I have recently read the NHS England report ‘Transformation of seven day clinical pharmacy in acute hospitals’, which describes the requirement for an equitable clinical pharmacy service for every day of the week. Although, there has been much discussion about seven-day services for a long time, the report describes a plan for its actual implementation. The extension of the clinical pharmacy service is a sensible idea and will reinforce the view that patients are at the centre of our healthcare planning. Once implemented, patients will undoubtedly have a greater chance of getting their medicines optimised in a more timely manner while on the ward. The objectives are logical and full of good intent. Indeed, one wonders why they are not already in place.
However, like most strategic reports, it is perhaps short of detail. For example, many hospital pharmacy departments are currently struggling to provide the existing high quality clinical pharmacy service that is expected. The continued pressure on cutting income to the acute hospital sector will not help maintain the existing service, let alone pay for any new costly implementation. Just introducing seven-day contracts for the workforce will not be able to cover additional work and will be like moving deckchairs on the Titanic.
The challenge to provide this same high quality clinical service at weekends without additional funding may be beyond the capabilities of many chief pharmacists to “fix”. Also, the outputs from the clinical pharmacy service will require the support of the entire pharmacy service in order to implement their patient outputs. The report does not appear to mention in any detail the need for other pharmacy services such as the dispensary, distribution, procurement and production. It is inevitable that these additional services will also require extending as well and yet these do not appear to be in the plan.
How can this report be effectively implemented? The answer is “appropriate” funding to cover the resources required. Sweating expensive acute hospitals (the assets) by implementing a “full” weekend hospital service should release savings by increasing the throughput of patients and enhancing the utilisation of beds. This principle works for many manufacturing industries and so could also apply to hospitals.
Anyway, the government has already indicated that this approach is part of its strategic plan, together with the drive towards moving more clinical services out of hospital. Ultimately, the size of the acute hospital service should diminish in the future. Perhaps some of these efficiency savings gained from a seven-day hospital service (reduced acute hospital sector) could fund the change in work practice rather than simply adding to the stress of the workforce.
Allan Karr
Management consultant, Karr Consultancy Ltd
Tring, Hertfordshire
