists at local levels to champion pharmacy and achieve integration of pharmacy into LCOs and accountable care organisations so not left as a poor relation looking in;
• Practical support to develop new pharmacy services;
• A cohesive workforce plan and clearly defined roles for pharmacists. Developing a pharmacist workforce who can deliver services, such as patient clinics, with an accompanying post-graduation framework of professional and career development.
• The RPS acting as a lead organisation for collaborations of work streams to develop the profession with others.

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Paul Rutter, academic

I believe that the changes to healthcare sector and how pharmacy contributes to patient care are the most pressing issues now and in the immediate future.

All sectors of the profession are facing challenges; from the implementation of the Carter Report and the Specialist Pharmacy Service Review in hospital to the fallout of the Murray Review in community. This will require the profession to work together and not in isolation. We cannot afford to look at service provision as distinct and discrete entities. We need to ensure that, as a profession, and through the RPS we articulate what we do. Our unique and distinctiveness in contributing to patient care has to be recognised by other healthcare professionals, commissioners and government departments. In my opinion this has to be delivered by the RPS.

We need to build on what the RPS has so far achieved and over the coming years ensure it flourishes. For this to happen we need more pharmacists to join the RPS; after all, if the RPS is to become the strong and major voice for pharmacy, then ultimately its influence will have an effect on all pharmacists – members or not. As the RPS matures, it needs to more vocal and have a greater visible presence to the outside world.

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Aamer Safdar, hospital pharmacist; academic 

Hospital pharmacy transformation programmes (HPTP), the meltdown of A&E services with an undercurrent of financial pressures and low morale owing to workplace pressures are some of the issues facing hospital pharmacy. The issue of lack of interoperability in many hospital digital systems results in inefficiencies and duplication of work, putting further pressure on the system and introducing a risk to patient and medication safety.

From the system-wide perspective, the Sustainability and Transformation Partnerships and the development of Accountable Care Systems means that there are opportunities for greater integrated working across traditional boundaries. The hospital pharmacy workforce has to evolve around the changes in the health and care landscape at the local level and this is not an easy thing to do while managing internal pressures in the system.

I would like to see greater use of pharmacists across patient pathways from cradle to grave and across traditional sectors. There are some excellent models around the country and the RPS needs to continue to lead on the sharing and signposting of these best practice models. The digital agenda is critical so that pharmacy is integrated across care systems and healthcare professionals have access to information when they need it. I would like to see the RPS continuing to lobby for read-write access to patient records.

The HPTP agenda is the most important matter because this will lead to the change needed to ensure better person-centred care alongside better use of data informatics for medicines use across the systems.

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Wales

Michael Curson, senior primary care pharmacist

In my arena, the most challenging issue that the profession is facing is around adapting, developing and supporting roles which can allow pharmacists to reach their true potential as members of multidisciplinary healthcare teams.

We must build on our successes and further train and develop the pharmacists of the future so that we have a clear pathway to attract more pharmacists into patient facing primary care roles. The demand for pharmacists to work in GP practices has never been so high, the development of specialist prescribing roles in, for example, pain management and respiratory therapeutics has also indicated that pharmacists can deliver high-quality care in “medicines heavy” areas.

Their activity in every day medicines management releases efficiencies as well as cementing the pharmacist’s role as the expert in medicines. Our currency as a profession has escalated; we now need to develop short- and long-term strategies to develop the pharmacists of the future and the RPS has a pivotal role in this.

Community pharmacy is tied by volume-based dispensing, which obstructs more patient-facing roles that pharmacists are more than able to take on. The important role in medicines supply amidst increasing polypharmacy should never be taken for granted, but in order to develop new roles, the pharmacy contract needs to be shaped to maintain viability and accessibility, but ensuring pharmacists are released to deliver direct patient care.

To enable this movement, we need to develop our people and systems to realise our full potential as healthcare practitioners.

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Janet Gilbertson, head of organisational development, education and learning at Cwm Taf University Health Board

I believe the most important matter currently facing us in the health sector is the healthcare professional workforce shortage crisis, at the same time as an increasing demand with an ageing population and advancements in treatment options.

This crisis is being felt most acutely in the medical and nursing professions, due in part to maintaining traditional working models that are no longer fit for purpose.

Pharmacy has done much, within the profession’s boundaries, to transform traditional models, developing competent professional support staff with clear delegation of responsibility and accountability, and so enabling clinical roles advancement.

However, this is mostly within our profession’s boundaries. The choice facing pharmacy now is to continue to focus on what the profession needs to develop, or actually consider first what the population health needs are, understanding the current context of the workforce crisis and focus on how the profession can utilise our expert knowledge and skills to take up our leadership authority in a fully multidisciplinary environment.

In reality, of course it is both, however we have to stop waiting for the ‘prescription to arrive’ and ‘checking it meets our requirements’ before we take action. We need to proactively co-create prescribing the future through embracing collaboration and interdisciplinary working to drive improvement and make a real difference to patient care and population health.

The Welsh government has shown itself to be supportive of the vision of the difference across health that pharmacy can make, we now need to take our leadership of that vision ourselves.

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Jodie Gwenter, education and training lead, ABMU  

Hospital pharmacy needs to be smart and safe. Undoubtedly, workforce and workload pressures are the most important matter facing hospital pharmacy right now. Balancing increased demand with limited resources, while ensuring quality care, is a tough nut to crack and let’s not forget, hospital pharmacy should also be a satisfying and fulfilling career. Of course, this matter sits within a complex system of capability, relying on integrated models of care, well-governed role extensions (prescribing, administration, assistant technical officer (ATO)-assisted services), fit-for-purpose digitalisation (data capture) and effective workforce planning. Each workstream in its own capacity warrants effective leadership and plays a significant role in building a hospital pharmacy workforce that is flexible, adaptive and innovative to managing increased demand.

Pharmacy in Wales is heading in the right direction. Organisational alignment is at long last allowing us to share common goals and work in partnership from within and outside the profession. Continued engagement is paramount for success and I would like to see us strengthen these relationships and draw on evidence-based practice to optimise the way in which we work. Use of pharmaceutical care acuity tools in hospitals is being explored across the UK and I believe requires further development to ensure prioritisation of workload against well-planned expansion of skills. I would also like to see hospital pharmacy move to a model of referral for the safe discharge of patients. This exists for therapies, why not pharmacy? Hospital pharmacy needs to move in a direction that is smarter and safer.

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Rafia Jamil, senior practice support pharmacist

Where the idea of pharmacist working in primary care is not entirely novel, however, it’s safe to say that its expansion to patient-facing roles mainly in GP practices is still under development. The role varies hugely from practice to practice across the UK, and while there is nothing wrong with it in essence, it highlights the importance of need of mentorship and training for the right skillmix, which is crucial to perform these widely varied roles in a GP pharmacist capacity. There are several training centres offering training programmes for aspiring GP practice pharmacists, however there is no clear information available about the structural content of the programme and who regulates them.

The RPS sits at the heart of envisioning, developing and delivering the future of pharmacy practice. There is incredible potential for the RPS, the Royal College of General Practitioners and health boards to work in collaboration to design a programme similar to the NHS Structured Training and Experience for Pharmacists (STEP) to equip pharmacists with the knowledge and skills to meet the needs of the role, getting an independent prescribing qualification is not the magic answer. There is a definite need for the introduction of structured mentorship programmes for new-to-role GP practice pharmacists and designing career pathways for those who see themselves progressing beyond the scope of current practice, including recognition of pharmacist advanced practitioners at a professional level.

Where pharmacists in patient-facing GP practice roles could be the missing piece of the puzzle, it is high time that the profession moves forward as one and works in collaboration to shape the future instead of getting consumed by the sector-based debate.

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Dylan Lloyd Jones, Pharmacy Manager, Welsh Contractual Support Manager, GP Support Pharmacist

The Welsh pharmacy sector must deliver an active response and willingness to diversify into service provision. Failure to capitalise on the current opportunity to have a greater integrated role in primary healthcare and service delivery will be detrimental to our profession. As a sector, pharmacy must respond both to changing demands and delivery environment, becoming prepared to adapt towards future trends. This is essential to ensure that pharmacy services can advance beyond its current boundaries.

With increased use of automation, threat of centralised dispensary services and a deprescribing agenda on the horizon, relying on dispensing income alone will not be a viable option for many pharmacies in the future. However, we are also seeing an increased demand and opportunity for wider services to be pioneered and offered. These advanced services allow an opportunity for the Welsh pharmacy sector to become integrated into primary care pathways and support patient care. To provide financial security and sustainability as a sector, we must prepare and advocate this as the future role of pharmacy.

Clinically, the profession must advance as a whole. Qualifications, guidance, training, workforce, workload management and legislation will all need review to address and adapt to these changes in services. This must be designed and implemented in a way that involves and engages the entire profession. This will allow pharmacy to enhance its’ provision and position as part of the modern NHS.

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Fiona Jones, clinical lead pharmacist in primary care

The most important factor for the whole of the UK must be to improve the public recognition of pharmacists and their teams, with emphasis now on community pharmacy. They must be supported with safe staffing levels, opportunities to develop their clinical skills further, and have more autonomy over decision making and a chance to become independent prescribers. This would raise their profile as clinical practitioners in the high street with patients, GPs, governments, commissioning groups and health boards.

They should all have training in clinical examination skills for acute conditions and in therapeutics to support chronic disease management.

I would like to see the RPS boards challenging the status quo, working with the chief pharmaceutical officer, the General Pharmaceutical Council, educational bodies, the government and health boards to ensure pharmacists have the above opportunities.

The RPS needs to improve their communication with members, continuing to utilise the different social media platforms that are out there; they need to be visible and board members should be playing an active role in this also.

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Helen Lewis, community locum pharmacist 

The most important issue we have across every sector has to be funding. In community pharmacy, private contractors are struggling to keep businesses afloat, and multiples are cutting staffing and shutting branches. In hospital pharmacy, pharmacists are worried about the number of wards they’re covering and of missing critical information because of work overload. Primary care needs more investment to really show what pharmacists can contribute.

In Wales, the government seems to recognise the worth of pharmacists much more than England, of which the WPB can be proud, but we are still affected by the cuts. The RPS is a professional leadership body not a regulatory body, a financial negotiating body or a trade union but I believe it needs to speak a bit louder on issues that are the forte of these as it all affects professional practice.

Workplace pressure is a huge issue for pharmacists but who is addressing it? Patient safety is an issue concerning many, which is why I’m supporting the Pharmacists’ Defence Association’s Safer Pharmacies Charter. The RPS needs to support the aspirations of the whole profession not just the few, too many pharmacists are not engaging as they don’t see RPS is relevant to their day-to-day experience. We all want to do our best for patients, but if that leaves you on your knees at the end of the working day you hardly feel inspired to participate.

This is a great profession; if all branches and all professional bodies work as one perhaps we can show how great.

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Cheryl Way, national pharmacy and medicines management lead

I think that creating the capacity and capability to deliver all that pharmacy aspires to do is the most important matter facing the sector now. Pharmacists are increasingly taking on more clinical roles, as I believe they should, but I would also like to be assured that there are plans in place to deliver the services that pharmacists have traditionally done.

I would therefore, like the RPS to work closely with the Association of Pharmacy Technicians to further develop the roles of pharmacy technicians to support the delivery of services. I would also like to see the evaluation of technologies that could support efficiency of service delivery being completed and shared. I would like the RPS to ensure that appropriate training and development opportunities are available for pharmacists throughout their careers to take on these new roles. I would hope that all pharmacists would avail themselves of these opportunities for development. I know how much both patients and other healthcare professionals value pharmacists undertaking these new and extended roles.

I would like to ensure that pharmacists are competent in these roles and that the services they have moved on from are still being provided safely and efficiently, if needed.

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The results of the Royal Pharmaceutical Society (RPS) national pharmacy board elections are due to be announced on or around 22 May 2018.