Specialist roles in pharmacy
An insight into specialist areas of pharmacy practice that you may wish to consider in the future
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Obtaining a pharmacy degree can be viewed as being synonymous with acquiring a key to endless career opportunities. With the continuously evolving and expanding role of the pharmacist, a pharmacy degree opens the doors to many unconventional and unique roles. This article will explore some of these opportunities.
In primary care, practice pharmacists provide specialist advice to GPs, nurses and other practice staff on all aspects of prescribing. They work closely with practice teams and clinical commissioning groups to implement and maintain cost-effective prescribing strategies. Practice pharmacists provide education and advise prescribers on the clinical and practical issues affecting prescribing following both local and national guidelines.
As well as providing prescriber support, pharmacists are the medicines experts on the team. They are available for patient consultations and medication reviews to optimise medication regimens. These consultations are often with patients with long-term conditions or those currently living in residential or nursing care and with polypharmacy issues. Using their clinical knowledge, practice pharmacists assess patients’ medical histories, test results and current medicines to optimise prescribed medicines and improve patient safety, both of which often result in cost savings for the practice.
In the current economic climate, with limited resources available for the NHS, practice pharmacists have an important role in providing cost savings against the prescribing budget. Generic and formulary switches ensure the most cost-effective product is prescribed, by reviewing expensive “specials” and providing alternative solutions to the prescribers.
Practice pharmacists also carry out audits to ensure safe prescribing. Part of the role involves implementing actions following safety alerts and drug recalls from the Medicines and Healthcare products Regulatory Agency, as well as reviewing high-risk medicines or those that require regular monitoring.
Practice pharmacists do not require additional training to be able to fulfil their role competently. However, a two-year postgraduate clinical diploma may help enhance their knowledge and improve the standard of care being provided to patients and the team. Independent prescribing pharmacists bring added value to such a role because they have specialist knowledge of diagnosis and prescribing.
Palliative care pharmacists work with terminally ill patients in a hospital or hospice. They provide pharmaceutical care to various departments including inpatients, daycare, specialty services (ie. lymphoedema) and out-of-hours services. On a day-to-day basis, the pharmacist’s role entails: medication reconciliation at admission; ward round updates; discharge counselling; recommending and monitoring medicines; and serving as the resident medicines expert on the team for consultations. Palliative care pharmacists are involved in education for patients and healthcare professionals including nurses, GPs and members of their own team. Since this is a specialised area of practice, the role involves audits and research in collaboration with academic institutions.
There are about 200 registered palliative care pharmacists nationwide, of whom less than a third work full-time in palliative care. Palliative care pharmacists are highly sought after. They are an invaluable source of expertise and information for non-specialist colleagues. Some pharmacists sit on regional and national palliative care committees, contributing to guideline authorship.
The role is emotionally demanding but extremely rewarding. Palliative care pharmacists need excellent communication skills and have to be able to maintain a good work-life balance, plan their workload and reflect on emotionally difficult patient cases. There is no specific training required for the role, however, additional training is an asset. Palliative care pharmacists obtain a Foundations of Palliative Care Certificate, and can complete training courses such as an advanced course in symptom control and advanced communication skills, along with continuous self-directed learning.
Some community pharmacies are affiliated with hospice services, providing the medicine supplies and pharmacist consultation services for the hospice. This may be a good introduction and first step into becoming involved with palliative care pharmacy.
Pharmaceutical services and supplies are regulated within the UK by various bodies that are each responsible for a specific aspect of regulation.
The General Pharmaceutical Council is set up to protect the health, safety and wellbeing of the general public using pharmacy services. The council is responsible for approving qualifications for pharmacists and pharmacy technicians, setting standards for pharmacy professionals, premises and education and dealing with fitness-to-practice issues. Within the GPhC, regulatory pharmacists are employed to enforce this mandate. Pharmacists form part of committees that define and accredit standards for professionals, premises and education. They provide advice to pharmacy professionals, patients and the public regarding the application of GPhC standards and pharmacy legislation. Regulatory pharmacists are also responsible for inspecting registered pharmacy premises to ensure compliance with the relevant professional and legal requirements.
As part of a team drawn from the GPhC’s accreditation and recognition panel, pharmacists from different backgrounds review current or prospective pharmacy schools to ensure the course of education and training meets the relevant standards and accreditation criteria. This involves visiting the training site to view teaching facilities and meet with academic, research, teaching and management staff, as well as talking to current students.
Registrant members — pharmacists and pharmacy technicians — from a variety of backgrounds are included in the fitness-to-practise panels for investigatory or fitness-to-practise hearings alongside lay members.
Pharmacists present on the investigating committee examine cases and decide whether the fitness-to-practise committee should consider the allegation or if it would be more appropriate to provide advice or a warning, or dismiss the case. Pharmacists on the fitness-to-practise committee make decisions on whether fitness to practise has been impaired and if so they may issue a warning or a direction for removal or suspension of registration.
The Medicines and Healthcare products Regulatory Agency regulates all medicines and medical devices in the UK, ensuring they are effective and safe. The MHRA employs over 900 people, including over 200 pharmacists, who work across the medicines regulation spectrum from clinical trials through to licensing, parallel-import approval, manufacture inspection and patient experience. The MHRA has a strong public health role and focuses on post-marketing surveillance, reviewing safety aspects of medicines in clinical use.
Pharmacists are involved in the detection and monitoring of adverse events via a range of sources, including the Yellow Card Scheme. Responsibilities also include assessing contraindications, side effects and patient information leaflets, alongside reviewing licensing of medicines where clinical use has changed. Pharmacists in this area can use their scientific expertise and knowledge on the safe use of both prescription-only and pharmacy medicines to facilitate the safe and effective use of medicines by both prescribers and patients. The MHRA influences the development, manufacture and marketing of medicines, which involves working with industry to ensure medicine safety at all stages of development.
A pharmacist or technician who is answering to the fitness-to-practise committee will often be present when their case is heard. The defendant may choose to have a legal representative to attend the hearing, and in some cases the lawyer may be a pharmacist by previous training. This pharmacist would have undergone legal training through a law conversion course. He or she would advise and represent registrants at all stages of proceedings including initial referral, investigating committee and fitness-to-practise panels. They are able to provide further advice regarding criminal law, civil law and employment law with the advantage of having a thorough understanding of the profession, being pharmacists themselves.
A surprisingly high number of solicitors did not study law at undergraduate level, taking advantage of law conversion courses, typically the Graduate Diploma in Law (GDL), which leads into the Legal Practice Course (LPC). This opens up opportunities for roles within pharmaceutical companies, or in solicitors firms specialising in pharmacy and healthcare law.
Pharmacists are employed in industry to discover, manufacture and supply medicines to the market. Working in multidisciplinary project teams alongside medicinal chemists and bioscientists, pharmacists develop and select drug compounds that may have valuable therapeutic effects. Factors such as compound properties, dosage form, desired route of administration and packaging are considered.
Compounds are then tested within clinical trials, and pharmacists are involved throughout the process from developing prototype formulations in animals to producing, packaging and supplying medicines for clinical researchers and reporting data. Pharmacists are involved in the manufacture of approved medicines and can take on Qualified Person roles, approving each batch of medicine before it is released to the market.
Pharmacists form part of an integrated and holistic healthcare team in prisons. They work alongside resident doctors, nurses, pharmacy support staff and substance misuse teams. The role involves clinical prescription checks and liaising with surgeries and community pharmacies to build accurate medication records.
Prisons often have their own formulary so medication changes for new prisoners are common, and the pharmacist plays a vital role in this. For instance, to reduce the quantity of medicines held on prison wings, switches to modified-release formulations and weekly prescriptions are often implemented.
Pharmacists within prisons work closely with substance misuse teams to provide care to prisoners with opioid and benzodiazepine dependence. New substance-dependent prisoners are provided with a “rattle pack” — vitamin B, loperamide, mebeverine and paracetamol — until it is possible to ascertain a correct dose of substitution therapy. Methadone is the drug of choice for these patients, primarily to reduce the diversion of buprenorphine and diazepam within the prison. Pharmacists supervise methadone consumption on prison wings. New technology such as iris and fingerprint recognition software is becoming the norm for supervised consumption.
Given the multitude of scientific and medicine-related material published, it is only logical to conclude that this is a big area for pharmacist involvement and a potential career pathway. Medical writers are involved in composing material for a variety of audiences, including, but not limited to, patients, healthcare professionals, students and researchers. They are employed by regulatory bodies, such as the MHRA, private organisations, such as a pharmaceutical company, or, in the case of this writer, a professionally endorsed journal. Medical writers may also be employed to write book chapters, congress materials (including presentations and posters) and scientific, data-driven publications.
The job calls for versatility in writing styles, depending on the target audience. The material written must be presented in an unbiased and balanced way. As a medical writer, one is expected to write accurately, with precision, ensuring that the message delivered is clear without a shadow of a doubt; a skill only enhanced with practice.
It goes without saying that a good grasp of the English language is required for such a role. Additionally, one has to be able to manage time effectively to meet deadlines, while working closely with a large network of people to obtain all relevant information for the task at hand. Although no further qualifications are required for a position as a medical writer, experience in writing goes a long way — this may be as simple as writing your dissertation for publication or presentation at a conference.
Other potential roles for pharmacists in the writing sector include working in health journalism (such as writing for The Pharmaceutical Journal), blogging, being a regular columnist for a newspaper or magazine, editing learned journals (such as the BMJ or International Journal of Pharmacy Practice) and publishing your own book (many books published by the Pharmaceutical Press are written by pharmacists).
These roles are unique in nature so positions are not as readily available as community and hospital pharmacist posts. That being said, demonstrating a keen interest in the individual areas will facilitate entry into the role. They all require a good grounding in basic pharmacyand medicines knowledge at a minimum, along with self-direction and motivation. Most pharmacists have entered these roles a few years after qualifying, having gained experience in pharmacy practice and perhaps additional relevant training to their area of interest.
Citation: The Pharmaceutical Journal URI: 11135403
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