Typically, most people want to achieve the same things from work, including a sense of purpose and belonging, a feeling of effectiveness, a team identity, reward, control, fairness and dignity. These, in essence, are fundamental human needs. As the NHS copes with and responds to a further round of unprecedented challenges, the pharmacy professions are currently reporting system-wide erosion of many of these factors, leading to significant difficulties in the profession maintaining its services and standards of care[2,3].
In many ways, operating in a challenging healthcare environment is not a recent phenomenon and these perceptions and feelings about our working lives are not new. Pharmacy perceives itself as the quintessential professional exemplar of untapped potential, underutilised skill and systematic underappreciation. These are classic markers of an alienated profession[5,6]. Our recent challenges have simply crystallised these issues further, leading many individual pharmacists and pharmacy technicians to struggle[3,7,8].
The current situation must lead us to reflect on the way we approach our professions, including how we practice, how we teach, how we innovate/adapt and, crucially, how we lead. This is vital if we are to provide our patients with the highest quality care and if members of our profession are to enjoy fulfilling and sustaining careers.
The medical and nursing professions have been preparing their current and future professionals for such challenges for decades, growing skills and attitudes about professional agency in the mass workforce. Professional agency is practised when professionals exert influence, try new things and make choices, in ways that affect their own work, the work of others and the services that they provide. Within medicine, there is an appreciation that medical knowledge and skills, while fundamentally important, are not enough on their own to deliver impactful and fulfilling careers — all modern doctors are empowered to practise, lead, educate and innovate. This vision is also mirrored in the nursing profession, through the ‘Transforming roles’ agenda[11,12]. Common across healthcare professions is the concept of advancing practice, based on these four pillars of practice. The Royal College of Nursing defines advanced nursing practice as “the freedom and authority to act, making autonomous decisions in the assessment, diagnosis and treatment of patients”, with the four pillars embedded into these roles.
Pharmacy has historically acted differently. Within our pharmacy professions, we commonly segregate roles by these very skills, where practitioners practice, leaders lead, educators educate and researchers innovate. Pharmacy has created these functions as separate roles. Recent evidence shows us that there are systemic deficiencies in the ability of pharmacy staff, across the entire career spectrum, to lead and innovate and/or current workplace cultures commonly do not empower staff to grow and utilise these skills in real life[14–16]. Owing to our organisational structures, most staff have limited autonomy or authority to collaborate widely and improve services. This both inhibits our ability to improve population health and leads to prevalent discontentment in staff.
Pharmacy professionals commonly describe their role through the lens of pharmaceutical care (i.e. the direct, responsible provision of medication-related care for the purpose of achieving definite outcomes that improve a patient’s quality of life). However, within our current education and development model, this vision is becoming undeliverable. The rate of innovation and development in medicines technology now means that the didactic clinical learning undertaken in undergraduate and standard postgraduate courses is rapidly outdated and the volume of material that is piled into the syllabi becomes unmanageable. No traditional pharmacy programmes, however well resourced, have sufficient time to deliver all relevant practice-based knowledge and training. If we hope to deliver a workforce around which a secure basis for effective, contemporary, equitable and sustainable services can be built, the pharmacy professions need to embrace a significant upscaling of practice-based longitudinal trainee placements, led by practising clinicians. The NHS only commissions services on the basis of universality, equity and consistency.
The publication of new General Pharmaceutical Council’s ‘Standards for the initial education and training of pharmacists’ in 2021, the new Royal Pharmaceutical Society curricula for post-registration foundation, core advanced, and consultant practice, and the imminent UK chief pharmaceutical officer commission, gives our professions (pharmacists and pharmacy technicians) a chance to reimagine a new future[19–23]. This must involve four pillar duties in all future roles.
All healthcare professions are established on the basis of a social contract built around professional values. Society expects us to the provide solutions to problems caused by illness; to be competent, altruistic, to act with integrity; to promote the public good; and to be accountable. In return, we expect to practise with autonomy, to be trusted and to operate a monopoly of practice (e.g. being a pharmacist is a protected title). We expect to be given status and rewards for our efforts and to be given the ability to self-regulate within an established system. The values of the healthcare sector are fairly ubiquitous across the globe, often including care and respect, excellence and equality in care delivery, and multi-stakeholder collaboration. Values are an important obligation of both our registration and our annual revalidation.
Pharmacists and pharmacy technicians must now primarily work as advocates for the benefit of their patients and their colleagues. To truly deliver this, we need to move from a state of isolation (i.e. where we often practice without needing or accepting help or resources from others) to a state of collaborative professional autonomy (i.e. where we have free will and together we each practice according to our skills and healthcare values). Although counterintuitive, this will require us to become more dependent on each other: where pharmacists and technicians rely on and trust each other; where healthcare organisations rely on the work of regulators and professional bodies to assure competence; where all professionals teach the next generation; where healthcare organisations work across boundaries for the betterment of population health; and where individual professionals are trusted to deliver their remit in accordance with their skills, values and professionalism.
Our research group has recently published a new theoretical workforce model, called ‘Collaborative care’. The model is defined, described and critiqued in-depth in a new publication in ‘Research in Social and Administrative Pharmacy’. This publication also sketches how a national career pathway can be implemented around this. The main step towards this future is through the integration of the four pillars of professional practice (practice, leadership, education, and research/innovation) into everyone’s roles in the future.
Accepting this transformation will necessitate the recognition that pharmacy professionals primarily are clinicians, but it will also require us to unlock our latent professionalism and acknowledge our need to pursue a balanced career. A targeted selection of the themes and statements that would demonstrate successful adoption of this are described in the Table below. Pharmacy must now consider each of these. Delivering this future has the potential to bring ‘meaningful work’ and professional satisfaction across our professions. The alternative is simply to acquiesce to the status quo.
Many people within pharmacy will be sceptical about these changes (e.g. “I just want to see patients, not do all this new stuff”, “This is too daunting”, “What difference will it make?”, “I cannot do research”) but we know what the status quo has brought us — professional discontentment, isolation, massive unfulfilled potential and widespread dissonance. Inertia is always the enemy. Rather than believing that a minority of leadership voices can lead us out of this place, it is time to ‘reprofessionalise’ each workplace by developing and trusting staff. This will require pharmacists and pharmacy technicians to act with purpose and deliver collaboration, skills integration and organisational integration on a scale not previously seen in UK pharmacy.
Alongside the other healthcare professions, we must now adopt professional remits based on exercising all four pillars as the first steps to this path, in all jobs, in all sectors and at all levels. The interdependence that this will create will help us achieve our professional ambitions by empowering and trusting all pharmacists and pharmacy technicians to understand their part to play in our collective benevolent efforts for society.
Conflict of interest disclosure
Paul Forsyth has delivered paid consultancy work for the Royal Pharmaceutical Society (RPS) in relation to aspects of both the core advanced and consultant curricula. Forsyth and Andrew Radley have undertaken a cross-sectional survey of training needs for people aspiring to practise at a consultant pharmacist event. This survey was jointly funded by the RPS, Health Education England, Health Education and Improvement Wales and NHS Education for Scotland. Forsyth and Radley received no payment from this funding. The paper was published in the International Journal of Pharmacy Practice in 2022.
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