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Community pharmacy vs hospital pharmacy - a tale of two worlds?

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Scottish ministers state that they are committed to protecting spending on the NHS in ScotlandI have many friends or fellow comrades who are hospital pharmacists. It’s just that I never get the chance to speak to them as often as I would have wished. It really does feel like sometimes that there is a world of difference between the areas of community and hospital pharmacy when it comes to the different kind of tasks expected to be carried out, the style of pharmacy practice and the different types of cases that are dealt with.

And because of my lack of experience in the hospital sector, I couldn’t possibly make a series of extensive comments about working in a hospital. Although I have made a few visits to various hospitals during my time at university and beyond, whether it’s been on an afternoon placement on the wards or just a morning visit to see a hospital pharmacy in action, my horizons has it’s severe limitations on this one.

But what I can say is that community and hospital pharmacy are definitely nowhere near the same. Whilst community pharmacy is a fast paced, hands on and entrepreneurial sector to work in it, arguably, isn’t as clinical as hospital pharmacy.

Community pharmacists don’t have access to patient notes nor key information about the patient’s overall care in other healthcare settings. Prescriptions come in thick and fast and with such little time to contemplate the whole context of the patient’s overall care (beyond the community pharmacy), you have to ensure that you use all the power and autonomy you have at your immediate disposal to give the patient the best possible care.

Whilst, on the other hand, hospital pharmacists rely on more of the knowledge picked up during the modules at university on the clinical elements of pharmacy, whether that is preparing sterile products, interpreting biochemistry values and medical notes or preparing intravenous medicines.

Yet the horizon for pharmacists in community could all change next decade in Scotland if the Scottish Government’s proposed plans (Prescription For Excellence) for pharmacy come into effect, meaning that more opportunity of a clinical approach will become necessary.

I have blogged on here in the past about my disappointment at the lack of networking opportunities that exist to talk with fellow pharmacists in other areas of work and even between other community pharmacists. The stress, strain and fast paced reality of modern life inhibits many chances for fellow pharmacists from all sectors of work to talk to one another, in real life, face to face. Being a pharmacist in practice may be isolating, but we are all human after all. We do need each other in some way or another, despite the stress and strain of modern day working life.

But on another issue, another question beckons (and another one of my extensive academical observations). How easy, or difficult, is it to really make the jump between both sectors? I get all kinds of responses on this very question, but the most popular answer I tend to hear ringing through my ears in conversation is it is apparently more difficult to jump to hospital pharmacy from community pharmacy then it is for a hospital pharmacist to move into community. 

When I was in the early days of my career as a registered pharmacist, I saw this difficulty screaming at me first hand. Knocked back at every opportunity to achieve any form of work in a hospital pharmacy, it became apparent to me that community pharmacy was here to stay in my immediate pharmacy career, once the opportunity to finally get on the employment ladder came (I’ve blogged about my first twelve months in a previous time).

Don’t get me wrong, I am absolutely blessed that I currently practise in a Scottish nation which is undisputedly world class for a community pharmacist to practise their profession.

But what concerns me in general is that those who want to take a chance at a stint in a hospital pharmacy and who have predominantly community pharmacy or other forms of pharmacy experience (such as industrial pharmacy for instance) are somehow at an immediate disadvantage. When I was at university, opportunities were lacking in terms of getting extensive hospital pharmacy experience. And when vacancies eventually come up for hospital pharmacists, overwhelmingly, the demand exceeds the supply, especially in today’s economic environment. The lack of past experience in a hospital pharmacy setting doesn’t help.

And even for some pharmacists with more hospital pharmacy experience than others, there is literally next to no chance of sealing a permanent job. Also, this isn’t necessarily an issue for hospital pharmacy as far as being overwhelmed with applicants is concerned. Other areas, like community pharmacy, see such overwhelming pressures for jobs exist too.

Now I don’t think anybody is to blame for all this, because I suggest that the lack of opporunity is down to, possibly, current pressures on funding on parts of the NHS. Scotland, like the rest of the UK, is not immune to this and spending priorities have had to be revamped in some areas. It can only be that so many pharmacists can be hired in the NHS and funding can only go as far as it can, especially in today’s economic environment. However, it’s also important to note that Audit Scotland has in recent times given credit to Scotland’s health authorities for their financial performance in the last year.

What would intrigue me more than anything is how pharmacists in hospital are coping with all the pressures that currently exist within the NHS (hospital pharmacists, I’m going to need you to help me out so please comment).  

But, overall, let’s face it. We are all pharmacists, community or hospital. Technically, we all do the same job. Agreed? 

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From BBC News, “NHS needs long-term spending focus, says Audit Scotland” - http://www.bbc.co.uk/news/uk-scotland-scotland-politics-24463121

Readers' comments (3)

  • I do both. work full time in hosp and some saturdays in community. I find community quite restrictive in the time spent with patients with the counter assistants looking at me strangely when I come to the counter when a mum wants Ibuprofen for a child (its the paed haematology pharmacist in me that worries me!). I love talking to patients - but theres no one else in the pharmacy to check FP10's! so back in the disp I go tediously checking the prescriptions left from the day before or owing medications. people say community has piles of prescriptionsto deal with.so does hospital with discharge meds, but it's a bigger team so you don't end up doing all the checking.we have time for ward work.community fellow pharms say but community is a business - so's a hospital, I can spend hours on drug expenditure reports and how to bring drug costs down in my area. I've worked with a few young community pharmacists who have got into hospital pharmacy as a junior after working a few years as a manager and they just don't like the heirachy and banding system in the hospital and dislike instruction - I understand they've been in charge of a pharmacy before but hospital is a big team where there are many senior pharmacists with vast clinical experience. I find it frustrating I can't take a patients blood pressure in community as I'm listed in the enhanced service - I check patients obs all the time in hosp and take it now im doing the prescribing course, doesnt mean I will just do it in community - we need to obide by rules. both sectors are expanding in such different ways, both good! I'm glad I have my hand in both! what I'd love to try and get into which was what I wanted to do since pre reg is industry! I find thays the most difficult area in pharmacy to get into! .

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  • I have a post- graduate clinical diploma (community Focus) and work with a multiple. What I find is that managers do not know how the clinical role of a pharmacists fit into the community setting, so you have to show them. To survive you have to create the balance between the commercial side of pharmacy and the professional side nobody can do that for you. We need to show that the advice from a pharmacist is Superior to the advice that a counter assistant or a dispenser could give, after all we are the drug specialist. I had to create my own practice. I use my clinical skills when I conduct MURs NMS and offering otc advice. I do blood pressure checks during MURs if it's needed and if work load allows I will do diabetes screening. I advice my local G .p surgery on alternatives for drugs that are not available. There is so many things that you can do to bring out that clinical role to the forefront in the community and the RPS and other pharmacy bodies are helping to create the opportunities to help us, we just need to be confident enough to take up the challenge.
    The difference between hospital and community pharmacists is how we apply the knowledge, we did study the same course at university. The hospital pharmacist see the the patient in an acute or unstable condition and helps that patient to re- gain a stable condition; as a community pharmacist I help to maintain that stablility and to prevent the patient going back to hospital, thus we apply the knowledge differently because the focus is different.
    I think that it would be easier to move from community to hospital because the hospital pharmacist has the advantage of having access to patients notes, in the community you have to rely on the indication of the drugs and the information you get from the patient. There also seems to be a better support network in the hospital, in the community we work in isolation.
    I like working in the community ,it has it's ups and downs, sometimes I'm under pressure and under a lot of stress but you learn to deal with it (the RPS has a guideline on how to deal with workplace pressure) , and I have had many arguments with non-pharmacist managers, but it would be nice if I could experience hospital pharmacy and community pharmacy. I have heard of hospital pharmacits working weekends in a community pharmacy but I have never heard of a community pharmacist working a weekend or even a day or two of the week in a hospital pharmacy.

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  • A great article. Having been a hospital pharmacist, whilst doing part time community work I can see both sides of this one too.
    However I used to interview potential pre-reg students, and it always amazed me how many applied without any hospital experience apart from the mandatory days that they'd done as part of their course. If you want to get a hospital job you will need to show that you are interested in this sector. Its a long time ago but when I applied I'd spent a week of my holidays on work experience at an NHS hospital and a few days at a private hospital. I would have liked to have done more but placements are hard to get.
    In the world of today we have too many pharmacists and not enough jobs, so my take on this is two fold, firstly make yourself stand out from the crowd, do the extra voluntary work, show that you really are committed to the sector you chose to apply to. Secondly think laterally. I now work as a practice pharmacist, I use the skills and qualifications I gained in hospital but I needed my community experience to help with my current role. There's a massive role for good clinical pharmacists to work in GP surgeries, and with the current lack of GPs they're desperate for help, and are fast recognising what a good practice pharmacist can do to lessen their workload. So with an excess of pharmacists my advice would be to get the necessary skills to move into a fast developing sector where jobs are being created!

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