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Clinical governance requires trust-wide communication

Clinical governance — Career opportunities for pharmacists

Pharmacists are becoming increasingly involved in clinical governance following Government reforms in recent years. This article examines the skills and experience required of pharmacists working in this field

A new career path is emerging in hospital pharmacy on the back of the Government’sclinical governance reforms. Trusts are increasingly appointing senior pharmaciststo take responsibility for the wider clinical risk agenda which is taking themto the heart of policy making.

Those pharmacists who have been forging thisnew role say it brings tremendous professional satisfaction because the toppriority is improvement of patient care and safety. However, the job does notcome without drawbacks. They warn that you have to be thick-skinned, preparedto be unpopular at times and not shy away from making decisions.

This is a job laden with responsibility on which some pharmacists will thrive.Liz Mellor, clinical governance lead pharmacist for Leeds Teaching HospitalsNHS Trust says: “I love the variety of the job. I enjoy seeing changeoccurring and that I can influence such change for the benefit of the patient.”

Background

Clinical governance first began to appear in NHS vocabulary after Labour cameto power in 1997 and was one of the foundation stones of the NHS planning blueprint.The NHS Plan was published in 2000 and the policy has underpinned the government’sraft of reforms ever since. The Department of Health’s clinical governancesupport team defines clinical governance as “A framework through whichNHS organisations are accountable for continually improving the quality oftheir services and safeguarding high standards of care by creating an environmentin which excellence in clinical care will flourish.”

The definition clearly illustrates that clinical governance crosses the breadthof an NHS organisation, and it is this breadth which makes a job as clinicalgovernance lead so appealing. Ms Mellor says: “It is not a clinical oroperations job — it is the whole breadth of pharmacy and medicines managementdevelopment.”

Nicky Thomas, clinical governance senior pharmacist for pharmacy for SheffieldTeaching Hospitals NHS Foundation Trust agrees. She says: “Before I tookon this job my world was within pharmacy and neuroscience. Now I am in contactwith staff of all different kinds in all different areas because clinical governancein pharmacy impacts on all these other areas.”

It was the opportunity to work trust-wide which also appealed to StephanieBarnes principal pharmacist clinical governance (medicines) at Guys and StThomas’ NHS Foundation Trust.

Responsibilities

Different clinical governance pharmacists have varying responsibilities accordingto their individual trust organisation and structures. For Ms Barnes, one ofthe first clinical pharmacist leads to be appointed in England, key responsibilitiesinclude medicines policy, extension of prescribing rights and the risk managementof unlicensed medicines.

Narinder Bhalla’scareer history

  • Community preregistration trainee
  • Manager of community pharmacy
  • Basic grade hospital pharmacist (Studied for clinical certificate in pharmacy practice.)
  • Hospital resident pharmacist (Studied for clinical diploma in pharmacypractice.)
  • D grade hospital pharmacist formulary and audit post (Converted diploma to a MSc in pharmacy practice.)
  • Pharmaceutical adviser for a health authority, primary care groupand primary care trust
  • Hospital lead pharmacist, clinical governance

Narinder Bhallar, lead pharmacist clinical governanceat Cambridge University Hospital NHS Foundation Trust, explains that hisremit is to consider all “medicines-relatedrisk for the trust”. He says: “I review drug incident formsand horizon scan national action from the National Patient Safety Agency. Iwork with the trust’s multidisciplinary medicines safety committee, whichI set up, to make sure that the trust’s medicines action safety planis pushed forward.”

The newness of the posts, most of which have only begun to appear in thepast five years, has given pharmacists the opportunity to develop the jobas theysee fit, which for many, attracted them in the first place.

Ms Thomas was the first clinical governance lead in pharmacy in her trustwhen she took up the post in 2001. She says: “Clinical governance was thenew buzz word. It was something which was in its infancy and our trust haddemonstrated enough commitment to it for me to realise that it was somethingwhich was really going to happen and have a big impact on patient care. I hadthe opportunity to get involved in that right at the start and to help shapeit for other leaders inside and outside the trust.”

Ms Barnes has also relished developing the parameters of the job. She says: “Itis one of those roles which is not always as defined as you think. I continueto do it and develop it as I go along.”

Mr Bhallar was also attracted to being given the chance to help design anddevelop the role. He says: “I like the idea of building up new thingswhich I can then develop. Typically, I change job every three years. I am justat that point now when, normally,I start to think that I have done as much as I can and should pass it on tosomebody else.” But contrary to his former career decisions, he has noplans to look for a new job at the moment. “I am still really enjoyingit. Perhaps I have another two years here. I have not decided yet.”

Experience

Clinical governance lead pharmacists are generally senior pharmacists withyears of experience. It is not a role which, according to those in the postand those involved with professional training, is suitable for those who arenewly qualified or have less than seven or eight years’ experience. MsThomas’ job description calls for a senior pharmacist with 10 years’ experience,some of which should be in management.

Mr Bhalla, on the other hand, also believes a minimum of seven or eight yearsexperience in necessary to be eligible for such a job role He points out thatpharmacists need to have a broad medical background and clinical experience.One problem, however, which may deter those who are most suitable for the levelof responsibility and vision required for the senior management role, is gradinginconsistencies between trusts for clinical governance leads posts.

One of the issues which may influence the variety of grades for the job isthat there is no established educational path to its door. Although some postgraduatetraining does include clinical governance components, there appears to be nonational qualification which will automatically open the door to this kindof career. However, that could all be about to change.

Heidi Wright, head of quality improvement at the Royal Pharmaceutical Societyof Great Britain, is helping to develop a clinical governance education package.She says: “As far as I am aware there are no national formal qualificationsfor clinical governance. At the moment, we are looking at some training aroundclinical governance, working together with the NHS clinical governance supportteam. It will be a modular electronic programme which will be available toall pharmacists. We are hoping to get something out next year.”

Broad experience, including some management responsibility, seems to be thecriterion for a clinical governance career. Ms Thomas decided to study fora postgraduate diploma in clinical audit after she realised it was an areaof professional weakness. She says: “It was the thing I identified thatI needed to take on for this role. At the time I went for the job, it was anarea where I had no experience at all.”

The diploma has been an “invaluable” benefit on two fronts — clinicalaudit is a significant part of her job and she is also a tutor for preregistrationtrainees who have to undertake an audit as part of their training.

Pharmacist lecturer at Aston University, John Marriott, says clinical governanceis included in all undergraduate pharmacy degrees and is part of the core curriculumfor postgraduate courses. The School of Pharmacy is also in the process ofdeveloping a new MSc in pharmacy management in conjunction with its businessschool partners. He says: “We expect to take our first intake next academicyear and a big element of that programme is the management issues around clinicalgovernance.”

Rewards

Pharmacists working in clinical governance say the job drives themon because its end result is improving patient care. Ms Thomas saysthis was one of the factors which attracted her to the post in thefirst place. She says: “The appeal to me was that the job is all aboutimproving services— everything around clinical governance is[considering] if mistakes are made, reflecting on them and finding waysof doing things better.”

Ms Mellor and Mr Bhalla were also both attracted by the diversity of the job.Mr Bhalla says: “It is an extremely varied job. Today, for example, Iwas working on a management of diabetes protocol, an alcohol-withdrawal auditand looking at paediatric drugs risk. There is satisfaction in seeing riskreduced, either through a reduction in errors or a department saying that theythink errors are being reduced.”

Although the rewards of the job are high, those in the post admit that theyrun the risk of being unpopular. It is not a job for the thin-skinned or over-sensitive.Mr Bhalla says: “You have to be careful or you are seen as interferingin a lot of people’s jobs. I used to joke when describing my job thatit meant interfering in everything.” Ms Mellor says: “You are solvingproblems all the time and I love the challenge of being given a number of disparateissues and trying to pull them together. It does make you unpopular but thenthere are occasions when you are popular when you solve problems. You haveto be clear about what your role is, your function in that role and the outcomeof your actions. You have to be a decision-maker. It is a big responsibilitywhen you are setting standards in an organisation.”

Ms Thomas believes pharmacists must have a keen interest in solving problemsto work in clinical governance. She says: “You have to be able to thinkaround things and deal with situations when they go wrong. When something hasnot gone right — that is when I investigate it. Some people thrive onthat, while others could feel demoralised. I do not think the job makes meunpopular, in fact, the contrary. I think staff are relieved that they havesomeone they can bring these issues to and that they do not have to deal withthem on their own. They can bring the problem to me and get on with their owndedicated role. Having said that it is crucial, particularly in a trust ofthis size, that you collaborate with the relevant staff groups.”

The achievements of clinical governance pharmacists are easily exposed — eithera problem has been solved and systems put in place to prevent it happeningagain, or a potential problem has been identified and tackled before it hasthe chance to occur. Those in the post can quickly real off their list of achievementswhich include establishing a trust-wide, multidisciplinary medicines safetycommittee; developing a policy on the use of unlicensed medicines and otherguidelines around the use of concentrated potassium, for example.

Ms Thomas says: “The satisfaction is sometimes a long time coming. Butit is when you have worked on a big project — a set of guidelines ora policy — and you have been through the research, completed the consulting,had it ratified and, finally, it is implemented; then you get positive feedbackon the difference it is making and that things are so much better than before — thatis when you think it has all been worthwhile.”

For Mr Bhalla the professional rewards are simple and stark. He says: “Itis the satisfaction of seeing risk reduced. Basically that is enough.”

Debbie Andalo is a freelance journalist

 

Citation: Hospital Pharmacist URI: 10971423

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