The changing role of the pharmacist in the 21st century

Fundamentals of the role

Are the fundamentals of the role of the pharmacist well understood? In an environment of increasing public expectations, workforce pressures, and significant scientific and technological advances, it is important to define the contribution the pharmacist makes not only to the healthcare team but more widely. Without clarity on the pharmacist’s role, we cannot effectively select, educate and train pharmacists, or plan for the future pharmacy workforce.

Attempting to create a generic definition of what it means to be a pharmacist is fraught with difficulties. Much seems to depend on context — the sector of work, the pharmacist’s career stage and experience. Furthermore, a role cannot be defined in isolation without considering the inter-relationships with other professionals. However, the drive for a flexible, adaptable workforce that can meet the health demands of an increasingly older population with multiple long-term conditions means that there is greater working across professional boundaries, and professional roles inevitably become more homogenous. Although taking on new roles can be enriching, there is also a danger that a profession can lose its way, or worse, lose its identity. Poorly defined professional role boundaries can also become a source of conflict and there is a risk that the best interests of patients and public are not served. The role of the pharmacist must be congruent with the roles of others such as doctors, nurses, pharmacy technicians etc. The nature of authority and responsibility between these relationships should be clear as should what the formal and informal expectations of one another are.

What’s in a role?

The word ‘role’ can be defined as “the function assumed or part played by a person or thing in a particular situation”. Further expansion on this definition includes the “socially expected behavioural pattern usually determined by an individual’s status in society”. A role statement can be used to describe what is required in terms of attributes and abilities. Such statements can distil how a profession perceives its own situation — to understand the knowledge, skills and behaviours that are expected of the person performing the role. Furthermore, a role statement also identifies the unique contributions of a profession to society and can be used to establish an agreed set of expectations, to enable policy formulation and assess performance.

It could be argued that the role of the pharmacist and other health professions has been devalued by the demarcation of boundaries and a wide application of the word ‘professionalism’ beyond established disciplines. Targets, monitoring and performance management are challenges faced by all professionals and there is a question about how much autonomy an individual has when taking up a role. Many entered the profession of pharmacy as a vocation but often end up pursuing organisational objectives that may not be congruent or inspire personal commitment to the work they do on a day-to-day basis. There may have been a loss of a sense of craft.

Evolution of the profession

Traditional attempts to summarise the role of the pharmacist have been ‘product focused’ i.e. through the medicine (usually its manufacture and supply) and the associated information provided. It could therefore be said that the primary role of the pharmacist was to be an expert in medicines.

Now the focus of what the role should be for many has moved to that of caregiver — the pharmacist is committed to person-centred care by ensuring the high-quality use of medicines. This encompasses effectiveness, safety and patient experience. The pharmacist may also have generic roles as an educator, manager, mentor, business/service developer, leader, researcher etc. The proportion of additional roles undertaken will depend on the location of their practice, experience, competencies, interests and other factors. The role may not need to be directly patient-facing to be person-centred.

The role of the pharmacist is changing and will continue to change alongside the needs and expectations of patients or service users. Change is ever present. The structure of the NHS and the wider economy is shifting, with the result that services need to be reconfigured to fit new models of care that are closer to the patient’s home. Advancements in technology, sociopolitical changes, the end of deference, greater access to information and a shift to multi-disciplinary working (that includes role substitutions, role enhancements and role extensions) all mean that the way pharmacists work will need to change.

By defining the core qualities of the role, appropriate selection, education, training and workforce planning can be developed. Pharmacists, therefore, need to be produced or (since the majority of the profession is already practising) adapt so they are able to develop their own practice and roles to meet changing needs. A readiness to be more actively involved in decision making and take on greater leadership responsibilities will surely need to be the core of the role. Pharmacists will also need to be able to move more flexibly, such as between hospital and community settings, and to understand that their roles will change throughout their careers.

Reaching a consensus

Agreeing a statement on the role of the pharmacist is a difficult balancing act. But by defining the fundamental qualities of the pharmacist we create an anchor point for the profession. Changing patient and service needs will describe how these qualities are applied over time. As an example, science must be a fundamental part of the role so it can then be applied in, for example, clinical problem solving. Other fundamentals need to be agreed and patients, the public and other professionals made aware of the depth and breadth of pharmacists’ training as well as the skills they can expect from them.

If the pharmacist’s role is too narrowly defined, we risk impoverishment. If the definition is too wide, it will become meaningless. The prize of truly understanding our role is that we each feel like a pharmacist (rather than just a position in an occupational hierarchy) and are recognised as being dedicated to our craft for the benefit of others.

More information on the survey, which closes on 5 March 2018, can be found here.