The focus of public health pharmacists is on improving the health of the population through the use of medicines and pharmacy services.
The role includes everything from managing the primary care organisation pharmacy team to developing a plan for access to anti-retrovirals in the event of an influenza pandemic.
Before taking on the role I worked as a health authority pharmaceutical adviser for five years. I have seen the role of the pharmacist in primary care change significantly, from influencing GP prescribing to a broader strategic role.
I was attracted to the role of specialist in pharmaceutical public health because of its big-picture emphasis on improving the health of the population and the option to work part-time. I spend the rest of my working week as managing director of a medicines management health consultancy.
I carry out my public health role on a job-share basis with a pharmacist who has a background in hospital and practice pharmacy. We bring complementary qualities to the job.
There are few posts in English primary care trusts with the job title “specialist in pharmaceutical public health”. To some extent this reflects the variety of job titles, eg, head of medicines management, that currently exist. Job descriptions vary, often according to which directorate the lead pharmacist is based in. Our role includes elements of “fire-fighting” and strategy.
In a typical day I might look at implementing safe methotrexate prescribing, then discuss a press statement on a high-cost drug. A significant part of my role is advising on investment in medicines and the associated service implications. High-profile drugs, such as cancer medicines, require critical appraisal, needs analysis and planning before ensuring that the drugs are getting to the right patients.
My skills as a facilitator and my ability to appraise information and come to a balanced view are used widely in my chairmanship or support of various PCT committees looking at evidence, delivery of objectives and clinical guidelines.
Public health pharmacists chair committees overseeing implementation of guidance from the National Institute of Health and Clinical Excellence. They are also involved in area prescribing committees and have a role in Controlled Drugs management, prescribing budgets and many other things.
Recently, more support has been required for commissioning decisions, especially when considering the implications of decisions by exceptional cases panels.
Stepping outside the box
Although we retain our specialist role we can also step outside of the box labelled “medicines” to use influencing, evidence-based practice and general management skills.
Senior pharmacist posts in PCTs vary significantly. For those who want to get involved in pharmaceutical public health, a post in a public health directorate is a must, but the job description should reflect a public health philosophy and show that your work will be integrated into the directorate work programme.
PCT senior pharmacist posts require a postgraduate qualification, such as a clinical pharmacy diploma, and at least three to five years’ post-qualification experience. Most applicants come from hospital or community pharmacy. The most common route is through practice-based pharmacy, then through having been a pharmaceutical or prescribing adviser working under a PCT lead pharmacist.
Public health as a discipline has changed considerably over the past 10 years. One significant change is its demedicalisation, providing opportunities for people from non-medical backgrounds to practise at a senior level.
Qualifications range from a diploma in public health to membership of the Faculty of Public Health. Experience at a senior level in a primary care organisation provides the opportunity for director level posts.
I have two postgraduate qualifications and do not wish to study for formal credentials, although I continue to develop new skills. This is supported by the NHS Knowledge and Skills Framework, which, under Agenda for Change, links ability to remuneration.
Public health is an essential part of the NHS and one in which investment is growing. We will soon open a PCT-commissioned community pharmacy in a deprived neighbourhood, using a local pharmaceutical services contract to provide services that have been lacking for a number of years.
The pharmacy provider (the Young Pharmacists Group) has a focus on improving the health of the population by facilitating access and providing new and innovative services tailored to local need.
Other work areas include
- Health equity audit of medicines (ensuring medicines are accessed by all who might benefit from them)
- Distributive justice (deciding who can have which medicine)
- Health economics (determining which treatments offer the best value for money)
As a specialist in pharmaceutical public health I work in some areas that are not traditionally pharmacy. The population perspective and working to a public health agenda creates new challenges and personal rewards. As a senior member of the PCT, remuneration is good and there are opportunities to diversify.
Key skills include person management, influencing, leadership, evidence-based medicine and critical appraisal.
If there is a downside it is that the pharmacy profession, as a whole, has been slow to recognise the pioneering work that happens in PCTs generally and particularly in public health.
2002 to date Specialist in pharmaceutical public health, Dudley Primary Care Trust
2001 Managing director, Morph Consultancy Ltd
1997–2002 Pharmaceutical adviser, Worcestershire Health Authority
1995–97 Antibiotic audit pharmacist, Hammersmith Hospital, London
1992–95 PhD, School of Pharmacy London
1991–92 Pharmacy clinical services manager, Ealing Hospital
1989–90 Full-time MSc in clinical pharmacy, School of Pharmacy, London
1988–89 Resident pharmacist, St George’s Hospital, London
1987–88 Basic grade pharmacist, Kingston Hospital, Surrey
I thank Alison Tennant, MRPharmS, MPH, for her help with this article.