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Delivering professional competence - options for pharmacy

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The Pharmaceutical Journal Vol 264 No 7101p928-929
June 17, 2000 Articles

Delivering professional competence - options for pharmacy

By Clive Jackson, MSc, MRPharmS, and Bryan Veitch, PhD, FRPharmS

In this article, the authors suggest that setting up a faculty system for pharmaceutical specialisms might demonstrate pharmacy's commitment to meeting the challenge of delivering professional competence in the NHS and provide other benefits as well

It is an uncomfortable fact that the reputations of all the main health care professions are increasingly suffering from the poor performance of a minority of their members. This has been reinforced by recent and disturbing, high-profile cases of incompetence, negligence and even almost inconceivable abuses of both position and professional trust. The ongoing, intense scrutiny of the NHS by the media, and their willingness to put the spotlight on to individual patients' personal experiences, has only raised the pressure on the Government to take action on professional standards, regulation and accountability.
The representative bodies of each health care profession are currently considering what action needs to be taken in the light of this evolving, and inherently less comfortable, environment for their members. It is becoming all too clear that, if the professions themselves do not act in a timely and effective manner to reassure society that high clinical standards can be consistently "guaranteed", then the Government will take action to ensure their delivery, using powers provided recently under the Health Act 1999.

Which approach would we prefer to see?

We doubt that there would be many dissenters from an initiative being led by each professional body. It is, therefore, reassuring to see the Royal Pharmaceutical Society proactively consulting members on a new regulatory framework to "ensure professional competence and lifelong learning".1
The questions on the comment form that made up part of the Society's consultation paper cover a range of issues, all of which are important to guiding the profession's future direction on standards. However, it is the questioning around competencies for "specialist areas" of pharmacy practice that seem particularly worthy of further consideration.
The days have long gone since the practice of pharmacy, irrespective of the area in which an individual worked, could be considered to be broadly similar. Furthermore, a single competency framework is unlikely to cover all the aspects of current practice, even for the majority of pharmacists working within one of the mainstream areas of pharmacy (eg, community or hospital). Pharmacists' roles have (rather reassuringly) diversified and evolved greatly over the past 15 years.
So, how will the profession address the issue of creating appropriate competency frameworks for different specialist areas within pharmacy? As one of the questions on the consultation paper implies, it might be possible to identify a limited set of "core" competencies applicable to the majority of practising pharmacists, irrespective of the area in which they work. However, what the consultation paper does not directly consider is the parallel need to develop and maintain bespoke competency frameworks for each identifiable pharmacy "specialism", over and above any "core" competencies.
Developing and validating a competency framework for one "specialism" has already been found to be resource intensive, requiring a considerable time commitment from experienced pharmacists (and others) in the relevant field.2 Producing a whole range of bespoke frameworks would be a major undertaking.
If the profession wishes to maintain its current high standing with both the public and the other professions, as well as grasp some of the major opportunities now beginning to emerge from fundamental NHS reform, it will need to possess (and be able to demonstrate the possession of) relevant knowledge and skills for a wide range of existing and emergent roles.
We have already seen that, in the current climate, society (and, therefore, the Government) will increasingly require "proof" that all professionals are appropriately trained, experienced and up to date for the specific tasks they undertake.
Pharmacy, therefore, appears to have little choice but to start addressing, in a more formal way, professional standards through the development of core and specialist competency frameworks, linked to a robust system of continuing professional development, life-long learning, reaccreditation and rigorous self-regulation.

Who should undertake these various tasks?

What is clear and essential is that the Society should be central to the whole process, ultimately being responsible for professional standards and ensuring that any system put in place is cohesive, robust, efficient and fair. What is less clear is whether the Society should be the body to develop all the individual elements of any such system.
For instance, does the existing infrastructure have the capacity to take on many of these tasks in the time required? Is it appropriate for a single body to lead the development of competency frameworks and then to be responsible for professional self-regulation of individuals working to them? If not, what alternative approaches might be considered?
Rather than continually trying to reinvent the wheel, it is sometimes useful to consider what models already exist that might be usefully refined to meet our needs. The medical profession has already addressed many of the same types of issues now facing pharmacy.
As well as the General Medical Council and the British Medical Association, medicine has developed a powerful college/faculty infrastructure both to represent and manage issues directly pertaining to its specialist areas of practice.

Advantages of the college/ faculty system to the medical profession

Colleges or faculties allow individuals with similar professional practices, interests and needs to work more closely together, providing peer support, peer review and peer pressure, where necessary. It also allows individuals within that specialism to have a more influential voice on issues of direct relevance and concern to them. After all, who is best placed to provide expert and representative opinion on issues pertaining to the work and development of specialist professional practice? Surely it is the body of specialist professionals themselves.
There is a strongly held perception by some members of the pharmaceutical profession that pharmacy is not sufficiently consulted on, or included in, national policy developments around clinical practice issues and health care delivery. This perception may or may not be correct. However, it is worth asking ourselves what options are readily accessible to national policy makers when trying to obtain expert and truly representative specialist input from the profession.
Does pharmacy currently have clear and recognised mechanisms to ensure that, when national policy is being developed in a specialist area, a truly representative corporate opinion from the relevant body of expert pharmacists can be requested and then developed and delivered in a timely manner? In most cases, the answer is, perhaps, less positive than we might wish.

Options

So what options can be considered to address most effectively the current and future issues facing pharmacy in this context?
To be effective and to create ownership across the primary users, the development of competency frameworks for pharmacy specialisms would have to be led by expert practitioners in that particular area.
A good example of this process can be seen in the UK Psychiatric Pharmacy Group (UKPPG) which is being proactive in creating both a professional and educational structure for its members, as well as defining the skills necessary to provide high quality pharmaceutical psychiatric services. In fact, the UKPPG plan is to set up a stand-alone College of Mental Health Pharmacists by October, 2000, which will, among other things, set out a competency framework for its members (see its website: www.ukppg.co.uk).
Pharmacy, however, is not a large profession and some specialisms will have relatively few individual practitioners at any one time. If all the potential specialisms within pharmacy, however small, set off in an unco-ordinated manner to "do their own thing" around formally ensuring competence, the profession could end up with a patchwork of approaches to competencies, all produced in different ways, to different quality standards and applied in variable ways.
Such broad fragmentation cannot be in the best interests of the profession or, ultimately, the patient. A possible approach, therefore, might be to create or identify an organisation that could provide the umbrella infrastructure, support and guidance to all those pharmacy specialisms that wish to avail themselves of it. In this way, effective and co-ordinated development of formal competency frameworks, by the specialisms themselves, could be achieved within a realistic time for many of the practice areas within pharmacy.
An appropriately structured umbrella organisation (probably a college - and hopefully, in time, a Royal college) would allow the formation of professional faculties for each pharmacy specialism. These formal faculties could have control of their own activities and, besides the work on competencies, would be able to provide a range of additional services and benefits to their members.
Benefits of belonging to a college or faculty could include:

  • Visible recognition of membership of a (hopefully) prestigious, specialist college or faculty (eg, the Royal College of Psychiatrists or Faculty of Public Health in medicine) with additional recognition for high level achievement (eg, fellowship, merit awards, etc)
  • Provision of a focus for developing and delivering professional specialist views and input into (and, therefore, influence on) national initiatives and policy development
  • Provision of a professional network for peer support, peer review (and peer pressure - linking into the new clinical governance agenda)
  • Provision of a system for the rapid and effective dissemination of national and local good practice, plus new clinical and service developments
  • Accreditation (and, on occasions, commissioning or delivery or both) of bespoke education and training courses targeted at the specialism's needs

The formation of a faculty structure would in no way obviate or reduce the need for other widely representative professional groups and organisations (eg, the Guild of Healthcare Pharmacists, the Primary Care Pharmacists' Association, the UK Clinical Pharmacy Association, etc) as their roles would be additive. This view is reinforced by again looking at the medical profession where colleges and faculties sit alongside other professional groups such as the General Practitioner Committee and the National Association of Non-Principals.

Pharmacy specialisms?

So, what is the definition of a pharmacy specialism? Clearly, this will require considerable thought within the profession and, no doubt, several iterative steps to gain consensus. However, to start the debate, a definition of a specialism might be: "A definable area of pharmacy practice, linked to a specific element of health care delivery, in which the services provided require competencies from those professionals over and above those that all practising pharmacists should be expected to have for the safe and effective dispensing and supply of medicines."
Based on this broad definition, a few examples of a specialism could be:

  • Mental health - in primary and secondary care
  • Intensive care - in the hospital setting
  • Health promotion and disease prevention - in the community setting
  • Prescribing advice and support - in primary care organisations
  • Medicines information - across primary and secondary care
  • Pharmaceutical public health - in health authorities and primary care trusts

Accordingly, practising in a specialist area could be either a full-time activity or just one role of several routinely undertaken as part of general pharmacy practice. It also follows, therefore, that an individual pharmacist might practise more than one specialism and would wish to be a member of more than one faculty.

Next steps

The next step would be to define and identify the appropriate umbrella organisation to provide the structure, administration and co-ordination to support the development of effective faculties. Clearly, the profession could start from scratch, just as the UKPPG did, and this remains a realistic, but resource intensive, option for many potential pharmacy specialisms.
Alternatively, redefining and extending the remit of the College of Pharmacy Practice to take on the role of supporting and formalising specialist area faculties could be considered. The advantages of this approach could include that the CPP:

  • Is already established and recognised
  • Has an existing structure, some available resources and outputs that could be modified and extended to be of value in this new initiative
  • Has shown a willingness and enthusiasm to redefine itself to ensure continued and increasing relevance to all practising pharmacists in the new millennium
  • Could gain the additional prestige of becoming a Royal college within five years

Clearly, the profession would need to see evidence that the CPP truly has both the will and capacity to make such fundamental changes to its current processes before embarking on this road. However, it is in the CPP's own medium- and long-term interests to get the majority of the pharmacy profession working with it, and it is currently taking preliminary steps to do so.
In conclusion, therefore, it seems that the time is right for pharmacy to take some fairly radical steps to ensure that it maintains its rightly deserved status as a trusted, valued and progressive health care profession.
The development of a college/faculty structure is not (and should not be thought of as) creating a pharmacy elite. Rather, it could be a pragmatic response to support most pharmacists in a rapidly changing health care environment. There will be very few pharmacists who, during the course of their work, do not routinely undertake at least one specialist practice or would not like to extend their work to encompass one. Furthermore, the vast majority of pharmacists would want to be considered "expert" in such work and have the chance for visible recognition for the effort that made them experts.
The ideas and concepts contained within this article are not meant to be exclusive, comprehensive or fully refined. They are meant to further stimulate the debate that is now starting within the profession. Co-ordinated specialist faculties are just one option (but an important one) to be considered as part of the process.
Doing nothing is not an option: collectively, we must now take the right decisions and action within the timescale being imposed on the profession by external events.

Clive Jackson is director of the National Prescribing Centre and Bryan Veitch is the chairman of the College of Pharmacy Practice

References

1.Society starts consultation on new framework for professional regulation. Pharm J 2000;264:400.
2.Competencies for pharmacists working in primary care. Liverpool: National Prescribing Centre/NHS Executive, 2000.

Citation: The Pharmaceutical Journal URI: 20001843

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