Issues identified in the current post-registration pharmacy workforce

It has become clear over the course of the review, particularly the oral evidence gathering sessions with key stakeholder groups that the post-registration workstream is very complex and there are a wide range of sometimes conflicting views on the key issues relating to post- registration career development for pharmacists and pharmacy technicians. There is a need to develop a common understanding of the key issues which impact on patient care and career development, as without a reasonable degree of consensus, it will be difficult to gain support from stakeholders for moving forward and developing potential solutions or recommendations.

By analysing the oral evidence, outputs from the sub-group meetings, submissions by individual members of the Review Team and research commissioned by the MPC Management Team, a number of themes started to emerge which resonated across sectors, staff groups and specialties. These themes, outlined below, are detailed in the following pages.

1. Greater clinical care and services by the pharmacy team requires staff to have the necessary core competencies; and such services to be commissioned

2. Lack of a structured career pathway to move from novice to expert, and beyond 3. Pharmacists and pharmacy technicians working together as two complementary

professions with implications for roles, responsibilities, skill mix and workforce planning across the pharmacy team

4. Separation of pharmacy careers at an early stage from individual sectors and from other healthcare professions

5. Supply side shortages in key sectors, e.g. pharmacists in academia, research and technical specialties

6. Research needs to be at the core of pharmacy practice across all sectors to add to knowledge, and engender a culture of lifelong teaching and learning among pharmacy professionals.

4.1 Greater clinical care and services by the pharmacy team

requires staff to have the necessary core competencies and

such services to be commissioned

The primary care contractual framework is based on prescription volume dispensary services, and may be seen to provide a barrier to the development of clinical services and the relevant pharmacy training provision. Increasing prescription volumes, and the need to deliver more services, including public health initiatives through pharmacies will require investment in developing these services and training to deliver them. New services are currently based upon transfer of funding from existing supply based services.

It is recognised that community employers have to address commercial and business needs. Where there is no business model for investing in clinical services the professional agenda has been seen as unaffordable. The long term benefits of training and professional development are perceived as a risk when there is no assurance of possible future services being funded, or trained professionals having the opportunity to maintain their level of competence.

Quantifying the potential value of improving use of medicines and reducing waste, perhaps by developing a business case, could be used to drive the necessary change and investment in pharmacy services and training by employers, commissioners and government.

Prescribing by pharmacists is a good example of a service which would bring benefits to patients but its development within community pharmacies and GP practices has suffered from limited commissioning of prescribing-based services. The extent of training and use of pharmacist prescribers varies widely within and across sectors, and is largely driven by the practitioners themselves rather than strategically organised around patient need. The GPhC register records in the region of 2,000 pharmacist prescribers but it is unknown how many of these are currently providing an independent or supplementary prescribing service. Prescribers may endeavour to keep their knowledge, skills and competencies updated through training courses or CPD, but unless they are delivering a service on a regular basis to a critical mass of patients, their competency is likely to lessen with potential risks to patient safety. Pharmacists with Special Interests (PhwSI) face similar difficulties where their additional qualifications are not recognised in commissioning practice, i.e. the services which would use these competences are often not commissioned.

Commissioning of pharmacy services requires good relationships with GPs and this will be important with Clinical Commissioning Groups in the recent changes with the NHS. Initiatives such as Medical Education England (MEE) have started to build trust and confidence between healthcare professions, and in the future Health Education England (HEE) will strengthen these relationships through more formal structures like Local Education and Training Boards (LETBs);132 meaning pharmacy has an opportunity to engage and influence their multi-professional colleagues.

Most professionals aspire to achieving something better both for themselves and their patients. Still, personal motivation to do more training and development is largely driven by

132 _{Department of Health, (2011) Education and Training Reform Programme Stakeholder Event: Local Education and Training Boards,}

19th September 2011, Available:

increased opportunity to practice and can be badly affected by an inability to progress or a lack of opportunity.

As workplace learning increases, in the proposed construct of the pharmacist five-year degree with integration of pre-registration training, undergraduate students will be exposed to the practice earlier. There is evidence that aspirations for the development of pharmacy do not map to the current practice environment in community pharmacy and lead to disillusionment in the workforce.133134

Pharmacy technicians entering a new profession may have aspirations for professional development and progression beyond that commonly found and may not match employer expectations.

The patient choice agenda is a key factor and its influence will increase with the proposed ‘any qualified provider’ government policy agenda. If there is greater choice and competition around medicines management services, i.e. between sectors or providers, the skills and competencies of staff will be an important determinant of patient satisfaction and outcomes for commissioners. If a patient does not receive/perceive added value from their pharmacy service they may see a purely supply role for medication fulfilled in new models of service.

133

Willis, S., Seston, L. and Hassell, K. (2010) ‘Work, employment and the early careers of cohort pharmacists: A Longitudinal Cohort Study of Pharmacy Careers’, The Pharmacy Practice Research Trust. Available: www.pprt.org.uk/Documents/Work_employment_and_the early_careers.pdf [22 Jun 2012].

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4.2 Lack of a structured career pathway to move from novice to

expert, and beyond

Presently England has no formal, consistently applied career pathways for pharmacy professionals and as a result, there is an inconsistent structure for post-registration and advanced level pharmacy education, training and continuing professional development (CPD). The process of moving from a novice to an expert pharmacy practitioner across all sectors and job roles is unclear. Although there are areas in pharmacy where frameworks are used to support professional development, their application varies according to how they are interpreted and applied by different employers.

Although application varies in secondary care, the use of postgraduate diplomas for pharmacists and the Agenda for Change system135 (whilst not specific to pharmacy) at least provide some structure and degree of consistency to professional development programmes. A number of national pharmacy-specific competency frameworks exist for hospital clinical pharmacy practice to support development (e.g. the General Level Framework (GLF) and Advanced and Consultant Level Framework (ACLF), developed by the Competency Development and Evaluation Group (CoDEG)).136 In the managed care sector some employers have made use of these frameworks, adapting them for their own use.

In the community sector, no formal professional career structures exist. Whereas employees within the hospital setting are generally required to complete postgraduate diplomas to progress beyond Band 6 level, pharmacists working in community have no similar requirement. The MPC-commissioned, independent review of frameworks137 suggests that this may reflect the lower potential for patient harm within current community pharmacist roles, which is subsequently a lower risk to the employer. This will change in the future if community pharmacist roles become more clinically orientated with greater individual professional autonomy.

For pharmacy technicians in the managed care sector, the situation is similar in terms of Agenda for Change. The development and definition of their professional practice is only in the first years of their registration as a separate profession. It has been suggested that the current pharmacy technician frameworks138139140 should be linked to a commonly recognised core development framework with links into specialist branches of pharmacy practice.