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Tuesday 25 September 2018
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How has UK hospital pharmacy changed over the past 70 years?

The UK’s National Health Service turned 70 this month, and while we celebrate the achievements of one of the nation’s most valuable institutions, it’s also the perfect opportunity to pinpoint the role that pharmacy has played in the NHS during those decades.

The role of pharmacists in the NHS has, unsurprisingly, evolved quite a bit since its inception. Growing from what was originally a supply service to become a clinical practice in hospitals, and with a range of new roles in primary care, pharmacists are now recognised as a valuable part of the multidisciplinary clinical team.
 
“The careers of pharmacists in the NHS have evolved massively from the start of the NHS to now,”says Aileen Bryson, practice and policy lead at the Royal Pharmaceutical Society (RPS). “Forty years ago, pharmacists were not often seen on the wards, whereas now they’re more visible at all levels, with a much wider scope and variety of roles. Similarly in community [pharmacy], although the actual career paths have remained much the same, the roles and services delivered are quite different and expanding clinically all the time.”
 
Sandra Gidley, chair of the RPS’s English pharmacy board, says that although “we are still not where we should be, particularly in the world of community pharmacy, we are heading in the right direction. I wasn’t around 70 years ago but even over the last 40 years there has been a clear progression for pharmacists in particular. New roles working in GP surgeries, urgent care and care homes are very exciting are good examples of where skills and knowledge can be better integrated in patient care.”
 
Technicians too are taking on greater responsibility, particularly in hospital, and are embracing a wider variety of roles that help free up pharmacists to become more patient-facing.
 
Tess Fenn is President of the Association of Pharmacy Technicians UK (APTUK) and is celebrating her own milestone in the sector this August, when she will have been a pharmacy technician for 48 years.
 
The Association of Pharmacy Technicians was formed in January 1952 by Katherine L Miles, who was awarded an M.B.E. in recognition for her work. “Since then, pharmacy technicians have evolved from humble assistants into critical and key members of the pharmacy team,” says Ms Fenn.
 
“During this time, their roles and careers have evolved from mainly dispensing to many enhanced specialist technical roles in all areas of pharmacy, such as production and technical services, procurement and distribution, information technology, clinical trials, education and development, dispensary management and medicines management, to name but a few – and there are now 23,363 pharmacy technicians working in all pharmacy sectors across the UK on the General Pharmaceutical Council's register.”
 
The pace of progress
 
While we have come a long way from the days of dispensing drugs from behind a wall, current career progression pathways for pharmacists and technicians within the NHS still differ by sector.
 
“There is a much clearer career progression in the hospital sector and pharmacists are able to choose a role that is more clinically or management oriented, depending on their skills and preferences,”says Ms Gidley, citing the “properly structured foundation course, which builds on University training and provides a firm foundation for the future” as something that would also “be helpful in community pharmacy”.
 
The career progression of a pharmacy graduate who wishes to specialise in hospital pharmacy follows a structured career path from the pre-registration year to two to three years as a rotational pharmacist, then four to five years as a Band 7 rotational or specialist pharmacist, and then stepping up to a Band 8 subdivided into tiers a-d.
 
Technicians also enjoy a wider variety of career opportunities, with many instances of technicians taking overall responsibility for certain areas of work and more opportunities for them to develop.
 
After initial education and training, Ms Fenn says pharmacy technicians in secondary care certainly have many choices: “They can progress through the Agenda for Change structure from Band 4 to Band 7 with various levels of responsibility in all areas, after which progression to Band 8 is linked to specialist service provision, such as education, procurement, IT or technical staff operational leads.
 
"Currently, and generally, pharmacy technicians, as part of foundation practice, will work towards the final accuracy checking of dispensed items role in the dispensary or medicines management roles on the wards or in clinics as part of the clinical team.”
 
Overcoming barriers
 
But there are still barriers to progress. A 2016 research collaboration between APTUK and the University of East Anglia to identify the roles of pharmacy technicians in the UK showed a number of obstacles in the hospital sector.
 
Ms Fenn says: “An overriding aspect was linked to ‘a lack of understanding of the pharmacy technician role by pharmacists and willingness to support their training’ and this was seen as a barrier to their professional development. The report recommended that developing a post-registration career framework to provide a career structure for pharmacy technicians could help overcome these barriers, and APTUK are currently looking to progress this.”
 
In the case of pharmacists, Ms Gidley says: “Many of the barriers come from within”. Shilpa Jethwa, principal pharmacist clinical services manager at London North West Healthcare NHS Trust, agrees: “People can be a barrier to their own progression because they think there is too much work required to move onwards and upwards, and believe they don’t have the time.
 
"If you have good time management skills and are efficient you can achieve it, but you also need to have a direction in mind. This means that while we need candidates to be amenable to change, managers must also give them increased exposure to the skills required to progress to the next levels, and sight of the opportunities available.”
 
 
Grasping opportunities
 
Rena Amin, joint assistant director of medicines management at NHS Greenwich CCG and clinical associate at Hartland Way Surgery in Croydon, says these opportunities to progress within the NHS are there right from the start of a pharmacy career.
 
She says: “It’s good to have a variety of experience under your belt, which is why from the earliest stages of a pharmacy career it’s a good idea to work in a variety of settings to find out what you like and don’t like. In the last five years, pharmacists have been breaking barriers in care homes, urgent care, public health departments and around care for co-morbidities, so having early wide experience gives you more options to choose from.”
 
Kalveer Flora, rheumatology specialist pharmacist at Northwick Park Hospital, has experienced this first hand. “I genuinely think the opportunities for pharmacists and technicians in the NHS are endless. Take for example my post, where rheumatology wanted their own pharmacist for years.
 
"Once they had me, we were able to work on national agendas and local medicines optimisation targets saving huge amounts of money. We were also able to set up clinics where patients could interact with pharmacists and gain the most of their medicines.”
 
As more pharmacists become independent prescribers, this also opens up opportunities for technicians to take on more clinically focused medicine optimisation tasks, such as clinical prioritisation. Ms Fenn adds: “APTUK also believes that pharmacy technicians being able to supply and administer medicines under Patient Group Directions would further support the delivery of person centred pharmacy services.”
 
NHS development programmes
 
The NHS itself runs ongoing development programmes for staff across all its disciplines.
 
For starters, its NHS graduate management training scheme offers two years (or two and a half if you opt for finance) of mentoring, support and training from experts from within and outside the NHS.
 
Aditya Aggarwal qualified as a pharmacist in September 2017, and started on the NHS Graduate Management Training Scheme in the same month. He says: “Exploring career options in my fourth year, I spoke to a pharmacist who was working in a bank and mentioned the scheme. I was intrigued and on further investigation saw an opportunity to work at a national level to support patient care and improve patient safety. As a result, I applied for the policy and strategy stream, which seemed most appropriate for me.”
 
Policy and strategy has four rotations over two years, which includes two placements in NHS England, each within a different team, and one in an NHS Trust. For education, Mr Aggarwal's stream undertakes half of the NHS Leadership Academy’s Elizabeth Garrett Anderson leadership development programme in the first year to postgraduate certificate level, followed by a postgraduate diploma in health policy in the second year.
 
Mr Aggarwal says the scheme offers “a fantastic opportunity to progress and make an impact to deliver improved patient care wherever I go.”
 
The NHS Leadership Academy is another portfolio of programmes providing targeted development for staff from all backgrounds and experiences. Someone who has jumped at the chance is Kristi Anderson, who is due to complete The Mary Seacole Programme (aimed at staff across the NHS who have recently moved into, or looking to step up to their first leadership role) in July.
 
Ms Anderson qualified as a technician in 2005, and is currently a Band 7 principal pharmacy technician for medicines management at Northwick Park Hospital in London, managing the service across two sites.
 
She says: “I blitzed all the courses possible when I was newly qualified and I wanted to start studying again. Management and leadership is the way for me to progress from Band 7 to 8a, so I thought this would be the best opportunity for me.
 
“Because teams are getting bigger you need managers in sections, which is where I come into play. In my ideal world I think the dispensary should be managed by a technician rather than a pharmacist, with the day-to-day running done by assistants, which then relieves the pharmacists to be up on the wards.”
 
Another proponent of the opportunities on offer is NHS England’s deputy chief pharmaceutical officer Dr Bruce Warner. He completed the Nye Bevan leadership programme (for candidates newly appointed to board level posts or whose next career move would be to board level) in 2015, while deputy director of patient safety at NHS England.
 
“It is very much a self-examination of your personal leadership skills and attributes, and a brutally honest assessment of where you have scope for improvement,”he says. “While the formal residential and presentational elements of the programme were excellent in helping to open our minds to new ways of thinking and different approaches, it was the learning sets that really made the programme worthwhile for me.”
 
Mr Warner took up his current post shortly after starting the programme, and says: “The programme has helped me to be more effective and look at the problems I face on a day-to-day basis in a very different way and consider perspectives that previously I may have been blind to.”
 
Future options
 
With new roles developing all the time, what will the career progression pathways of pharmacists and technicians in the NHS look like over the coming decades?
 
“The management and supply of medicines and pharmaceutical services will always be integral to the role of the pharmacist regardless of which sector they practice in,”says Helga Mangion, policy manager at the National Pharmacy Association (NPA).
 
Ms Gidley predicts “a greater degree of portfolio working”, which Dr Manir Hussain – head of medicines optimisation at NHS North Staffordshire and Stoke on Trent CCG and an independent prescriber working in a GP practice – also foresees.
 
He says: “Looking into the crystal ball, I believe pharmacists of the future will have a portfolio career path based on their interests. A typical week for a pharmacist may mean a few sessions in a community pharmacy, a few clinics in General Practice and a few sessions on a cardiac ward on hospital.”
 
Dr Hussain says the upskilling of technicians is also essential: “In my vision for the future, technicians will be in charge of the technical side of procurement and supply. I believe one career path for a technician will be to become a dispensary manager and oversee all aspects of procurement and supply. There will also be an opportunity to pursue a more patient-focused career pathway.
 
“I hope that technician training will be such that those who wish to progress to become pharmacists can do that seamlessly, and pharmacists will have access to a greater number of clinical qualifications which will allow them to progress to a recognised consultant pharmacist status.”
 
With the NHS in flux, pharmacists and technicians are well placed to meet the challenges this brings in the decades ahead if they are willing – and supported – to explore and use their expertise as part of a cross-sector skill mix.


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