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NHS England

Lack of leadership and clinical skills are a 'barrier' to pharmacy investment, warns NHS England

Deputy chief pharmaceutical officer worries that pharmacists are unwilling to engage with clinical and leadership training programmes as they “don’t see it as a priority”.

Bruce Warner headshot

Source: Emma Page

Bruce Warner, deputy chief pharmaceutical officer for England, said it was essential for pharmacists to “have the right skills and the confidence to do what is being asked of them”

A lack of “skill mix” among pharmacists is a potential barrier to the investment in the sector that is detailed of the ‘NHS Long-Term Plan’, the deputy chief pharmaceutical officer for England has warned.

Speaking at the pharmacy All-Party Parliamentary Group (APPG) on 15 January 2019, Bruce Warner, the deputy chief pharmaceutical officer for England, said the uptake of places on leadership and clinical programmes, which were designed to improve skill mix among pharmacists, had been “poor”, despite having a “significant amount of money” committed to them.

He said the lack of skill mix in the sector could be a barrier to the investment promised to pharmacy and primary care. In the plan, the NHS committed £4.5bn to the creation of “expanded community multidisciplinary teams”, which would include pharmacists, to work alongside primary care networks of GP practices covering 30,000 to 50,000 patients.

Bruce Warner’s comments came in response to a question from the committee on “the next steps in achieving that investment” and “the barriers to enabling us to get to that point”.

Warner replied: “In terms of barriers I think we need to make sure the skill mix is right. We need to make sure people have the right skills and the confidence to do what is being asked of them.”

“We have committed a significant amount of money to that, particularly in terms of bespoke training programs for pharmacists,” he said, adding that this includes both clinical and leadership training programmes.

But he continued: “The uptake for that has been mixed. Certainly the uptake on the leadership programmes being offered has been poor. Some of the uptake on the clinical programmes has been less than we would have hoped as well.”

He noted that part of the reason for poor uptake on leadership programmes could be workforce issues, adding that “there are also some parts of the sector that perhaps don’t see it as a priority”.

“We feel [pharmacists] have a lot of potential, a lot to offer, particularly if community pharmacy and pharmacy within primary care networks are going to step up and take a role then we need equip pharmacists both with the confidence and the skills to actually vie for those leadership roles.”

At the APPG meeting, Warner also defended the document’s use of the phrase “clinical pharmacist”, saying that while pharmacists “are all trained the same” initially, “the training throughout our careers leads us down a certain path and so I think there are distinctions”.

In general practice, he explained, pharmacists are handling “patient-facing clinical medication reviews — sometimes quite complex clinical cases”.

He continued: “I’m afraid, I don’t accept that all pharmacists can do everything just because they’re a pharmacist.”

Julie Cooper, Labour Party MP for Burnley, who raised the issue with Warner, said it was “regrettable” that the term “has been used to deride community pharmacists’ contribution” and has created an “implication of a lesser quality” of care.

However, Warner clarified that not all the pharmacists working in primary care networks will be based in general practice.

He said: “There is a commitment in the long-term plan to put more pharmacists into those primary care networks and it doesn’t talk about them being based necessarily in general practice — so there’s no reason why they can’t be working in different physical settings within that primary care network.”

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20206017

Readers' comments (10)

  • I find,somewhat worrying the statement that : "uptake of places on leadership and clinical programmes, which were designed to improve skill mix among pharmacists, had been “poor”, despite having a “significant amount of money”.

    Having the right qualifications and skills for the job, should be a priority for every single registrant. However, we still see or hear od cases of staff being promoted above their qualifications and skills on what seems to be a chase after the money and status instead of a chase after the skills and experience. Perhaps, it is time to raise the bar so certain qualifications are made essential when applying for certain jobs. While this is the case in paper, the criteria is sometimes overlooked to the detriment of the services provided and staff wellbeing.

    Potential:
    While it s true that pharmacists have a lot of potential, the speed at what changes are occurring, requires that they keep abreast of new ways of practice and thinking if they are going to effectively contribute to the multidisciplinary team work. So why are we not taking advantage of the opportunities available to us?

    Funding:
    Also interesting to hear that a significant amount of money was committed to clinical and leadership training. While this is positive, maybe NHSE and the RPS need to work together to ensure there are clear and simple pathways for the workforce to be able to access and attend these programmes. I know of pharmacists who have been denied training because they are working as locum or because there never seem to be the right time to release them for training. The reality is that in the long run, staff that are not properly trained and skilled are more expensive.

    In summary, a painful lost of opportunity by the profession.

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  • Graham Phillips

    I am astonished and incredibly disappointed to find Bruce Warner, himself an ex-community pharmacist, propagating the Keith Ridge prejudice against community pharmacists.

    First of all, around 60% of GP Practice Pharmacists are ex-community. Do they suddenly become "clinical" when the cross the GP threshold? Second: the definition of "clinical" as Bruce well knows is "having direct contact with patients.” On any reasonable interpretation EVERY community pharmacist is, by definition, "clinical" whereas Keith Ridge and Bruce Warner are clearly not.

    On the training issue Bruce is being equally disingenuous.

    First off, NHS-E haven't invested a single penny in the training of community pharmacists. Quite the reverse. They have continually "robbed" from the community pharmacy contract and the vast majority of the missing money has gone to prop up other parts of the NHS entirely. The simple truth is that only a fraction of the #pharmacycuts cash has been re-invested in pharmacy. Such re-investment there has been has mainly gone to non-community pharmacy schemes such as GP pharmacists and a variety of other NHS-E schemes. In fact NHS-E has consistently refused to invest in Community Pharmacist Independent Prescribing and when challenged Keith Ridge made it clear that such investment would go to GP Practice Pharmacists only. Despite all of the above, 4 pharmacists from my group have self-funded as Independent Prescribers. As a reward for which the NHS has commissioned precisely NOTHING from us.

    Maybe Bruce should try writing some of these false premises on the other side of the infamous #Brexit Bus!

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  • I'm sure the headline has been written incorrectly. Surely it should read

    "Lack of leadership and vision from NHS England is 'barrier' to investment, warns pharmacy - Pharmacists worry that Deputy chief pharmaceutical officer is unwilling to engage with clinical and leadership training programmes as NHS England “don’t see it as a priority”.

    Community pharmacists - owners and employees - continue to invest substantial amounts of time, effort and money in developing their own skills only to be constantly rebuffed by NHS England as Graham describes. I know of several community pharmacists who have qualified as independent prescribers and the only ones who are even vaguely likely to be able to use their skills are those who have subsequently left community pharmacy.

    You cannot criticise community pharmacists, Mr Warner, when you and Dr Ridge have absolutely no vision for our profession; no vision for using the existing network of thousands of pharmacies to help the constant crisis in primary care and no vision for working across boundaries.

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  • It seems a disappointment that the opportunities being offered have to date not been fully taken up by the profession - all our foundation pharmacists undertake this training. However it is good for the profession that 60% of the GP Practice Pharmacists entering the training programme are previous employees in Community Pharmacy- this is roughly in line with registration numbers and the role provides new clinical roles separated from supply.

    Personally I accept many of the patient facing skills utilised by community pharmacy of clinical decision making and either reassure, referral or treat are the same but the clinical and leadership training is needed to develop the advanced clinical diagnostic and decision making skills supported by an improved therapeutic armamentarium from the prescribing qualification to move into this new role and become fully embedded in GP practice team.

    It appears there will be more clinical opportunities for pharmacists in primary care as part of the 10 year plan so these programmes need to have a similar if not long-term life-span.

    I wonder if we will as a profession continue to stand complaining on the side-lines and look back at the end of those 10 years and see yet another missed opportunity?

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  • Interesting to read the comments related to the funding when HEE have announced reduced funding for pre-registration places in 2020/21 intake, so employers (community pharmacy, NHS trusts) have to find extra money to employ pharmacists at the same banding as they are now, or reduce what they get paid.

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  • I am very interested in clinical training programs but the opportunities for official training are not easily attainable other than articles in journals

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  • Graham Phillips

    @David: I think you have missed the point. No one is disinterested in training but tell me - in hospital do the individual pharmacists fund their own training? Do it in their own time? And, having qualified, receive zero benefit? Or is funded, with time allowed in lieu and is it the basis of professional career progression? None of this is the case in community pharmacy.. we have been stripped of resource and refused funding to train as independent prescribers . And when we self-fund the rewards are? A pay cut!

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  • For the sub-headline "Deputy chief pharmaceutical officer worries that pharmacists are unwilling to engage with clinical and leadership training programmes as they “don’t see it as a priority”." - can the readers please be provided with the evidence to support this statement - in particular the phrase 'unwilling to engage with clinical and leadership training programmes'. It would be helpful to include this in a follow-up article together with an analysis of the availability as well as the uptake across the various sectors that Bruce Warner refers to so that the readers can get an understanding of what the comments by Bruce Warner are based on.

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  • Whilst respecting Bruce Warner, Keith Ridge and the team they head I must take issue with the comments about poor take up of clinical leadership and academic courses. It’s surely not yet “old news” that community pharmacists have been working in a severely tightened area since the funding cuts were announced and implemented. The “efficiencies “ demanded of us have meant that more is being done by fewer and time is at a rarified premium. How many companies can invest in the protected learning time and backfill costs required to study and achieve these qualifications for staff when there has been absolutely no discussion of what roles such staff may occupy, what roles will develop and what, (God forbid) will be paid to those undertaking such responsibilities? At last the LTP is announced almost a year after the announcement of the funds for training but the LTP is incredibly light on detail. A proposed new contract has been on the cards for over a year with no discussion or even wish list yet in the public domain ( punishment for having the temerity to seek leave for a judicial review?). Investment requires confidence and the support of a lending organisation. With government policy being pharmacy closures and even PSNC announcing it’s intention to facilitate closures, pharmacies struggling to pay wholesale bills and defaulting on bank commitments, exactly what is the incentive to invest and why should a bank agree?
    Why is the CPRS not yet a national scheme? Why are CCGs encouraged to scrap minor ailments schemes, Local authorities scrapping EHC and Smoking cessation schemes? How many community pharmacists have completely wasted their time acquiring prescribing qualifications to date?
    In this climate ( funnily enough not the case in Wales or particularly Scotland which has long encouraged and invested in pharmacies recognising the recruitment crisis in practice nurses and GP doctors) why does anyone expect pharmacy companies to invest in supporting staff to acquire higher qualifications?
    Give us a steer and start talking about a framework including financial incentive ( you know, like GPs are offered in order to change their practice?) and I guarantee that pharmacy companies will be there. Until then Bruce, please own the vacuum that exists and accept it’s stultifying impact.

    Unsuitable or offensive? Report this comment

  • Whilst respecting Bruce Warner, Keith Ridge and the team they head I must take issue with the comments about poor take up of clinical leadership and academic courses. It’s surely not yet “old news” that community pharmacists have been working in a severely tightened area since the funding cuts were announced and implemented. The “efficiencies “ demanded of us have meant that more is being done by fewer and time is at a rarified premium. How many companies can invest in the protected learning time and backfill costs required to study and achieve these qualifications for staff when there has been absolutely no discussion of what roles such staff may occupy, what roles will develop and what, (God forbid) will be paid to those undertaking such responsibilities? At last the LTP is announced almost a year after the announcement of the funds for training but the LTP is incredibly light on detail. A proposed new contract has been on the cards for over a year with no discussion or even wish list yet in the public domain ( punishment for having the temerity to seek leave for a judicial review?). Investment requires confidence and the support of a lending organisation. With government policy being pharmacy closures and even PSNC announcing it’s intention to facilitate closures, pharmacies struggling to pay wholesale bills and defaulting on bank commitments, exactly what is the incentive to invest and why should a bank agree?
    Why is the CPRS not yet a national scheme? Why are CCGs encouraged to scrap minor ailments schemes, Local authorities scrapping EHC and Smoking cessation schemes? How many community pharmacists have completely wasted their time acquiring prescribing qualifications to date?
    In this climate ( funnily enough not the case in Wales or particularly Scotland which has long encouraged and invested in pharmacies recognising the recruitment crisis in practice nurses and GP doctors) why does anyone expect pharmacy companies to invest in supporting staff to acquire higher qualifications?
    Give us a steer and start talking about a framework including financial incentive ( you know, like GPs are offered in order to change their practice?) and I guarantee that pharmacy companies will be there. Until then Bruce, please own the vacuum that exists and accept it’s stultifying impact.

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