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Community or hospital pharmacy?

Are you trying to decide between the hospital and community sectors? Gareth Malson explains what you can expect from both, including responsibilities, salaries and career progression.

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Deciding whether to work in community or hospital pharmacy is an important decision for many pharmacy students and pre-registration trainees

Although there are many career options within the profession, most pharmacists are employed in either the community or hospital sector. Deciding which to work in can be a challenge for pharmacy graduates — so this article describes what you need to know about both.

Responsibilities

Cutting your teeth in hospital

As a hospital pharmacist your ‘bread and butter’, at least to begin with, will be to check prescriptions for inpatients clinically. In broad terms, this can be considered in three parts:

1. When patients are admitted to hospital, you ensure that an accurate drug history is documented. This helps determine the likelihood of any drug-related problems — particularly those that could have caused the admission. You work with doctors to ensure all medicines listed in the drug history are prescribed or deliberately withheld or discontinued (with a valid reason documented).

2. The clinical appropriateness of any new medicines prescribed during admission should be checked and advice given on necessary monitoring. Cautions, contraindications, side effects and interactions should be considered. As you become more experienced, you will gain the confidence to advise on which treatment should be prescribed.

3. Before patients leave hospital, their discharge prescriptions should be checked against the inpatient prescription charts to ensure accuracy. Each patient should be aware of any changes to treatment, the rationale for them, and he or she should be been suitably counselled.

Most of this work takes place on wards where you can access patients’ medical notes and, ideally, discuss any issues directly with doctors, nurses and other healthcare professionals.

Most hospital pharmacists spend some time in a dispensary — either assisting with accuracy checking or conducting clinical checks. Since assessing the appropriateness of a medicine from the dispensary (without access to notes or being able to see the patient) is more difficult, such remote clinical checks are becoming rarer. They tend to be reserved for a weekend or evening — when reduced staffing levels make it impossible to visit all hospital wards.

Starting life in the community

For the typical community pharmacist, overseeing the supply of prescription medicines will usually constitute the lion’s share of the workload. That means being responsible for clinically checking each prescription and, usually, for accuracy checking each dispensed medicine, although accredited-checking technicians are becoming more common. Telephone contact with prescribers is required to deal with clinical issues. However, the clinical check is limited by a lack of access to medical notes — cautions and contraindications are often not obvious and interaction checks are limited because the patient’s regular medicines list is not always available.

Most prescriptions are monthly repeats so this aspect of work can become somewhat repetitive. However, regular patient contact allows you to build relationships that enable proactive interventions into your patients’ ongoing management. Such opportunities are less common in hospitals.

Medicines use reviews (MURs) and the new medicines service (NMS) are recent additions to the community pharmacist’s to-do list. Both are intended to help ensure patients are taking their medicines correctly and have the opportunity to ask any questions they may have, or for making recommendations to improve the safety or appropriateness of treatment.

Pharmacies are paid for completing and submitting the necessary paperwork. Therefore, employers now expect their pharmacists to conduct MURs and the NMS part of their daily routine.

The other main responsibility is for overseeing the sale of over-the-counter medicines. Although most recommendations will be made by support staff, you are responsible for the advice they give and the safety of the products they sell. Ensuring your staff are properly trained to do so and knowing when to intervene or refer patients for medical treatment is essential.

Most pharmacists will also be involved with delivering other services, such as:

  • Supply of methadone or other treatments for substance misuse
  • Smoking cessation
  • Emergency hormonal contraception
  • Influenza vaccinations

The team

Perhaps the biggest difference between the two sectors is a social one. As well as pharmacists, the hospital pharmacy team includes: technicians (many of whom now work on wards); dispensers; support workers (who ensure wards are supplied with routinely used medicines); and administration staff.

Hospital pharmacy departments often employ upwards of 100 members of staff, which can make them sociable places to work. Start your career there and you will typically be surrounded by many people who are your age. Furthermore, when faced with a problem, there is usually someone more experienced who can advise accordingly.

By contrast, the community pharmacy team is much smaller. In little pharmacies, you may only work with one or two other people (either dispensers or healthcare counter assistants). Larger stores may have a bigger workforce but most will be non-pharmacy staff. Working with another pharmacist is not common so the job can be isolating. Arguably though, since they have no senior colleague on hand to run things by, community pharmacists are faster to develop their problem-solving abilities.

Career progression

Agenda for change in hospitals

NHS pharmacy roles are aligned with Agenda for change (AfC) terms and conditions (see “Agenda for change”). After qualifying, most hospital pharmacists start life in a rotational post — AfC band 6. This usually involves gaining experience in several core areas (for example, dispensary, medicines information, aseptic manufacturing) while building clinical experience on relatively basic wards (for example, orthopaedic surgery or elderly care rehabilitation). Once pharmacists are familiar with basic skills and practices, they may be offered experience in more interesting wards. Most newly registered pharmacists are encouraged to study a clinical diploma (see “Further education” below) to supplement their learning.

After a year or two, often corresponding with completing the diploma, a band 7 role can be sought. These tend to involve permanent duties in aseptics or medicines information, or some heightened clinical responsibilities. This may involve the production of financial reports for a clinical directorate, assisting consultants with applications for the use of new medicines or the development of clinical guidelines.

Promotion into a band 8 role usually involves becoming lead pharmacist for a complex clinical specialty (for example, intensive care, renal, haematology/oncology), considerable management duties or a senior role in medicines information, aseptics or medicines management/formulary development.

Agenda for change

Most NHS jobs comply with a standard set of terms and conditions, named “Agenda for change”, which ensures pay is consistent across all roles. After each year of employment, assuming job performance is adequate, employees receive a specified pay increase until they reach the maximum for the band in which their job lies. Pharmacy jobs are assigned an AfC band according the roles and responsibilities that they involve.

Pay ranges for the various bands (as they stand for the 2014/15 financial year) are shown below:

Agenda for Change bandMinimum salaryMaximum salary Job example 
6£25,783£34,530Basic grade pharmacist 
£30,764 £40,558 Senior clinical pharmacist 
8a £39,239 £47,088 Specialist pharmacist 
8b £45,707 £56,504 Lead divisional pharmacist 
8c£54,998£67,805Lead clinical pharmacist
8d £65,922 £81,618 Deputy chief pharmacist 
£77,850 £98,453 Chief pharmacist (large hospital)

Higher starting salary in the community

The community pharmacy career path depends on the employer. In larger chains, you are likely to start as a relief pharmacist — providing cover wherever it is needed within a given locality. The next step would be a store-based pharmacist or store manager. Those with the knack for management may then be put in charge of more than one store or seek out an area or regional manager post.

Pay rates in community pharmacy are less formulaic and typically start higher. Salaries for a 40-hour week with the large pharmacy chains start at around £34,000. However, higher rates might be negotiable for working in less desirable locations. Annual bonuses are common, particularly in larger companies. Annual pay increases will depend on store and company performance rather than the standard increase seen in the public sector.

If management is not your bag, fear not. Opportunities for involvement with clinical services (for example, vaccinations, long-term condition management, care home review, obesity management) are becoming more common.

In smaller chains, you are more likely to be store based from the start but there are fewer opportunities for regional management. However, that is not to say there are no opportunities for development at all.

Further education

Most band 6 hospital pharmacists undertake a two-year clinical diploma through one of several universities — normally funded by the employer. Completion will usually hasten your progression to higher band posts. In addition, a prescribing qualification is rapidly becoming a sought-after addition to the hospital pharmacist’s CV.

Beyond that, several further education opportunities are available to those who wish to do them. These include research-based qualifications (such as an MSc or PhD), management qualifications (for example, an MBA) or specialist training (for example, diploma in psychiatric pharmacy). In recent years, with austerity measures shallowing the depth of the NHS’s pockets, funding for such opportunities has become rare so expect to part with your own cash to receive such training.

Formal further education is less essential for progression in community pharmacy. Local training or accreditation is required to deliver local services — however such training is relatively short. A clinical diploma in community pharmacy is available and some larger pharmacy chains also offer internal management training.

Prescribing qualifications are not common in community pharmacy but many in the profession hope this will change in the near future.

No decision is final

Many pharmacists, with varying levels of experience, have switched successfully between sectors so never assume that a decision to work in one sector will close the door on opportunities in the other. Experience of both community and hospital pharmacy has its benefits wherever you work.

For some people, neither sector is suitable, and other careers, such as primary care, academia, industry or medical writing, will be more appealing.

Citation: The Pharmaceutical Journal URI: 20066992

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