Wes Mountain/The Pharmaceutical Journal
By using the specialist knowledge gained through our undergraduate degrees, as well as commonly undertaking further postgraduate qualifications, such as non-medical prescribing and clinical diplomas in pharmacy practice, pharmacists are ideally suited to becoming dually qualified as advanced clinical practitioners (ACPs).
NHS England defines an ACP as an individual who practices with “a high degree of autonomy and complex decision making” underpinned by an MSc in advanced clinical practice.
This MSc is open to eligible clinicians who have completed a relevant healthcare undergraduate degree — be this in pharmacy, nursing or other allied healthcare professions — and are currently employed in clinical practice.
The course focuses on and maximises your experience as a clinician to date. It is often conducted part-time by a variety of university institutions and concentrates on development of the individual into an ACP, through focusing on the key pillars of practice in line with NHS England’s ACP framework: clinical practice, leadership, education and research.
Gaps in learning
My main motivation for becoming a pharmacist ACP was to become as autonomous a practitioner as possible. Within my role as a pharmacist in acute and emergency medicine, I encounter on a daily basis patients presenting to hospital acutely unwell with undifferentiated diagnoses.
In my pharmacist role, I was able to improve the care of the patient through time-effective medicines reconciliation, prescribing time-critical medications without delay and reducing harm caused by medicines upon arrival to hospital. However, I still felt a lack of overall competence in regard to diagnostics, interpretation of imaging, such as X-rays and electrocardiograms, and overall complex clinical decision making. I felt that such skills were essential in order for me to comfortably and reliably manage patients in an independent manner.
The ACP course helped overcome such gaps in my learning from a clinical practice point of view, through helping to develop my skills so that I can triage patients, history-take, examine, request and interpret imaging, diagnose and implement management plans.
Taking the course has allowed me to now split my working week between being an emergency department pharmacist and an ACP, where I work under medical staffing alongside the acute medicine on-call team to clerk and manage patients independently.
Challenges and rewards
This role is both challenging and rewarding. Having to shift your thinking from a pharmacy focus towards a more diagnostic arena can at times be difficult and there may be limitations if you meet a case that is beyond your competence. However, there are benefits in that within your team you have the overarching support of a responsible consultant physician, on-call medical registrar and other senior doctor colleagues to give you advice and guidance should you need it.
As well as development in your clinical practice, the course sets out to enhance your leadership qualities
The role also develops your own knowledge and skills through being embedded within this multidisciplinary team. This may be your communication skills when discussing decisions about resuscitation and advanced care planning, or your clinical skills in the form of advanced physical examinations or venepuncture and cannulation.
As well as development in clinical practice, the Msc sets out to enhance leadership qualities through both a reflective process of the way you lead as an individual, as well as active learning of different leadership styles, their benefits and drawbacks and how they can be used. Such learning has a focus on the relationship with the NHS, with a lot of the modules using recognised learning from the NHS leadership academy. This largely complements the pillar of research.
Within my role I actively pursue and lead on service improvement projects that are no longer limited to the pharmacy department but also within clinics in emergency medicine.
Three wins
Within secondary care, the role of the pharmacist ACP can help provide three wins: access to care for patients; a reduced burden on current medical staffing; and upskilling of the pharmacy workforce.
Through the inclusion of ACPs into the workforce, patients have greater access to clinicians and care. As well as this, through use of our pharmacy background, patients have assurance of high-quality prescribing/deprescribing in their management, through local and national best practice guidelines. This benefit also extends to departments that may be struggling with staffing shortages and so reduces overall pressure on clinicians on the front line.
There are several significant benefits to the individual pharmacist themselves; most notably, the career development and upskilling that leads to being able to act as an autonomous practitioner in their own right. Such a level of autonomy positively empowers clinicians to be responsible for the care they deliver to their patients at a high level and become final decision makers within this role. This is something of great significance within the ever-changing pharmacy world.
With the upskilling of newly qualified pharmacists becoming non-medical prescribers, an additional qualification such as the advanced clinical practice Msc would only further complement these clinicians to maximise their capability in patient management.
