Some virtual wards created with no budget for pharmacy staffing, says CQC

The Care Quality Commission has advised that a lack of resource for pharmacists in virtual wards is leading to policy, practice and governance being “overlooked”.
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Medicine governance, policy and practice are being “overlooked” in virtual wards because of a lack of pharmacist involvement, a report from the Care Quality Commission (CQC) has warned.

In a report, the CQC said that pharmacy teams were often “not involved in setting up a virtual ward from the outset, so they had no influence in decisions on the use and supply of medicines”.

Virtual wards — also known as ‘hospital at home’ — allow people to receive hospital-level care from a multidisciplinary team (MDT) in their home setting.

Data published by NHS England on 12 October 2023 show that an NHS target to provide 10,000 virtual-ward beds by the end of September 2023 has been met, with more than 240,000 patients already treated at home for illnesses such as chronic obstructive pulmonary disease, heart failure or frailty.

However, in its annual report on the state of health and social care in England, published on 18 October 2023, the CQC said it was aware of concerns over which medicines guidance and formularies virtual wards should use.

Between December 2022 and March 2023, the CQC’s medicines optimisation team held discussions with acute and community health providers and other key stakeholders to understand the best ways to use medicines in virtual ward settings, the report says.

“Sometimes there was no allocated budget for pharmacy staffing, which meant leadership often fell to a trust’s chief pharmacist without any additional resource, resulting in policy, practice and governance of medicines being overlooked,” it continues.

The CQC said that one provider addressed this issue “by using existing pharmacy staff in primary care networks and community pharmacists to support the virtual ward, which also improved continuity of care”.

Nathan Burley, president of the Guild of Healthcare Pharmacists, told The Pharmaceutical Journal that involvement of pharmacy staff in virtual wards “appears to be an unfunded afterthought”.

“Medicines governance and safety in a complex area like this must be high in the priority list or patients will come to harm. Ever-increasing tasks for hospital pharmacy staff simply cannot be shoehorned into existing stretched services without increasing risk to patients,” said Burley.

James Davies, director for England at the Royal Pharmaceutical Society (RPS), said it was “very disappointing” to learn that pharmacy teams have not always been involved in setting up a virtual ward from the outset.

The RPS published new interim professional standards for pharmacy services delivered in ‘virtual wards’ on 17 October 2023.

“Medicines are a key part of ‘hospital at home’ and our new interim standards state that a senior pharmacy lead must be assigned to the service from the very beginning to design, implement and maintain pharmacy services,” said Davies.

He added that it was “concerning” that the CQC has found a lack of additional resource for the pharmacy workforce risks undermining good governance of medicines in virtual wards.

“With financial pressures across the NHS, it is vital that pharmacy teams get the funding, staff and resources they need, including in system leadership roles, to support the safe and effective use of medicines across the health service,” added Davies.

Last updated
The Pharmaceutical Journal, PJ, October 2023, Vol 311, No 7978;311(7978)::DOI:10.1211/PJ.2023.1.198799

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