A decade has passed since consultant pharmacist posts were established within the NHS. These roles offered experienced pharmacists an alternative to management in terms of career development.
Now, England’s chief pharmaceutical officer Keith Ridge has called for a ten-fold increase in the number of consultant pharmacist posts — there are currently 68. So what does it mean to be a consultant pharmacist, how do you become one and what might the future hold once in post?
Defining the role
Caroline Parker has worked in mental health for around 15 years and has been consultant pharmacist for adult mental health at Central and North West London NHS Foundation Trust since 2008. “In some ways, being a consultant pharmacist does not differ from being a non-consultant — there are many pharmacists operating at that same advanced level of practice but just not in a job with this title,” she says. “In other ways, though, it does differ. A consultant post must incorporate certain elements, such as expert clinical practice, education and training, audit and research, and it needs to consider issues that may be outside of the post-holder’s immediate place of practice but relevant to the wider profession.”
Tim Banner, consultant pharmacist for community healthcare across Wales, says: “Clinically you are at the forefront of the profession and provide leadership to drive the profession forward.” He adds: “In my role, I am required to provide advice to the Welsh government and make sure a pharmacy voice is heard at the highest level.”
Sharron Gordon is one of five consultant pharmacists for anticoagulation in the UK and has been in her role at the Southern Haemophilia & Thrombosis Network for the past six months. She says her role exists to “decrease the incidence of stroke across Wessex by improving the prescribing of anticoagulation in patients with atrial fibrillation”. She explains that all of the consultant anticoagulation posts share a common goal of having regional or national responsibility to influence others to improve services alongside significant direct patient contact.
Nina Barnett, consultant pharmacist for care of older people, based at Northwick Park Hospital, Harrow, was one of the first consultant pharmacists to be appointed in the UK. Her path to the post started in 1987 when she had been a pharmacist for only a few weeks. “I was asked to cover a care of the elderly ward and was invited by the consultant to join his multidisciplinary ward round. I soon realised how useful a pharmacist’s input was to those ward rounds and I became inspired to see what other services could be developed.”
In 2001, Barnett started working on a project where elderly patients received multidisciplinary medication reviews on admission, as inpatients and on discharge. She would write letters to GPs explaining any medication changes made and telephone patients after discharge to see how they were. The project subsequently showed this approach enhanced clinical outcomes, reduced costs associated with inappropriate prescribing and improved communication with GPs. Now, 14 years on, that project has developed into a service available to any patient in Northwick Park Hospital who is deemed to be at risk of preventable, medicine-related problems. The service now offers referrals to community pharmacies for follow up through the new medicine service or via a medicines use review and, in September 2015, it became a winner at the HSJ Value in Healthcare Awards.
“My career grew through identifying a service need, creating a pilot to collect evidence for the benefit of that service, then establishing and providing it before expanding it elsewhere and helping others deliver it,” she recalls. “That, in essence, encompasses the role of a consultant pharmacist. It is not just about delivering expert care to your own patients but also helping others to develop the care they deliver to theirs.”
Route to consultancy
Anna Murphy, consultant respiratory pharmacist for University Hospitals of Leicester NHS Trust, has been in her role since 2001 — although it was only ratified as a consultant post in 2007. Her enjoyment of working with patients led her to the role: “I was working in a managerial role before I took up the post but was not happy to be moving away from patients,” she explains. “Motivating patients is one of my biggest strengths. As well as being an expert in your area, you need to be a good communicator and teacher — since educating patients and other healthcare professionals is part of the role.”
She also believes a consultant should have, or be working towards, a higher-level degree, such as a PhD.
Banner says: “You need to be approachable and have the ability to foster relationships and gain people’s trust quickly.” He adds: “You also need to have confidence in what you are doing and in your skills as a pharmacist.” His role is strategic — developing pharmacists’ roles across primary and secondary care to improve the service patients receive with regards to medicines, and to facilitate other pharmacists to do the same. He supports development in community healthcare across Wales. “It is crucial to learn how to work with people in different organisations who do not necessarily ‘speak the pharmacy language’ — such as care workers and government agencies.”
Having worked both as a specialist pharmacist for elderly care in a hospital and as a primary care prescribing adviser, he believes having experience in both primary and secondary care is vital for his post.
Gordon was a deputy chief pharmacist before she took up her consultant post. While, like Murphy, she moved away from management to spend more time with patients, she does not regret her time as a deputy chief. “Getting extensive management and leadership experience in a senior managerial post, where you deliver strategic change, is hugely beneficial when looking to develop services and commissioning activity.”
Consultant pharmacists must be pragmatic in their approach, she adds: “Pharmacists often tend to be black and white in their approach to patient care. However, you soon realise, when working in an outpatient-type setting or when guiding drug choice through joint discussion with patients, that you need to be a lot more ‘grey’ in your thinking — and support the patient in choosing the appropriate care, rather than simply following guidelines.”
Barnett suggests that patience is an important quality for consultant pharmacists to develop. “You may have a good idea on how to develop a service but it may not be the right time for it. However, you must not give up — you need to keep hold of those ideas and be aware of what’s going on around you so that you know when the time is right to take them forward.”
Highlights and challenges
Parker says: “To me, still, the most fulfilling aspect of a consultant pharmacist role is no different to that of any pharmacist — it is when you have made a direct difference to a patient’s care or when someone says thank you for your help with something about medicines.”
Banner, it seems, likes the variety that his job affords: “It is particularly enjoyable to spend some time in a patient-facing role while also being able to drive change and create opportunities to change practice for the better.
“I have gained experience of working at a senior level and of high-level project management,” he adds. “Also, with research and evaluation being such an important component of my role, I have developed a greater appreciation of its importance in moving the profession forward.”
Moving out of a management post represented a new challenge for Gordon. “There is a big difference between the managerial responsibilities of running a team to having a role that requires you to influence people who are outside your managerial structure,” she explains. “It does mean you have to develop your influencing skills.”
While Ridge may have aspirations for an explosion in consultant pharmacist numbers, Murphy believes the immediate issue is to protect the posts that exist currently. “Succession planning is a big challenge but an important one that consultant pharmacists need to tackle,” she suggests. “I do wonder, when we move on or retire, whether trusts will try to downgrade our posts in an attempt to save money. We need to consider, as a group, how we can prevent this from happening.”
Life beyond a consultant post
“My understanding of research and my academic network have grown since I started my role,” says Murphy. “I would be keen to do more national-level research in the future; although I would not want to lose the patient-facing aspect of my work completely.”
Banner predicts: “There may, in the future, be more opportunities for pharmacists to work in senior positions as clinical leaders. For those who develop strong links in academia, there may be opportunities to become further involved in research. Also, working with the government may open doors with regards to political opportunities.”
Parker believes that opportunities for consultant pharmacists, as for all pharmacists, depend on self-motivation. “There are lots of opportunities to develop — either by working with national organisations, such as [the National Institute for Health and Care Excellence], or with specialist clinical groups,” she says, “but do not wait for things to come to you. Take some initiative and go looking for them.” That said, she adds, you do not necessarily need to be a consultant pharmacist to get involved with such opportunities.