John Cromarty, chairman of the Scottish Pharmacy Board spoke on behalf of all three national board chairmen. He highlighted plans that the RPS has for producing the first all-sector process of professional recognition for advanced practice. This is an edited version of what he said:
“All aspects of what we have heard said today demand changes in the way we practise pharmacy within the new healthcare environments being created in all three home nations. Pharmacy is used to innovation, we are good at it, and we will see many examples showcased throughout the conference.
Research, whether scientific, technological or clinical, must inform healthcare policy and service developments. It must be adopted into routine practice, if the full benefits for patients are to be realised. This is facilitated through local formulary management systems for the adoption of evidence-based guidance from the Scottish Medicines Consortium and the National Institute for Clinical Excellence.
We need to ensure that their appropriate and safe clinical use in individual patients is assured through the provision of pharmaceutical care services. [And] how can the NHS help ensure that these services are effective? Pharmacists must have access to the full patient record.
We are making good progress in discussions on the need for access to the emergency care summary and patient records. Undue delay in achieving this jeopardises the pharmacist’s opportunity and potential: to improve the quality of patient care; to reduce preventable adverse effects of medicines; and to reduce unnecessary hospital admissions.
We’ll look to the governments to adopt the recommendations from the RPS Report on Improving Pharmaceutical Care in Care Homes, published in March of this year. This excellent work was carried out by the RPS in Scotland, and presents the UK with a series of recommendations that will help to remove the threat of additional risk through unnecessary prescribing for a particularly vulnerable group of patients. The report demonstrates how pharmacists can make a real difference to patients, extending their lives and improving the quality of their final years.
Medicines review in one health board in Scotland led to a reduction of potential or actual harm in over 40% of patients surveyed. Almost 50% had a potential or actual improvement in their therapy. A number of studies in the UK have shown that up to 7% of admissions in the UK are due to preventable medicine-related harm. Another study quoted 19% of admissions of elderly people to hospital are due to therapeutic misadventure. This is unacceptably high. The judicious and well timed use of pharmacists’ clinical skills could improve pharmaceutical care, reducing the level of preventable iatrogenic disease. We think of the cost of this drug-induced disease particularly for patients but, of course, it also comes at a very significant cost to the NHS.
It is right to challenge the status quo of an ever-increasing healthcare budget, particularly in the light of the demographic changes expected in the near future, with an increasing elderly population and a much greater prevalence of long term conditions. As stated by Dr. Martin Wilson, our NHS Highland guru on Polypharmacy, “there’s nothing wrong with being old, it certainly beats the alternative”, however; we need to protect what pharmacists already do well for these patients; we need to do more and, in some cases, prescribe less; and the Society has emphasised this in its responses to the reviews of pharmaceutical care in Scotland and in Wales.
What do we expect of our professional body?
A professional body must also be able to respond to change, and to work on behalf of the profession to minimise the negative effects of that change. It must speak on behalf of its members during a period of change: to ensure that pharmacists’ voices are heard; to ensure that the best possible outcome is achieved for patients, its members and the profession as a whole.
I’m proud to say that’s exactly what we’ve done.
The Scottish Government is examining every aspect of pharmaceutical care in the community and the results of the review are eagerly anticipated and expected in October. We are also expecting the outcome of the review in Wales to be announced shortly. We commit to work with both countries to deliver proposed changes in a way that maintains standards of patient care and improves patient outcomes.
Throughout the year we have continued to work towards improved patient safety.
â€¢ In Westminster we have continued to press our case for a more open and learning culture that allows any dispensing errors to be overseen by our regulator rather than the judicial system.
â€¢ In Wales, we have worked with their national patient safety programme: 1000 Lives Plus to create a quality improvement guide for pharmacy. This single initiative introduces new methodologies to pharmacy practice, and introduces learning behaviour and new ways of working which help to improve quality and safety across the NHS.
â€¢ In England, our joint work with the Royal College of General Practitioners continues and we hope to see outcomes that deliver real benefits to patients and pharmacy in the near future.
â€¢ In Scotland, immediately following our Joint Statement with RCGP in February of this year, we already have a commitment to joint post graduate education modules which will facilitate greater understanding of the respective roles and remit of both professions.
â€¢ And the corresponding work between RPS and RCGP in Wales is reaching conclusion, with an announcement planned in the Welsh Assembly Building in November.
â€¢ Our work – led by the English Board – on the transfer of care between secondary and primary care settings, has been recognised widely as a valuable piece of work that will assist in reducing the unacceptable number of readmissions to hospital. Pharmacy has been leading a piece of work that is critical to driving up the standards of patient care across all the main healthcare professions.
What has the Society done for individual members?
And the Society continues to support our daily work during this time of change, for example: with the publication of guidance; by the availability of a dedicated team answering calls from members who need guidance and advice on issues that require more detailed discussion and resolution; by means of the map of evidence, sharing practice research and identifying exemplary practice and promoting it to all throughout the profession; and by developing the mentoring programme.
Development of standards
In 2011, we began the development of professional standards that will ultimately create a library of high level professional guidance which illustrates best practice for all areas of the profession. The first set to be completed is the Professional Standards for the Hospital Pharmacy Service.
These professional standards provide a framework to underpin patient experience and the safe, effective management of medicines. They are currently being piloted at development sites across GB.
We are speaking on behalf of pharmacists, pressing for an enhanced role in delivering public health services. We are working with the Faculty of Public Health to produce standards in public health in pharmacy practice.
Promoting an enhanced role for pharmacists
The RPS is also promoting the enhanced role pharmacy can play, in providing pharmaceutical care and medicines optimisation in the new healthcare environments. The Society is gathering an evidence base and patient narratives to support the development of a set of core principles. They will underpin patient experience and the safe, effective use of medicines. They will also help other healthcare professionals appreciate the role pharmacists play in improving patients’ understanding of their medicines.
Presence in the media
We have increased our presence in the media, helping to shape public debate on issues relating to medicine. There have been more pharmacists speaking on issues on TV, the radio and in newspapers.
Contributions from members
One key strength of the Society is the level of contributions from members, either individually or through one of the many specialist groups. These are the views we use when in front of the television cameras, or a government. Through your input into the many debates on our virtual networks, or at Local Practice Forums, our policies are formed and used on your behalf.
Our local practice forums have grown further in their second year and are hosting meetings on issues important to the members of each individual LPF, such as professional empowerment, public health and the transfer of care. They are also working in conjunction with the education bodies in each home nation to fulfil members’ CPD requirements.
Listening to you
Your continued flow of ideas and views means that we are a truly responsive leadership body, listening to what is important to members and presenting the outcomes to those who are able to influence the environment in which we operate.
Pharmacy’s ability to improve standards of care, enhance patient outcomes and reduce patient harm is increasingly recognised and respected in all healthcare sectors. In all sectors of the profession we have generalists providing excellent clinical care and we now see specialist pharmacists in almost every clinical discipline in secondary care, on ward rounds, in clinics, in critical care and high dependency areas, in antimicrobial management teams.
For pharmacists delivering services to patients, there is a need to be able to provide evidence of competence and improvement in patient outcomes, to patients, to employers and to commissioners.
We need to help pharmacists identify what they need to be able to know and do at different levels of practice; where they can access the knowledge, skills and experiences and how they can demonstrate that they are best placed to deliver complex care across all sectors.
â€¢ We have more members who wish to attain the same high standards of expertise as our leading practitioners.
â€¢ We know from members across all sectors that there is a need for flexible, yet consistent methods of professional recognition of what they do in practice, wherever they work
â€¢ We fully intend to support and enable them to advance their practice and to recognise their progression for the benefit of patients and the health of the public.
Two to three years ago, in 2009/10 I had the good fortune to participate in the work of the Department of Health and the RPSGB led strategic working groups on Advanced & Specialist Practice. At that time, we had again made advances towards ongoing professional development but still we hadn’t fully defined what the requirement was.
Professional recognition for advanced practice
Today, however, following a sustained period of hard work, led and coordinated by Dr Catherine Duggan and her staff at the Society, I feel particularly privileged to be able to announce that: we are planning pharmacy’s first all-sector process of professional recognition for advanced practice. At present we are working across the profession to develop knowledge networks and a framework of processes that we need to put into place before this becomes fully functional.
[It will] comprise: professional curricula for all elements of advanced practice; mentorship and coaching support; evidence around the support tools and developmental frameworks that already exist; the various methods of assessment, so that we are ideally placed to support the advances in the professional careers of our members.
Consistent with other disciplines, many of our partner groups have developed systematic ways to recognise advancement and specialism that we would want to recognise under this umbrella. That recognition will include five specific aspects:
â€¢ an online portfolio, support tools and professional development frameworks
â€¢ peer reviewed knowledge, skills and experiences across specialist, clinical and generalist practice
â€¢ mentorship and coaching in flexible ways that help assist consistent professional development.
â€¢ RPS directories of experience / expertise to help members find the people with the expertise they need
â€¢ an assessment scheme that provides a form of consistent assessment that delivers our first method of professional recognition
We are a profession that rightly relies upon evidence in almost every aspect of our work and this will provide evidence to support our own abilities and experience.
So, a professional body that is:
â€¢ listening to its members and offering daily support
â€¢ representing them at the highest levels across three governments
â€¢ putting the case for pharmacy
â€¢ standing alongside other healthcare professions and playing a bigger role in healthcare
â€¢ supporting members in the ability to develop a career, no matter where they work, no matter which sector of pharmacy they wish to enter
â€¢ facilitating portfolio working in a way that hasn’t been available to members before
With your help, we can continue to represent your views. You can help:
â€¢ by engaging with us
â€¢ by contributing to our responses to the many government consultations
â€¢ by contributing to the discussions on our virtual networks
â€¢ by your letters in The Pharmaceutical Journal
With these contributions you help us deliver the things that are relevant to the profession as a whole and that matter to you as individuals.
In conclusion, RPS supports, encourages and leads. Many of you have continued your membership of RPS for good reason and we take this opportunity to thank you for your support and your confidence in our direction of travel. I hope that we have illustrated today and at this conference that your confidence was well placed. RPS has modernised its structure and functions, with an ambitious yet realistic programme of work which aims to meet the challenges we face now and to future proof the rightful place of pharmacists as integrated and valued members of the healthcare team.”