Modernising Pharmacy Careers Programme. Review of post-registration career development: Next steps

Transcription

1 Modernising Pharmacy Careers Programme Review of post-registration career development: Next steps Report to Medical Education England Board September 2012 On behalf of Helen Howe and Keith Wilson

2 Foreword The pharmacy professions, comprising of pharmacist and pharmacy technicians, are responsible for the safe and effective use of medicines and for their safe supply. Our review of post-registration career development within pharmacy considers how the existing workforce of pharmacists, pharmacy technicians and their staff can be developed to deliver safer, more efficient, patient-focussed care, centred on medicines optimisation and public health and well-being. Recent and ongoing healthcare reforms driven by changes to the demographic profile of the country and the downturn in the economic environment mean that the pharmacy professions face different challenges in delivering healthcare. Medicines remain the most common treatment offered to patients and are the single highest outlay by the National Health Service (NHS) after salary costs (an estimated 12.5 billion in 2010/11). In an outcome-driven health service, society needs to get maximum effectiveness and value from its investment in medicines and it is clear from evidence, some of which is presented in this report, that there is scope for improvement in the effective use of medicines. Equally important is the need to tackle public health challenges such as rising levels of obesity, alcohol-related harm, high rates of sexually transmitted infections and a relatively high population of problem drug users. Evidence gathered as part of our review highlighted the complexity of the landscape for postregistration career development within pharmacy. Over the past few decades, the practice of pharmacy has evolved to varying degrees from a predominantly dispensing and supply function to a greater emphasis on clinical input, delivering new services to patients and playing a greater role in public health initiatives. However, the pharmacy workforce is diverse and not all pharmacists and pharmacy technicians work in patient-facing roles, or are employed by, or provide services to the NHS. Overall, our conclusion is that career development pathways for pharmacy professionals post-registration are not well defined. We believe there is much potential to improve the confidence and skill-set of the current workforce to enable pharmacists and pharmacy technicians to deliver safer and higher quality services to the public. Our review identified many areas of innovation within the profession by individual employers and through collaborative approaches. However, if pharmacy is to contribute fully to the public health agenda and help patients gain maximum benefit from their medicines we believe that a coordinated and strategic approach is required. We also recognise that emerging areas of policy such as commissioning and the supervision of the sale and supply of medicines will have implications for the outcomes of this review and MPC will need to take account of these in future work programmes. We believe that our proposals for reform of post-registration career development will help to maximise the effectiveness of the pharmacy professions and so ensure that patients gain full benefit from medicines, and that the whole population derives value from its investment in medicines to benefit patients, the public and the NHS. Helen Howe Chief Pharmacist, Cambridge University Hospitals NHS Foundation Trust Keith Wilson Professor of Pharmacy Practice, University of Aston 2

3 Contents Foreword 2 Contents 3 Executive Summary 5 Professionalism and early career development 6 Developing the workforce to deliver medicines optimisation and enhancing the skills of the pharmacy team in the delivery of public health messages 6 Maintaining an appropriate supply of technical, scientific and specialist pharmacists 7 Professional leadership 8 Clinical leadership 8 Developing the clinical academic workforce 9 1. Purpose and background Context Optimising the use of medicines A new educational context Making the case for change Assumptions used in the analysis of evidence 18 Responsibility 18 Two regulated pharmacy professions 18 Skill mix and technology 18 Common competencies and inter-professional learning 18 Commissioning 18 Funding The current pharmacy workforce The regulated pharmacy workforce: pharmacists Pharmacy technicians: a newly registered and regulated profession Professionalism and being a professional core competencies Professionalism and the early years Early Years frameworks Research 28 Proposal Medicines optimisation and public health Enhancing the skills of the pharmacy team in the delivery of public health messages 31 Proposal Technical and scientific services Clinical trials 33 Proposal Professional leadership Corporate level professional leadership 36 Proposal 4 36 Proposal Clinical leadership Development of consultant pharmacists Clinical research leadership 38 Proposal Developing the clinical academic workforce Teaching and learning Pharmacy technician teaching and learning 39 Proposal

4 Proposal Conclusion 40 Annex 1 41 Background and Context 41 Aim of Workstream II: Review of Post-Registration Career Development 41 Objectives of Workstream II: Review of Post-Registration Career Development 41 Deliverables 42 Outcomes 42 Membership 43 Roles and Responsibilities of the Review Team 44 Meetings 44 Wider Engagement and Working Practices 45 Annex

5 Executive Summary Post-registration career development within pharmacy needs to be more efficient and effective in preparing pharmacists and pharmacy technicians to deliver safer, more efficient, patient-focussed care, to meet the needs of a growing, older population with increased expectations about what health services can deliver. The sub-optimal use of medicines remains a major challenge and evidence suggests that pharmacy can do more to maximise the benefit that patients derive from medicines and improve the well-being of patients through pharmacy-delivered public health services. The aim of the proposals described in this paper is to maximise the contribution of pharmacists and pharmacy technicians to the healthcare of patients and the public, and in so doing, to optimise the value that the NHS gains from the pharmacy professions. Evidence gathering and feedback from stakeholders informed us that: to deliver a comprehensive approach to medicines optimisation will require development of the current workforce; there is currently a lack of structured career pathways needed to enable pharmacists and pharmacy technicians to move from novice to expert and beyond; pharmacy careers separate at an early stage between the sectors; there are supply side shortages in certain areas of the pharmacist workforce, notably in academia, research and technical specialities; pharmacy technicians are a new professional group and the relationships between them and pharmacists needs to be developed to ensure that these two complementary professions make their maximum contribution to healthcare; research needs to be at the core of pharmacy practice in all sectors to add to knowledge, drive innovation and engender a culture of lifelong teaching and learning amongst pharmacy professionals. This report outlines proposals for a number of areas of work to be taken forward as part of the ongoing Modernising Pharmacy Careers (MPC)/Health Education England (HEE) work programme. Other areas of work have been identified that fall partly or wholly outside the remit of MPC. These may be best taken forward by others such as the professional bodies (the Royal Pharmaceutical Society (RPS) and the Association of Pharmacy Technicians UK (APTUK)), employers, and the General Pharmaceutical Council (GPhC), or by those organisations listed in partnership with MPC/HEE. We are proposing that work is progressed in the following areas: Professionalism and being a professional The further development and use of professional development frameworks to support pharmacists and pharmacy technicians in their early careers Developing the workforce to deliver medicines optimisation and enhancing the skills of the pharmacy team in the delivery of public health messages Maintaining an appropriate supply of technical, scientific and specialist pharmacists and pharmacy technicians Developing clinical and professional leadership Developing the clinical academic workforce. 5

6 Our detailed proposals are as follows: Professionalism and early career development Proposal 1 We propose that the MPC Programme Board develops strategies to enhance the development, performance management and capability assessment of junior pharmacists and all pharmacy technicians. To support this work programme we propose that: the relevant professional bodies review and update the General Level Framework (GLF) for pharmacists and post-qualification pharmacy technician frameworks to reflect changes to service delivery and are informed by the recommendations of the University of East Anglia (UEA) evaluation of professional development frameworks. Appropriate core competencies relating to professionalism, using research results and contributing to research should be developed and embedded within each framework. performance management techniques and capability assessments, including appraisals, are developed, as well as both formative and, where appropriate, summative assessments of performance, reflecting the different levels of complexity and the nature of the decision making for each profession. further work is undertaken to establish with employers, commissioners and the GPhC, whether there is a need for the external validation of assessments of competence. Currently only prescribing by pharmacists is formally regulated post-registration. This programme of work should be taken forward in a way that ensures national ownership of the frameworks and consideration should be given to: continuing with two frameworks for pharmacists and pharmacy technicians, or one framework using common domains where appropriate, but with different levels of competence; how such frameworks can be used for enhancing the early years development of pharmacists and pharmacy technicians; how to build on current and planned work programmes aimed at supporting pharmacy technicians as a newly regulated profession and promoting effective team working between pharmacists and pharmacy technicians; and whether and how a more formal mentoring structure for the post-registration development of pharmacists and pharmacy technicians might be implemented and funded to support the utilisation of the frameworks. Developing the workforce to deliver medicines optimisation and enhancing the skills of the pharmacy team in the delivery of public health messages Proposal 2 We propose that the MPC Programme Board completes a detailed review of current postregistration learning, development and assessments relevant to the delivery of medicines optimisation and public health services. 6

7 This work should consider: for the development of the current pharmacist workforce 1 : whether a standard assessment of core competencies can be designed and piloted to inform the development of a flexible learning and development programme to up-skill pharmacists in order to deliver comprehensive medicines optimisation; the most appropriate form of summative assessment to assure patients, the public, other healthcare professionals and employers and commissioners that pharmacists have the appropriate skills, knowledge and behaviours to deliver safe and effective optimisation of medicines and/or prescribing competence; the resources that will be required for the learning, development and assessments needed to deliver the medicines optimisation workforce; the number of pharmacists competent in medicines optimisation that will be needed to deliver a comprehensive service to all patients that need this level of care with their medicines, wherever they might need that care; for the development of pharmacy technicians: the learning and development needs of pharmacy technicians in relation to medicines management to support the delivery of medicines optimisation; for pharmacists and pharmacy technicians: the leadership and management skills development needed within the two professions to maintain the safe and effective running of a pharmacy; and for the development of the whole pharmacy team: the inclusion of teaching, learning and assessments relevant to delivery of public health messages within programmes to enhance the competence of the pharmacy team in consulting. 2 This proposal is seen as an interim measure that will need to be reviewed again if undergraduate education and pre-registration training are reformed to deliver significant clinical focus 3 and/or the prescribing legislation is developed and reformed. Maintaining an appropriate supply of technical, scientific and specialist pharmacists Proposal 3 We propose that workforce planning and post-registration education and training commissioning for technical and other speciality pharmacists and pharmacy technicians is undertaken at a national level by HEE and builds on pre-registration and undergraduate training. This work should include the development of strategies to enhance the number of pharmacists accredited as Qualified Persons (QP). 4 1 Proposal for the reform of pharmacists preregistration education and training, endorsed by Medical Education England (MEE) in June, 2011 will address the future pharmacist workforce. 2 This skillset is relevant to medicines optimisation too. 3 Pharmacist Prescriber Training Working Group Report for the MPC Programme Board: Available: 4 QPs are responsible for the release of a finished medicinal product and must certify the release of each batch. The duties of the Qualified Person (QP) are set out in article 51 of Directive 2001/83/EC and the 'Code of Practice for Qualified Persons in the Pharmaceutical Industry': Available: 7

8 This is a particular issue with pharmacists and therefore the focus in the first instance should be: the development and evaluation of options for developing combined basic clinical and specialist technical education, training and work-based rotations (at bands 6 and 7), including options for joint training with healthcare scientists; the development of opportunities to ensure that undergraduate pharmacy students and pre-registration trainees are exposed to the work of the technical specialities and provided with opportunities to undertake work experience and research projects in the technical areas to encourage uptake of the specialist training rotations; consideration of whether similar extended rotations are needed to train other small and specialist workforces, for example procurement and medicines information; and a programme of work to support the development of competence in research governance and enhance the number of pharmacists seeking accreditation as QPs. Professional leadership Proposal 4 To support the development and achievement of advanced and specialist practice amongst pharmacists at a level that is recognised by peers and accepted by employers and commissioners, we propose that the MPC Programme Board encourages and supports the continued development and use of the Advanced and Consultant Level Framework (ACLF) as the core professional development framework for supporting the development and achievement of advanced and specialist practice. This work should consider the extension of the use of the framework into areas such as the technical services, supply and procurement and how an ACLF may be developed and used to support advanced and specialised practice amongst pharmacy technicians. Proposal 5 We propose that the MPC Programme Board undertakes a programme of work to consider how best to use existing leadership frameworks to support the development of senior pharmacists with corporate responsibilities, such as Trust chief pharmacists and superintendent pharmacists. Clinical leadership Proposal 6 We propose that the MPC Programme Board undertakes a programme of work to consider how formal and sustainable links between employers and academia can be developed to deliver research, teaching and learning to support clinical leadership development. This work should also consider how consultant pharmacists might develop in the future. A programme of funding should be secured to support the development of the research workforce amongst early to mid career practitioners. 8

9 Developing the clinical academic workforce Proposal 7 We propose that the MPC Programme Board undertakes a programme of work to consider how to expand and develop the clinical academic workforce. This work should include the provision of appropriate learning coupled with postgraduate qualifications and the development of formal joint appointments between academia and practice. A programme of funding should be secured to establish a cadre of clinical research leaders with senior university appointments and joint posts linked to clinical research. Proposal 8 We propose that the MPC Programme Board undertakes a complementary programme of work to consider how formal joint appointments between employers, further education colleges and universities can be developed to support the post-registration development of pharmacy technicians. As part of our review, we collected, collated and analysed a huge volume of detailed evidence. This is presented in our background paper Review of Post-Registration Career Development of Pharmacists and Pharmacy Technicians 5. 5 Medical Education England, Modernising Pharmacy Careers Programme Post-Registration Career Development of Pharmacists and Pharmacy Technicians: Available: 9

10 1. Purpose and background Medicines are at the heart of modern healthcare and remain the most common treatment offered to patients. As the experts in medicines, pharmacists, supported by a new regulated profession, pharmacy technicians, are best placed to encourage and embed the safe and effective use of medicines. Yet it is clear from the evidence considered in our review that there is scope for improvement. A guiding principle of the NHS Constitution is that the NHS will aspire to the highest standards of excellence and professionalism in the provision of high-quality care that is safe, effective and focused on patient experience 6. Emerging Coalition Government health policy, set out in Equity and excellence: liberating the NHS 7 outlines the role of pharmacists working with doctors and other health professionals in optimising the use medicines to support better health. Medicines optimisation encompasses a whole systems approach to ensure the NHS is achieving maximum health gain and least harm from all medicines. It involves maximising the efficient and effective use of medicines in preventing disease or the progression of disease and in improving patient outcomes from the use of medicines. The Government s vision for improving the health and wellbeing of people in England, set out in Healthy Lives Healthy People 8, recognises community pharmacies as a valuable and trusted public health resource and highlights the potential to use community pharmacy teams even more effectively to improve health and wellbeing. Proposals for reform of pharmacists pre-registration education and training aim to establish a five-year programme that will provide pharmacists with the clinical and communication competencies to carry out medicines optimisation services safely, confidently and effectively, and to enable their faster development after registration. These are set out in the advice provided to the Secretary of State by the MPC Programme Board, and endorsed by MEE, in June The purpose of our review of post-registration career development within pharmacy was to consider: how to develop the existing workforce of pharmacists and pharmacy technicians to be capable of delivering safer, more efficient, patient-focussed care, particularly around medicines optimisation and public health and well-being; how to locate this development in the context of a clinically-led commissioning system and a diverse provider sector; and how to prepare for the future development needs of pharmacists who qualify after the reforms recommended for pharmacists pre-registration education and training. The Modernising Pharmacy Careers (MPC) Post-Registration Review Team, comprising of more than 40 individuals recruited from different staff groups, sectors and specialisms within all sectors of pharmacy began its work in January A copy of the review team s Terms of Reference is available in Annex 1. The review team took evidence from a range of stakeholders in June 2011, the detail of which is available in Annex 2. 6 NHS Constitution, 2009: Available: 7 Equity and excellence: liberating the NHS: Available: andguidance/dh_ Healthy Lives Healthy People: Our strategy for public health in England, 2010: Available: 10

11 The review team s work began by considering the vision for the future of pharmacy, set out in Pharmacy in England: building on strengths - delivering the future 9. In the later stages of the work, the team reflected on and responded to Equity and excellence: liberating the NHS as it relates to the optimisation of medicines use, and Healthy Lives Healthy People 10 which recognises the potential to use pharmacy teams even more effectively to improve health and wellbeing. Initial findings from the independent inquiry into care provided by Mid Staffordshire NHS Foundation Trust 11 were also taken into account. Several pieces of independent advice were commissioned, including a review of approaches to career and post-registration development in other professions, and an evaluation of professional development frameworks in pharmacy. The University of East Anglia (UEA) report, An Independent Evaluation of Frameworks for Professional Development in Pharmacy is available on the Medical Education England (MEE) website, together with the Modernising Pharmacy Careers Post-Registration Careers Development - Background Paper, both of which provide a detailed review of the evidence received. The task of generating, gathering and critically analysing data on post-registration career development and engaging more widely with practitioners as appropriate was achieved by dividing the review team into four content-generating sub-groups. Stakeholder organisations, identified by the sub-groups, were invited to attend oral evidence gathering sessions. Outputs from the four subgroups were analysed to identify issues common across sectors and staff groups, resulting in a number of overarching themes. Box A: Issues raised in the evidence gathering sessions 1. Greater clinical care and services delivered by the pharmacy team requires staff to have the necessary core competencies and such services to be commissioned 2. Lack of a structured career pathway to move from novice to expert, and beyond 3. Pharmacist and pharmacy technicians working together as two complementary professions with implications for roles, responsibilities, skill mix and workforce planning across the pharmacy team 4. Separation of pharmacy careers at an early stage from individual sectors and from other healthcare professions 5. Supply side shortages in key sectors, e.g. pharmacists in academia, research and technical specialties 6. Research needs to be at the core of pharmacy practice across all sectors to add to knowledge, drive innovation and engender a culture of lifelong teaching and learning amongst pharmacy professionals. 9 Pharmacy in England: building on strengths - delivering the future: Available: 10 Healthy Lives Healthy People: Our strategy for public health in England, 2010: Available: 11 The Mid Staffordshire NHS Foundation Trust Inquiry, (2010) Robert Francis Inquiry report into Mid- Staffordshire NHS Foundation Trust: Available: 11

12 During the summer of 2012, stakeholder feedback was gathered on a draft discussion paper setting out the current landscape, together with the emerging issues, in order to build consensus on the key issues, to consider where the responsibility for addressing these issues lay and how the work might be progressed. 12

13 2. Context It is widely recognised that medicines are at the centre of modern healthcare and the most common treatment offered to patients. After salary costs, medicines constitute the single largest investment that the NHS makes in patient care, representing a total spend of 13bn in England in 2010, and a 5% increase on the preceding year. For an outcome-driven health service performing in a financially constrained environment, there is a clear need to achieve maximum value by optimising the use of medicines and medicines-related services. In 2010, the White Paper, 12 Equity and Excellence, signalled that pharmacists, working with doctors and other health professionals, have an important and expanding role in optimising the use of medicines and in supporting better health. In tandem, the Government intends to move to a system of value-based pricing 13 for NHS medicines to ensure access to effective and innovative treatments and deliver value for money from NHS spending. There are now two registered and regulated pharmacy professions, pharmacists and pharmacy technicians. For pharmacists, delivering medicines optimisation will require them to make clinical decisions, utilising and building on their Masters level education and training. To support pharmacists, pharmacy technicians will need to build on their NVQ level 3 education and training. The mandatory requirement for pharmacy technicians to be registered has only existed for a short time and the new profession will need time to mature. 2.1 Optimising the use of medicines The pharmacy professions have an unparalleled line of sight on the medicines pathway from discovery to market authorisation, from formulation to prescription, from effective use to the potential for waste and from successful outcomes to the risk of misadventure. The insights drawn from this wide awareness confirm a common set of challenges: A growing and relatively older population with an increasing prevalence of long-term conditions Innovation and the potential to expand intervention in health and disease Increasing expectations of patients and the public A need to get the fundamentals right, particularly in relation to older and vulnerable people and the extent of medication misadventures. The pharmaceutical industry and health and healthcare services have played a substantial role in the achievements of the last decade, including a 14% reduction in cancer mortality and a 41% reduction in mortality from circulatory disorders 14. Steps are currently being taken to deliver 20bn of efficiency savings by It is clear, however, that suboptimal medicines use remains to be resolved in a number of areas, as highlighted in Table 1 on the following page. 12 Equity and excellence: Liberating the NHS, July 2010: Cm Response to a consultation on a new value-based approach to the pricing of branded medicines: Department of Health, July, Innovation, health and wealth, accelerating adoption and diffusion in the NHS, DH

14 Avoidable medicines wastage in primary care is estimated to be 150 million per year. 15 NICE reports that 30 50% of medicines are not taken as intended. 16 Ambulatory care-sensitive conditions (i.e. actively managed conditions not normally requiring hospitalisation) account for 1 in 6 emergency admissions at a cost of 1.42bn each year. 17 Adverse drug reactions account for 6.5% of hospital admissions and over 70% of the ADRs are avoidable. 18 A study of the Use of Medicines in Care Homes finds that 70% of residents were exposed to one or more medication errors. 19 An estimated 180,000 people with dementia are treated with antipsychotics each year; of which, it has been estimated that less than 36,000 may derive some benefit from them at a cost of 1,800 additional deaths and 1,620 cerebrovascular events. 20 The General Medical Council s EQUIP study demonstrates a prescribing error rate of 8.9% in medication orders in 19 acute hospitals. The study found that errors are associated with all levels of doctors ,186 medication incidents were reported to NPSA between 2005 and 2010; 16% involved actual patient harm. Delayed or omitted doses (16%) and wrong dose (15%) were found to be the commonest categories. 22 In a small study group of 108 people re-admitted to hospital, documentation of changes to medication was incomplete on two-thirds of previous discharge documents. Readmission was considered to be medicines-related in 41 (38%) of the 108 cases examined and preventable in 25 (61%) of this sub-group. 23 Table 1: Examples of sub-optimal medicines use In this context, medicines optimisation s primary goal is maximising value; the value that a patient derives from their medicines and the value that the whole population experiences 15 Evaluation of the scale, causes and costs of waste medicines. York Health Economics Consortium and School of Pharmacy, University of London, NICE Clinical Guideline CG76 17 Emergency hospital admissions for ambulatory care-sensitive conditions. Identifying the potential for reductions. Kings Fund, Adverse drug reactions as a cause of admission to hospital: prospective analysis patients. BMJ 2004; 329: Care home use of medicines study: prevalence, causes and potential harm of medication errors in care homes for older people. Qual Saf Health Care 2009; 18: The use of antipsychotic medication for people with dementia: time for action. A report for the Minster of State for Care Services, An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education. EQUIP study ( GMC, A review of medication incidents reported to the National Reporting and Learning System in England and Wales over six years ( ) Br J Clin Pharmacol (online) Witherington EMA, Pirzada OM, Avery AJ. Communication gaps and readmissions to hospital for patients over 75 years and older: an observational study. Qual Saf Health Care 2008; 17:

15 from the NHS investment in medicines. Optimal medicines use is a crucial step in both improving the quality of care and balancing the costs of healthcare. Improving the use of medicines is also necessary to ensure that avoidable problems do not undermine scientific and technical advances in therapy. Genomic technologies have the potential to transform the delivery of healthcare, meaning more patients receive the right treatment at the right time, and to enhance preventative care and population health. Successful translation from laboratory to care pathway relies, in part, on a workforce that is primed for innovation, and the recent report on genomic technology in healthcare 24 argues that education and training in genetics and genomics should form part of the overall function of Health Education England (HEE), including core educational standards for genomics. It also calls for an immediate review of the existing provision of genomics training and education for each profession. New developments bring new knowledge and skill demands, whilst providing a reminder that the unique body of knowledge in pharmacy (and within that the domains of formulation, preparation and administration) remain important in the education of pharmacy professionals. Nevertheless, it is evident that therapeutic advances will mean little if safe use and patient adherence are not supported. Pharmacists, supported by pharmacy technicians and other members of the pharmacy team are well placed to deliver on medicines optimisation and improve health and wellbeing, with community pharmacy offering over 10,700 points of access to pharmaceutical services in England. An estimated 1.6m people visit a pharmacy each day, of whom 1.2m do so for health-related reasons, and in 2010 over 926m prescription items were dispensed from community pharmacies. 25 Hospital pharmacy services have developed to support the safe use of complex and novel medicines, accompanied by professional differentiation into therapeutic or technical clinical specialties. The EQUIP study referred to earlier noted that almost all of the 11,077 prescribing errors made in 124,260 medication orders in 19 acute trusts were intercepted by pharmacists as part of their routine practice. Interviewees identified pharmacists as being particularly helpful in preventing prescribing errors. Moving beyond the prevention of harm, systematic reviews of the published literature demonstrate that pharmacists furnished with appropriate knowledge, skills and abilities make a positive and measurable impact on patient outcomes in diabetes, hypertension, hyperlipidaemia and cardiac failure. 26,27,28,29,30 A Cochrane database review of 25 studies (16,000 patients) and a further systematic review of 298 studies confirms that pharmacy services improve system efficiency and have positive therapeutic and safety outcomes across the range of healthcare settings. 31,32 These findings support the ambition for the post- 24 Building on our inheritance. Genomic technology in healthcare. A report by the Human Genomics Strategy Group, Community pharmacy. Our prospectus for better health. Pharmacy Voice, Sensitivity of patient outcomes to pharmacist interventions. Part I: a systematic review and meta-analysis in diabetes management. Ann Pharmacother 2007; 41: Sensitivity of patient outcomes to pharmacist interventions. Part II: a systematic review and meta-analysis in hypertension management. Ann Pharmacother 2007; 41: Sensitivity of patient outcomes to pharmacist interventions. Part III: a systematic review and meta-analysis in hyperlipidemia management. Ann Pharmacother 2008; 42: Clinical pharmacists and inpatient medical care: a systematic review. Arch Intern Med 2006; 166: Pharmacist care of patients with heart failure: a systematic review of randomised trials. Arch Intern Med 2008; 168: Expanding the roles of outpatient pharmacists: effects on health services utilisation, costs and patient outcomes. Cochrane Database Syst Rev

16 registration development of the pharmacy workforce to deliver the goals of medicines optimisation. It is also clear that to enable pharmacists to address complex medicines use problems, a post-registration career and development strategy for pharmacy technicians will be needed as well as an appropriately resourced and trained support staff workforce. As a specific reference to the latter, there is an emerging picture of the value of (non-pharmacist) healthy living champions in the roll-out of healthy living pharmacies, coupled with a growing body of evidence of the benefit of pharmacy-delivered public health services A new educational context This drive for value also mandates improvement in the way the healthcare and public health workforce is developed; specifically that employers, supported by the professions, should have the opportunity to both shape the workforce and the ways in which they develop the people they employ. From an NHS perspective, the key requirement is to develop a capable and flexible workforce in the right numbers to support the delivery of healthcare and health improvement. In the current and anticipated future financial context, workforce development will also need to be focussed on value; literally the outcomes gained relative to the costs incurred in achieving them. Consequently, education and learning need to be linked with improvements in patient and public health outcomes, and the developing NHS Education Outcomes Framework will form the locus for establishing this link. To date, five high level domains of the Framework have been described, as shown in Table 2. Excellent education Education and training is commissioned and provided to the highest standards, ensuring learners have an excellent experience and that all elements of education and training are delivered in a safe environment for patients, staff and learners. Competent and capable staff There are sufficient health staff educated and trained, aligned to service and changing care needs, to ensure that people are cared for by staff who are properly inducted, trained and qualified, who have the required knowledge and skills to do the jobs the service needs, whilst working effectively in a team. Adaptable and flexible workforce The workforce is educated to be responsive to innovation and new technologies with knowledge about best practice, research and innovation that promotes adoption and dissemination of better quality service delivery to reduce variability and poor practice. NHS values and behaviours Healthcare staff have the necessary compassion, values and behaviours to provide person-centred care and enhance the quality of the patient experience through education, training and regular Continuing Personal and Professional Development (CPPD) that instils respect for patients. 32 US pharmacists effect as team members on patient care: systematic review and meta-analyses. Medical Care 2010; 48: Interim report of the outcomes of the Portsmouth Healthy Living Pharmacy Initiative. NHS Portsmouth September,

17 Widening participation Talent and leadership flourishes free from discrimination with fair opportunities to progress and everyone can participate to fulfil their potential, recognising individual as well as group differences, treating people as individuals, and placing positive value on diversity in the workforce and there are opportunities to progress across the five leadership framework domains. Table 2: Five domains of the Education Outcomes Framework Responsibility for setting up the new system for developing a capable and flexible workforce, which has the ability to support and adapt to innovation, sits with HEE. In turn, HEE will authorise and support Local Education and Training Boards to fulfil their core purpose of defining local development priorities and commissioning education and training to underpin high quality service provision and health improvement. This will be achieved by bringing together all healthcare and public health employers providing NHS funded services with education providers, the professions, local government and the research sector, to develop a skills and development strategy that meets employer requirements and responds to the plans of service commissioners. 2.3 Making the case for change The areas of focus around which our proposals are framed, have been drawn from our evaluation of the published literature, stakeholder contributions and the UEA evaluation of professional development frameworks. Health reform has reignited discussion of the role of innovation and located this in the concept of value. The 2010 White Paper indicated that the community pharmacy contract, through payment for performance, will incentivise and support high quality and efficient services, including better value in the use of medicines through better informed and more involved patients. The recently published Pincer study, a pragmatic randomised controlled trial of 72 general practices, has found that a pharmacist-led screening and review of patient computer records for selected groups of patients at potential risk of prescription errors significantly reduces the frequency of future clinically important prescription and monitoring errors, when compared with simple computer generated screening. 34 Coupled with US literature, 35 there is a substantial amount of evidence that pharmacy can and should aspire to deliver medicines optimisation and public health services. The financial, demographic and system challenges of the present and future have been well described. Healthcare demands provide the opportunity for different delivery models and some aspects of a new paradigm may already be in place, if under-utilised, including pharmacist prescribing, collaborative practice, appropriate delegation of responsibilities, skill mix and the academe-practice bridging potential of consultant pharmacists. The next steps are to work with the pharmacy professions and other stakeholders to build, from the analysis presented in this report, a coherent vision and strategy for post-registration pharmacy careers. 34 A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, clusterrandomised controlled trial and cost-effectiveness analysis. Lancet 2012; 379: Improving patient and health system outcomes through advanced pharmacy practice. A report to the US Surgeon General, Office of the Chief Pharmacist 17

18 2.4 Assumptions used in the analysis of evidence Responsibility Post registration education, training and development will continue to be a matter primarily for employers and individuals, based on professional body guidance where appropriate and not subject to statutory regulation and legislation, although the pharmacy regulator, the GPhC, will keep this under review as roles and responsibilities evolve and practice increasingly moves away from core registration competences. Two regulated pharmacy professions Although there are now two registered and regulated pharmacy professions, the mandatory requirement for pharmacy technicians to be registered has only existed for a short time and the new profession will need time to mature. The two professions have very different educational backgrounds and in terms of their contributions to medicines optimisation, will play different roles with different levels of responsibility. Skill mix and technology Innovative developments in skill mix and technology are likely to continue and these should be encouraged and supported as a means of improving efficiency and productivity whilst enhancing quality and maintaining safety. This is not to pre-empt any future debates and consultations on supervision but recognises a need to build on the evidence that many pharmacy teams are already working very differently across pharmacy under current legislation. Common competencies and inter-professional learning Although our proposals have been focussed around the pharmacy workforce, we would expect any resulting professional development frameworks to incorporate, where appropriate, common competencies and models for delivery, where possible, to include opportunities for inter-professional learning building on existing examples of good practice such as the multidisciplinary training events being developed by the Centre for Pharmacy Postgraduate Education (CPPE). 36 Commissioning The NHS Commissioning Board, due to become operational from April 2013, will work with a range of stakeholders to ensure that services are commissioned in a way that supports consistency of standards nationally. As the process and focus for the new commissioning arrangements for health services becomes clearer, work will need to start to plan how to develop and competence assure the workforce in the new era of commissioning any willing provider. Funding Post-registration education and training funding issues will be key elements of the MPC/HEE work programmes arising from this report. Any proposals for reform accepted by HEE will need funding and, in the current climate will need to meet affordability, sustainability and cost-effective criteria. HEE will need to consider the current investment in these areas and the likely costs of any development in either infrastructure or programmes. This will be 36 Centre for Pharmacy Postgraduate Education workshops Inter-professional learning between pharmacists and GPs. 18

19 challenging as the current funding streams are disparate and complex. The cost of not investing in medicines optimisation or public health will need to be part of the case for change. 19

20 3. The current pharmacy workforce Taken across all sectors (hospital, community, primary care, academia and industry) the pharmacy workforce is neither small nor is it simple. There are over 39,000 pharmacists and approaching 18,000 pharmacy technicians registered with the GPhC and practising in England. 37,38 The professional staff are supported in their work by at least 100,000 trained, but not registered, pharmacy assistants working within teams across all sectors of pharmacy. The pharmacy workforce is made up of individuals with expertise in three broad areas of practice: procurement and supply (including operating safe and effective pharmacies); clinical and public health (including strategic medicines management advice) and technical services and research (including health sciences research in universities and academic health science centres). All three groups share professional and leadership competency sets and are underpinned by core professional, scientific and professional knowledge. The groupings and areas of practice used in this report and summarised in Figure 1 below represent one way of describing the workforce. There are many others adopted by the GPhC in their various standards, by professional bodies in their various frameworks and by the NHS in its Agenda for Change (AfC) framework. This broad horizontal analysis, which works for the purposes of this piece of work insofar that it allows the emerging issues for both pharmacists and pharmacy technicians to be considered in parallel, can be mapped onto all the various profession specific standards and frameworks. Fig.1: Summary of groupings and areas of practice for the pharmacy workforce 37 General Pharmaceutical Council, Hassell K, (Mar 2012) Analysis of GPhC Pharmacist Register Available: 38 General Pharmaceutical Council (August 2012). Personal communication re pharmacist and pharmacy technician registration numbers. 20

21 Most individuals will have roles that cover more than one competency area. Many midcareer roles in the pharmaceutical industry, academia or strategic advisory areas build on core clinical and public health practice experience. A range of employers will employ individual practitioners from large foundation trusts and multi-national corporations, through to small independent pharmacies and family businesses. They will be working in teams of varying sizes with different and changing skill mix arrangements. They will be working within widely differing cultures with different approaches to, and resources for providing training and development and capacity to monitor and provide feedback on clinical performance. The roles and responsibilities described in this section illustrate the diversity of the workforce, employment arrangements and career development pathways. We have not set out to describe the sector as a whole and many other examples could have been cited. The Modernising Pharmacy Careers Post-Registration Careers Development - Background Paper 39 document provides more detail of the current landscape. 3.1 The regulated pharmacy workforce: pharmacists Traditionally, the pharmacist s role was focussed around the supply of medicines or, in the community sector, the safe and effective running of a pharmacy. In recent decades, pharmacists roles have shifted and are now much more clinically focussed. Community pharmacists increasingly deliver clinical and health and wellbeing services, and within the hospital sector, medicines supply is often managed by pharmacy technicians enabling hospital pharmacists to undertake a range of specialist clinical and technical roles. Despite the difference in the academic levels of their initial education and training, the roles of senior pharmacy technicians often overlap with those of junior pharmacists, with pharmacy technicians playing a supervising or mentoring role. Example 1: A community pharmacist has responsibility for the safe and effective running of a small to medium sized pharmacy providing core sale and supply services. The pharmacist contributes to the dispensing and sale of medicines and delivers clinical services including medicines use reviews and the new medicine service. The pharmacist manages and leads a small team with one pharmacy technician and two assistants, one of whom is trained as a healthy living champion, 40 proactively promoting health and well-being support to the public. They work with at least one locum pharmacist to cover one day a week. Their employer is a small family-run business with three pharmacies, two of which are run by family members. Example 2: A community pharmacist is responsible for the safe and effective running of a high volume dispensing practice with a team of one additional full-time pharmacist, three or four pharmacy technicians and up to ten assistants. They deliver a range of clinical services and employ a 39 Modernising Pharmacy Careers Post-Registration Careers Development - Background Paper, Medical Education England (June, 2012): Available: 40 Health Champions will have achieved, as a minimum, the Royal Society for Public Health s level 2 award in Understanding Health Improvement. 21

22 further part-time pharmacist to cover for them whilst they undertake sessional work in the local GP practice. Example 3: A locum community pharmacist is responsible for the safe and effective running of up to five community pharmacies each working week. The pharmacies in which they work are all very different in terms of the volume and diversity of work and the staff teams that the locum works with vary in both size and skill mix. The pharmacist will deliver a range of clinical services depending on where they are working. Example 4: A hospital pharmacist is responsible for the safe and effective running of a large technical services department, with personal clinical responsibility for a paediatric ward and the safe and effective prescribing and manufacture of complex total parenteral nutrition preparations. They also deliver clinical services and have responsibility as a Qualified Person (QP) for a number of clinical trials operating within the Trust. Example 5: A senior medicines information pharmacist working in an acute Trust has ward-based responsibilities and responsibility for the Trust formulary and prescribing guidance. Example 6: A hospital pharmacist is responsible for the safe and effective prescribing and medicines use on a ward; for prescribing in an outpatient clinic; for providing specialist advice to the Trust s drug and therapeutics committee and is involved in a number of clinical trials, working with a senior clinician who is the principal investigator for the trial. They work with pharmacy technicians who undertake medicines reconciliation services and supply on the ward. The pharmacy technicians have completed advanced-level training and are accredited against the NHS Pharmacy Education and Development Committee s (PEDC) Medicines Management framework. 41 Example 7: A pharmacist working in a strategic commissioning role within primary care is responsible for the planning and commissioning of local pharmaceutical services and the financial management of prescribing budgets. They manage the work of a small team of pharmacists and pharmacy technicians who work with local GP practices to develop formularies and promote good prescribing practice. They also offer advice to local community pharmacies on contractual and clinical governance issues. Some pharmacists who have completed their early years experience and development in hospital trusts, develop their careers in industry and primary care where they might hold senior marketing or regulatory affairs posts, providing strategic commissioning and medicines management advice, or delivering clinics in primary care as a prescriber. Pharmacists and pharmacy technicians working in hospitals are often involved in mentoring colleagues, particularly those aspiring to transition between AfC bands 6, 7 and 8. They may also be involved in supervising the clinical practice of others such as trainee doctors and preregistration pharmacy staff. Increasingly, they will have teaching and assessment commitments in local colleges, in universities, and some will be qualified as National 41 NHS Pharmacy Education and Development Committee (PEDC) Medicines Management Framework for Pharmacy Technicians: Available: 22

23 Vocational Qualification (NVQ) assessors. Others will be responsible for delivery of teaching and learning in the practice or Trust when small groups of students, or individual students, undertake work-based placements. The evolving and critical roles of clinical, and indeed professional, leaders in shaping and delivering the learning of the next generation of pharmacists and pharmacy technicians are considered in Sections 7 and 8. For a relatively small number of usually senior consultant pharmacists working in hospital trusts, involvement in research, as part of joint academic posts in university schools of pharmacy, is an integral part of their role. For other hospital-based pharmacists responsibility for undertaking research, audits and service evaluations is expected but may not be linked to formal joint academic appointments. As part of our review we took evidence from industry, where pharmacists are recruited for specific posts through open competition. Experienced pharmacists are employed in a range of areas including regulatory affairs, NHS liaison, marketing, and research and development, where pharmacists often compete for posts with science graduates. Most will not have fixed career pathways, but many companies have impressive internal development programmes to allow employees to develop expertise as part of professional development plans agreed between individuals and their line managers. 3.2 Pharmacy technicians: a newly registered and regulated profession It is perhaps worth reflecting on the position of the newly registered pharmacy technicians and whether there is more to be done to embed core professionalism competences. Many examples of highly effective team working between pharmacists and pharmacy technicians in clinical, as well as technical, contexts were highlighted in the evidence provided to the review team. The RPS evaluation of the responsible pharmacist regulations has demonstrated the degree to which team working is embedded and supported by the regulations, but also the variation in the way in which service and practice has developed as a result. 42 The majority of pharmacy technicians will be experienced and many will be operating in senior roles, working with and for pharmacists, from newly registered to senior leaders. Becoming a registered professional in their own right however is different, and brings with it different levels of expectation, expertise and judgement. The CPPE 43 has begun a series of workshops to identify the learning and development needs of pharmacy technicians and is considering the extent to which bespoke learning opportunities need to be developed, as well as how pharmacists and pharmacy technicians might learn together. 44 There are likely to be many underlying concerns and issues arising from the registration of a new profession, which need to be understood and addressed. The professional bodies and the regulator are currently considering what needs to be done to embed professionalism and to support pharmacy technicians as a newly registered and regulated profession. 42 Evaluation of the impact of the Responsible Pharmacist Regulations (Commissioned by the Royal Pharmaceutical Society and Pharmaceutical Society of Northern Ireland) TNSBRMB (2011): Available: 43 Centre for Pharmacy Postgraduate Education 44 Centre for Pharmacy Postgraduate Education Annual Report (2012): Available: 23

24 From an education and training perspective, understanding the extent to which trust and confidence between pharmacists and pharmacy technicians depends on a clear demonstration of professionalism, as well as technical skills and knowledge, is important. Also for pharmacists, leadership and management competence around managing teams, allocating work and auditing performance become ever more crucial. Example 8: A pharmacy technician is responsible for the day-to-day management of a team that includes pharmacy assistants, registered pharmacists and pharmacy technicians, together with a preregistration pharmacist and pharmacy technician trainees who are delivering the dispensing, manufacturing or assembly service in a large community or hospital pharmacy department. Responsibility for professional activities rests with the pharmacists as required by legislation and the GPhC. Example 9: A pharmacy technician in community pharmacy works with an experienced pharmacist who acts as the responsible pharmacist with responsibility for the overall safe and effective running of the pharmacy. The pharmacy technician has undertaken post-registration qualifications and practise as an accredited checking pharmacy technician. They have also completed a number of management training courses. Example 10: A pharmacy technician works in a highly automated dispensary with much of the dispensing carried out by robots. They are responsible for the clinical and educational supervision of both pre-registration pharmacists and pharmacy technicians. 24

25 4. Professionalism and being a professional core competencies There are some areas of competence, which, regardless of scope of practice, go to the heart of being a professional; things which employers, colleagues, patients and the public take for granted when dealing with a registered professional. These are summarised under the following headings: Practising in context 31 Leading and managing 45 Practising effectively Professionalism and the early years Whilst it is clear that for pre-registration trainee pharmacists, work-based assessments, are designed to evaluate performance in relation to these competences, 47,48 it is widely accepted 49,50,51,52 that continuing to embed professionalism in the early months and years of practice is essential. For both pharmacists and pharmacy technicians, making the transition from novice to expert, building confidence - particularly in making decisions, taking responsibility for decisions and knowing when to seek to advice or refer to others, needs re-enforcement and support. Allowing newly registered professionals to develop independence and reflective practice and to exercise professional practice in a safe and supervised environment requires mentors and line managers to work with newly qualified practitioners. This is a critical area of workforce development. Management of the all-important transition to registered professional is not consistently applied across all sectors and by all employers in pharmacy. Opportunities for newly registered pharmacists and pharmacy technicians to be mentored and supervised in their early years of practice also vary. A newly qualified hospital pharmacist for example, is likely to be involved in a system of rotation around the key areas of clinical, dispensing, medicines information and preparation services. They are also likely to be completing a further programme of study designed to support their early years development and transition from a novice to an expert practitioner, which may include formal postgraduate qualifications and more informal learning such as that offered by CPPE. They will usually have access to mentor support from other pharmacists 45 Leadership Competency Framework for pharmacy professionals Royal Pharmaceutical Society (2011), Available: 46 National Prescribing Centre Single Prescribing framework (2012), Available: 47 Securing excellence in commissioning primary care NHS Commissioning Board (June 2012), Available: 48 Pre-registration pharmacy technician education & training standards, General Pharmaceutical Council, (2010), Available: 49 Tomorrow s Doctors (2009 ) General Medical Council: Available: 50 Allied Health Professionals, Preceptorship Report (2010): Available: 51 Can patient-centred professionalism be engendered in young pharmacists? Pharm J 2011; 287: Elvey R, Lewis P, Schafheutle E, Willis S, Harrison S, Hassell K. (2011). 52 Patient-centered professionalism among newly registered pharmacists. London: Pharmacy Practice Research Trust 25

26 within the Trust while they gain the necessary experience to secure promotion to an NHS AfC band 7 senior clinical post. A newly qualified hospital pharmacy technician is likely to be working towards completion of the accredited checking pharmacy technician and/or medicines management accreditation. A newly qualified community pharmacist might work as a locum, as a responsible pharmacist in a low-volume dispensing pharmacy with a small team or as a second pharmacist in a large and busy pharmacy; although it would be incorrect to imply that all newly qualified community pharmacists only work in quiet pharmacies. Whilst there are few formal further qualifications in community pharmacy, a newly registered pharmacist is likely to be completing a range of assessments to be able to provide enhanced and advanced services linked to the NHS community pharmacy contract. They are also likely to be undertaking a variety of clinical skills or therapeutics knowledge-based learning programmes, or leadership and management training programmes, many of which are delivered by the CPPE. A newly registered pharmacy technician practising in community pharmacy might be undertaking training towards accredited checking pharmacy technician accreditation or qualification as a health champion, 53 and undertaking CPPE learning. There is still much to be done to embed a culture of developing the skills and, more importantly perhaps, the professionalism of our junior practitioners in their early years in practice, which is a joint responsibility of the practitioners themselves, their employers and the wider representative and professional organisation network. This is of particular relevance in relation to developing medicines optimisation and public health competences and supporting the level of inter-professional working that this will demand, particularly for pharmacists working with other prescribers where confidence in professionalism, as well as the required core skills and knowledge, are of growing importance. It is also clear that, when things go wrong and mistakes happen 54,55,56 it is often problems with core professionalism that have prevented reporting of errors and poor performance. This in turn has led to protracted problems within organisations. The GPhC has published its plans to introduce revalidation for pharmacists and pharmacy technicians, 57 which it has defined as: The process by which assurance of continuing fitness to practise of registrants is provided and in a way which is aimed primarily at supporting and enhancing professional practice. 53 Interim report on the outcomes from the Portsmouth healthy living pharmacy initiative, NHS Portsmouth (2010) Available s.pdf 54 Learning from Bristol: the Department of Health's response to the Report of the Public Inquiry into children's heart surgery at the Bristol Royal Infirmary, Department of Health (2002) : Available: 55 The Shipman Public Inquiry : Available: 56 Robert Francis Inquiry report into Mid-Staffordshire NHS Foundation Trust, The Mid Staffordshire NHS Foundation Trust Inquiry, (2010): Available: 57 The General Pharmaceutical Council (2012) Regulate: issue 3: Available: 26

27 It has concluded that the standards against which assessments of performance will be undertaken will be based on its standards of conduct, ethics and performance. Appraisal is a key component of the medical revalidation model and its use in revalidation is being considered by some of the other health professions. We know from research conducted to inform development of thinking in relation to revalidation by the GPhC that, whilst many employers in pharmacy do undertake regular performance appraisals, this is not uniform across the sectors and the focus of those appraisals may be corporate objectives rather than professional objectives and not reflect the aspects of professionalism described above Early Years frameworks The UEA evaluation of professional development frameworks recommends that the General Level Framework (GLF) for pharmacists and pharmacy technician developed by the Competency Development and Evaluation Group (CoDEG) 59 should be re-cast as professional development frameworks for early career pharmacists and pharmacy technicians. It makes a number of suggestions to guide that development these are summarised in Box B below. Box B: Learning points for development and use of frameworks Frameworks should include a limited number of competencies to optimise utility A list of behaviours that could potentially underpin a competency, should be included within frameworks when it is necessary to signpost the user to these Competencies should be written to be generic for the hospital, community and primary care setting, with underpinning behaviours bespoke to each setting provided, where appropriate Frameworks should be defined using a multi-method approach Assessment should be at the competency level, with evidence taken from a sample of behaviours Trainees should use professional development frameworks to regularly reflect on their current performance, identify future learning needs and agree a personal development plan with their mentor Formal assessments of performance against a competency framework should be undertaken within the workplace by an independent supervisor Assessment of performance against a competency framework to ensure consistency between sites should be undertaken by a trained assessor who is independent of the workplace. Most of the stakeholders we consulted were strongly supportive of the further development of these frameworks to support the early years development of pharmacists and pharmacy technicians. 58 Revalidation in pharmacy: evaluation of appraisal and alternative sources of evidence: final report, Centre for Pharmacy Workforce Studies, University of Manchester, (2010): Available: %20Final%20Report%20Volume%201.pdf 59 Framework for General Level Practice and Framework for Pharmacy Technicians in Medicines Management, Competency Development and Evaluation Group (2010): Available: and 27

28 4.3 Research It is clear from the evidence that, for clinical leaders and academics, the development of research leadership skills and expertise is crucial but difficult to acquire. This is dealt with in Section 8. However, service evaluation, audit and critical appraisal skills are pivotal to delivering evidence-based practice. This is the case for all professionals, not just those identified as being in clinical and professional leadership roles. In this context research can and should be part of everyone s core practice, not something that only academics do and which is separate and detached from what happens to patients. Findings from the UEA evaluation indicate there is a gap in the current GLF in relation to research. A clear progression needs to be established between using research results and participating in the research of others, and this needs to be embedded in any re-drafted framework. There needs to be a clear progression between using and doing research in the early years framework and leading research in the Advanced to Consultant Level Framework (ACLF). Proposal 1 We propose that the MPC Programme Board develops strategies to enhance the development, performance management and capability assessment of junior pharmacists and all pharmacy technicians. To support this work programme we propose that: the relevant professional bodies review and update the General Level Framework (GLF) for pharmacists and post-qualification pharmacy technician frameworks to reflect changes to service delivery, informed by the recommendations of the UEA evaluation of professional development frameworks. Appropriate core competencies relating to professionalism, using research results and contributing to research should be developed and embedded within each framework; performance management techniques and capability assessments, including appraisals, are developed as well as both formative and, where appropriate, summative assessments of performance, reflecting the different levels of complexity and nature of the decision making for each profession; and further work is undertaken to establish, with employers, commissioners and the GPhC, whether there is a need for the external validation of assessments of competence beyond the current regulation of prescribing. This programme of work should be taken forward in a way that ensures national ownership of the frameworks and consideration should be given to: continuing with two frameworks for pharmacists and pharmacy technicians, or one framework using common domains where appropriate, but with different levels of competence; How such frameworks can be used for enhancing the early years development of pharmacists and pharmacy technicians; How to build on current and planned work programmes aimed at supporting pharmacy technicians as a newly regulated profession and promoting effective team working between pharmacists and pharmacy technicians; and 28

29 Whether and how a more formal mentoring structure for the post-registration development of pharmacists and pharmacy technicians might be implemented and funded to support the utilisation of the frameworks. While the focus of any work arising from this proposal will be pharmacy professionals who are working within the NHS or providing services to the NHS, for example through community pharmacies, the use of the frameworks within industry, academia and other areas where pharmacy professionals practise will need to be considered. 29

30 5. Medicines optimisation and public health To meet the current and future challenges envisaged for the delivery of health and social care, health care professionals will need to ensure that the use of medicines is optimised to generate maximum benefit for patients and the best value from the money spent by the NHS. Pharmacists will play a key role in this and will be required to work more closely with patients and other healthcare professionals than is currently the norm. They will need to take a greater level of direct clinical responsibility for decisions about medicines prescribed and focus on the delivery of patient care, as well as improving the prescribing practice of others. They will need to be supported by pharmacy technicians who have undertaken the necessary training and competence assessment to enable them to complete tasks such as final dispensing accuracy checking and medicines reconciliations safely and effectively. With the shift of complex conditions from hospitals to primary care, medicines optimisation practice will need to become embedded outside secondary care. The development and implementation of advanced services in community pharmacy over the last decade such as the Medicines Use Review (MUR) Service and the New Medicines Service (NMS), aimed to improved adherence and help patients to maximise the benefits of their medicines, 60 have started to shift the focus of community pharmacy practice away from medicines supply. Medicines optimisation will build on these services but require community pharmacists to spend more time with patients, in some cases outside the pharmacy, for example in GP practices, care homes and in their own homes. For them to be able to do this whilst also being responsible for the safe and effective running of a pharmacy, the ability to manage a team, allocate tasks appropriately, and to maintain appropriate levels of safety and quality through the implementation of quality systems, will be crucial. At this stage, it is not clear how medicines optimisation policy will be implemented. The legislative framework relating to prescribing could be changed to allow pharmacists to make more changes to what is dispensed without referring back to the prescriber. Alternatively, medicines optimisation could require more pharmacists to register and practice as independent prescribers. It is however, clear that more pharmacists will need to be able to demonstrate the competences needed to prescribe. 61 Taking the National Prescribing Centre Single Prescribing Competency Framework as the starting point, it is clear that the competency domain for consulting (which includes the following competency statements: Knowledge: Has up-to-date clinical, pharmacological and pharmaceutical knowledge relevant to own area of practice Options: Makes or reviews a diagnosis, generates management options for the patient and follows up management Shared decision making: (with patients care givers and advocates) Establishes a relationship based on trust and mutual respect and recognises patients as partners in the consultation), could form the required competence domain for medicines optimisation. 60 Impact Assessment on the Introduction of the New Medicine Service, Department of Health, (2011): Available: [6 Mar 2012]. 61 Single Prescribing framework (2012), National Prescribing Centre: Available: 30

31 Pharmacists with a few years of experience, practising in either community, hospital or primary care pharmacy, will have developed expert practice in many aspects covered in the consulting domain. Many of the assessments and accreditations carried out to enable payment for provision of MURs and NMS services in community, and to allow progression from AfC band 6 to 7, relate to a number of the competency statements. However, none, with the exception of those qualified and practising as a prescriber, will have met them all and been assessed in the workplace as part of programme accredited by the GPhC. 5.1 Enhancing the skills of the pharmacy team in the delivery of public health messages We do not see public health as a separate and additional competence domain. Pharmacists and pharmacy technicians should be able to identify and discuss health-related behaviours as an integral part of the sale and supply of medicines, as well as part of clinical practice. However, we recognise that work may be needed to enhance the confidence of pharmacists, pharmacy technicians and other members of the pharmacy team in delivering public health messages and, where appropriate, brief interventions as an integral part of all consultations. Delivery of public health advice is already included within the required learning outcomes for pharmacist independent prescribers. 62 However, there may be a need to review the underpinning professional and core knowledge required for consulting and to update accordingly to ensure an understanding of the public health context. Proposal 2 We propose that the MPC Programme Board completes a detailed review of current post-registration learning, development and assessments relevant to the delivery of medicines optimisation and public health services. This work should consider: for the development of the current pharmacist workforce 63 : whether a standard assessment of core competencies can be designed and piloted to inform the development of a flexible learning and development programme to up-skill pharmacists in order to deliver comprehensive medicines optimisation; the most appropriate form of summative assessment to assure patients, the public, other healthcare professionals and employers and commissioners that pharmacists have the appropriate skills, knowledge and behaviours to deliver safe and effective optimisation of medicines and/or prescribing competence; the resources that will be required for the learning, development and assessments needed to deliver the medicines optimisation workforce; the number of pharmacists competent in medicines optimisation that will be needed to deliver a comprehensive service to all patients that need this level of care with their medicines, wherever they might need that care; 62 Pharmacist Independent Prescribing Programme. Indicative syllabus and Learning Outcomes, General Pharmaceutical Council (2010): Available: %20Learning%20Outcomes%20and%20Indicative%20Content.pdf 63 Proposal for the reform of pharmacists preregistration education and training, endorsed by Medical Education England (MEE) in June, 2011, will address the future pharmacist workforce. 31

32 for the development of pharmacy technicians: the learning and development needs of pharmacy technicians in relation to medicines management to support the delivery of medicines optimisation; for pharmacists and pharmacy technicians: the leadership and management skills development needed within the two professions to maintain the safe and effective running of a pharmacy; and for the development of the whole pharmacy team: the inclusion of teaching, learning and assessments relevant to delivery of public health messages within programmes to enhance the competence of the pharmacy team in consulting. 64 This proposal is seen as an interim measure that will need to be reviewed again if undergraduate education and pre-registration training are reformed to deliver significant clinical focus 65 and/or the prescribing legislation is developed and reformed. 64 This skillset is relevant to medicines optimisation too. 65 Pharmacist Prescriber Training Working Group Report for the MPC Programme Board Available: 32

33 6. Technical and scientific services There are a number of small and highly specialist workforce groupings that are based in NHS Trusts but share expertise with academic and industry researchers and technical staff. In many of the teams, day-to-day management of the work is provided by senior pharmacy technicians with clinical responsibility and leadership provided by senior pharmacists, who often have wider clinical responsibilities and who may be registered prescribers. These teams can be providing manufacturing, aseptic dispensing, quality control, radiopharmacy or MHRA governance work for clinical trial services, all of which share common competence domains and for pharmacists, build on their core clinical competences. MPC received evidence from the technical service specialists and from industry that undersupply of registered Qualified Persons (QPs) was an emerging problem in a number of technical areas. 6.1 Clinical trials We believe there is a need for a better understanding of Good Clinical Practice and Good Manufacturing Practice (GMP) in the workforce generally and particularly amongst those pharmacists who are involved in clinical research and clinical trials (see also section 8.2). Proposal 3 We propose that workforce planning and post registration education and training commissioning for technical and other speciality pharmacists and pharmacy technicians is undertaken at a national level by HEE and builds on pre-registration and undergraduate training. This work should include the development of strategies to enhance the number of pharmacists accredited as Qualified Persons (QP). 66 This is a particular issue with pharmacists and therefore the focus in the first instance should be: The development and evaluation of options for developing combined basic clinical and specialist technical education, training and work-based rotations (at bands 6 and 7), including options for joint training with healthcare scientists; The development of opportunities to ensure that undergraduate pharmacy students and pre-registration trainees are exposed to the work of the technical specialities and provided with opportunities to undertake work experience and research projects in the technical areas to encourage uptake of specialist training rotations; Consideration of whether similar extended rotations are needed to train other small and specialist workforces, for example procurement and medicines information; and A programme of work to support the development of competence in research governance and enhance the number of pharmacists seeking accreditation as QPs. 66 QPs are responsible for the release of a finished medicinal product and must certify the release of each batch. The duties of the Qualified Person (QP) are set out in article 51 of Directive 2001/83/EC and the 'Code of Practice for Qualified Persons in the Pharmaceutical Industry'. Available: 33

34 Opportunities for joint development between the technical services, academia, and industry should be explored as part of initial scoping work. 34

35 7. Professional leadership There are many professionally-led initiatives that were brought to our attention which recognise and support development of advanced practice, particularly in relation to different aspects of clinical practice. Many groups have come together to provide supportive and collegiate environments to promote best practice and support development, learning and research. A significant number have produced competence frameworks and assessments that have been based on CoDEG s Advanced and Consultant Level Framework (ACLF). 67,68 In addition, the Department of Health-led initiatives to develop consultant-level posts and practitioners with a specialist interest have been based on the ACLF competence domains. 69,70 The UEA evaluation of professional development frameworks supported the continued use of the ACLF as the basis for supporting the development of advanced and specialist areas of clinical practice amongst pharmacists. The RPS should be encouraged to continue its work with all the many specialist practice groups to identify flexible routes to meeting the requirements of expert practice required in the consultant pharmacist accreditations. These routes should identify, wherever possible, common or shared competence domains to avoid narrow specialisations and support employers in succession planning and supporting flexible career paths, but meet the needs of advanced practitioners to share details of best practice, underpinning knowledge and research in their specialist areas. Professional leadership and clinical leadership are not necessarily synonymous. Advancement in other areas of practice, in particular supply and procurement and technical services should also be recognised and it may be appropriate to use the ACLF to support this. There are elements of pharmacy technician practice that are advanced and there are pharmacy technicians in positions of leadership and management. Advanced practice for pharmacy technicians is assessed and training accredited in a number of areas of medicines management 71 and in relation to final accuracy checking of dispensed prescriptions. 72 We also recognise that from time to time, the GPhC may review whether aspects of advanced and specialist practice require regulation, as is currently the case with prescribing, particularly if specific fitness-to-practise cases prompt it. The Council for Healthcare Regulatory Excellence s (CHRE) advice on advanced and specialist practice is likely to inform any decisions on whether standards, rather than a professional development framework, are appropriate. 73,74 67 Advanced to Consultant Level Framework: Competency Development and Evaluation Group (2009): Available: 68 College of Pharmacy Practice faculties and specialist groups, e.g., BOPA, mental health Pharmacists 69 Guidance for the development of consultant pharmacist posts, Department of Health (2005): Available pdf 70 National Framework for Pharmacists with Special Interests. Department of Health (2006): Available: pdf 71 Medicines Management Framework for Pharmacy Technicians, NHS Pharmacy Education and Development Committee (PEDC): Available: 72 Nationally recognised framework for final accuracy checking of dispensed items, NHS Pharmacy Education and Development Committee (PEDC) (2011): Available: 73 Advanced Practice: CHRE 2009, 35

36 7.1 Corporate level professional leadership Findings from the independent inquiry into care provided by the Mid Staffordshire NHS Foundation Trust 75 identified a series of deficiencies including difficulties in maintaining professional standards, a weak professional voice and lack of support for staff through appraisal, supervision and professional development. The GPhC consultation on draft standards for registered pharmacies sets out the responsibilities and duties of pharmacists who are owners and superintendents, as well as corporate pharmacy owners. 76 These cover similar areas, including training in governance, staff training and the development and supervision of trainees. It is clear from these documents that the role of senior professional leaders, Trust chief pharmacists and superintendents are likely to come under the spotlight over the next few years. Whilst we did not seek or receive any specific evidence in relation to the education, training and career development for these professional leadership roles, we believe that further work in this area building on existing leadership frameworks, would be helpful. Proposal 4 To support the development and achievement of advanced and specialist practice amongst pharmacists at a level that is recognised by peers and accepted by employers and commissioners, we propose that the MPC Programme Board encourages and supports the continued development and use of the Advanced and Consultant Level Framework (ACLF) as the core professional development framework for supporting the development and achievement of advanced and specialist practice. This work should consider the extension of the use of the framework into areas such as technical services, supply and procurement and how an ACLF may be developed and used to support advanced and specialised practice amongst pharmacy technicians. Proposal 5 We propose that the MPC Programme Board undertakes a programme of work to consider how best to use existing leadership frameworks to support the development of senior pharmacists with corporate responsibilities such as Trust chief pharmacists and superintendent pharmacists. 74 Managing extended practice; is there a place for distributed regulation? CHRE, London, June Robert Francis Inquiry report into Mid-Staffordshire NHS Foundation Trust, The Mid Staffordshire NHS Foundation Trust Inquiry, (2010): Available: 76 Standards for pharmacy owners and superintendent pharmacists of retail pharmacy businesses, General Pharmaceutical Council, (Sep 2010): Available: 36

37 8. Clinical leadership The need for clinical leadership will increase, whether as part of local clinical or professional networks, or in healthcare provider organisations. The ability to link leaders with practitioners to support delivery of care, or to provide commissioning advice or professional and peer review and feedback on performance, is becoming critical. Formal and sustainable links with academia are essential in order to deliver research, teaching and learning as part of clinical leadership. It is clear from the evidence presented to us that meeting the ACLF competence statements relating to research and evaluation has been problematic. Work in this area should draw on the experiences of the pharmaceutical industry in recognising the role of research and its assessment by practitioners. Doing and leading research and the delivery of more formal teaching and learning in this area needs to begin early to mid career to provide opportunities to develop competence and gather experience, as part of working towards posts designated and recognised as being at a clinical leadership level (see Figure 2). Teaching & Assessment Skills Curriculum & Assessment Academic Teaching Leading Research (Principal Investigator) Research skills JOINT ACADEMIC POSTS Education Supervisor Clinical Supervisor Mentoring Doing Research Using Research Fig.2: Developing research and teaching competence 8.1 Development of consultant pharmacists The Department of Health guidance on the development of consultant posts sets out four areas of practice against which approval for posts should be assessed. These are expert practice, research, teaching and learning and professional. There are now some 50 consultant pharmacists in post across England; the first appointees will have been in post for five years or longer. As the initial post holders mature and develop different portfolios in teaching or research and balance those with regional/national leadership roles and responsibilities there is a need to consider how consultant pharmacists might develop in the future. 37

38 8.2 Clinical research leadership We recognise that senior research leadership roles, for example Principal Investigator-level recognition, require the development of a strong record of doing, not just using research. Experience as a researcher working in either health services, medicines safety or clinical research provides a strong foundation on which to build, and the National Institute for Health Research s research strategy provides opportunities for involvement in research at this level once clinical leaders can establish a strong publications track record and complete formal research training at doctorate level. We also believe that linking clinical research leadership to clinical trials governance is appropriate. Development of mid-career posts with recognised academic sessions, linked specifically to the governance of clinical trials, would be useful. Proposal 6 We propose that the MPC Programme Board undertakes a programme of work to consider how formal and sustainable links between employers and academia can be developed to deliver research, teaching and learning to support clinical leadership development. This work should also consider how consultant pharmacists might develop in the future. A programme of funding should be secured to support the development of the research workforce amongst early to mid career practitioners. Any funding programme should be open to pharmacists from any sector who are aspiring to take up clinical leadership or academic posts and should reflect recent developments in clinical, health services and pharmaceutical science research. 77 Funding should strengthen or indeed create links with academic researchers in relevant subject areas. 77 The Pharmaceutical Journal (2012) 288: 272. Phase II trials a groundbreaking development for community pharmacy 38

39 9. Developing the clinical academic workforce Formal and sustainable links between academia and practice are essential in order to deliver research, teaching and learning. Serious supply-side issues in relation to the clinical academic workforce are well recognised. 78 With the move to a more clinical pharmacy undergraduate programme and the need to develop a more clinical workforce postregistration, the need to address this has become acute. The cadre of clinical academics within schools of pharmacy needs to grow, with academic careers linked to the clinical workforce, for example through honorary posts within Trusts. 9.1 Teaching and learning There needs to be closer working between employers and universities to develop, in particular, teaching and learning posts, and to provide postgraduate development in relation to teaching. Traditionally, there has been a number of often employer funded, part-time teacher practitioner posts in universities, but very little investment in more senior and formal joint appointments. Whilst there are signs that this may be changing, this change needs to be formalised. 9.2 Pharmacy technician teaching and learning There is also a need to consider how formal joint teaching and learning appointments between employers, further education colleges and universities can be developed to support the post-registration development of pharmacy technicians. Proposal 7 We propose that the MPC Programme Board undertakes a programme of work to consider how to expand and develop the clinical academic workforce. This work should include the provision of appropriate learning coupled with appropriate postgraduate qualifications and the development of formal joint appointments between academia and practice. A programme of funding should be secured to establish a cadre of clinical research leaders with senior university appointments and joint posts linked to clinical research. Proposal 8 We propose that the MPC Programme Board undertakes a complementary programme of work to consider how formal joint appointments between employers, further education colleges and universities can be developed to support the post-registration development of pharmacy technicians. Implementation of the MPC Workstream I reform proposals provides an important context for this work, as it will require more formal recognition of the role of educational supervisor and the development of curriculum development skills amongst employers. 78 Future Pharmacy workforce requirements: workforce modelling and policy recommendations. Guest, D, Battersby, S & Oakley, P (2004) Royal Pharmaceutical Society: London 39

40 9. Conclusion As part of our review of the post-registration education, training and development landscape across pharmacy, we collected, collated and analysed a huge volume of detailed evidence. Pharmacy practice has changed significantly in recent years, but will need to change further to meet the challenges of an outcome-driven health service operating in a financially constrained environment. We believe that our proposals for reform of post-registration career development within pharmacy will help to ensure that patients receive maximum benefit from the skills and expertise of the pharmacy team. 40

41 Annex 1 MPC WORKSTREAM II TERMS OF REFERENCE WORKSTREAM II: REVIEW OF POST-REGISTRATION CAREER DEVELOPMENT Background and Context 1. Modernising Pharmacy Careers (MPC) is a complex programme designed to ensure the pharmacy workforce has the knowledge, skills and capacities to deliver the services of the future for patients and the public. It is setting out a strategic direction for education, training, and workforce planning across all sectors and staff groups in pharmacy. 2. The MPC Programme was launched in February 2009 and has its origins in numerous initiatives including Pharmacy in England: Building on Strengths Delivering the Future (April 2008). However, the ultimate drivers for this programme do not owe their existence to any one initiative, but are firmly rooted in the overall trajectory of the NHS, health and patient care. 3. Pharmacy professionals already make a strong contribution to the delivery of patient care across the whole NHS, in hospitals, clinics, GP Practices, local Primary Care Trusts, Strategic Health Authorities, in education and research, and in the pharmaceutical industry. However, they remain a significant untapped resource for delivering accessible services to the people who need them most. Opportunities exist to improve the education and training of pharmacy professionals so that practitioners are better equipped to meet future service needs when they register. In addition, the career development pathways for pharmacy professionals after registration are not well defined and there is potential to improve the profession so that the workforce is utilised more effectively and has the ability, confidence and skill-set to deliver more efficient, safer and higher quality care to patients and the public. In essence, the Pharmacy workforce in England has the potential to offer even more to the industry, patients and the public, preventing illness, improving the public s use of medicines, promoting public health and well-being, and contributing to the delivery of patient care in the community in innovative new ways. 4. To realise the full potential of the post-registration workforce, the MPC Programme will undertake a review of post-registration career development to identify how the profession can improve and what options there are for change. Aim of Workstream II: Review of Post-Registration Career Development 5. The aim of the review is to provide advice and recommendations to the MPC Programme Board on developing the registered pharmacy workforce, across all fields of practice, to be competent practitioners capable of delivering safer, more efficient patient focussed care and contribute to the improvement of public health and wellbeing. 6. Having a well-trained and motivated pharmacy workforce will be critical in meeting the coalition government s priorities of better health outcomes, more patient-focussed care, more accountability and greater efficiency in the health service. Objectives of Workstream II: Review of Post-Registration Career Development 41

42 7. The key objectives are as follows: a) To map current post-registration pharmacy workforce career pathways to understand how pharmacy professionals progress from registration to senior positions across all fields of practice. b) To identify existing models, and possible future developments, of post-registration career development (education and training, both formal and informal) in the wider medical field and health policy (eg Medicine, Nursing, Dental Professions) and identify opportunities to apply these models to the pharmacy profession. Specifically, how these professions support practitioners throughout their careers to develop, gain the skills, competencies and knowledge to be effective in their roles. c) To review how current post-registration formal and informal training, education and learning opportunities/provisions support pharmacy professionals to develop the competence, lifelong learning and leadership skills needed to be effective in delivering services to patients and contribute to innovation and development in the pharmaceutical industry. Specifically: i) What opportunities, barriers, constraints and /or gaps exist in supporting the post-registration workforce becoming effective in their roles? ii) ii) What are the interfaces between other related careers and how can we optimise the contribution of the pharmacy workforce alongside other medical professions to deliver more efficient, higher quality patient care? d) To engage stakeholders and obtain a comprehensive evidence base, and foster a common understanding of the strategic direction needs for post-registration education and training in the future pharmacist and pharmacy technician workforce. e) To scope current post-registration frameworks, standards and regulations and how these are applied to ensure that pharmacy professionals are, and remain, motivated, competent and safe to practice. Deliverables 8. The workstream deliverables are: A consolidated report bringing together the literature review and oral/ written evidence gathered, providing recommendations on post-registration pharmacy career development which identifies the opportunities, options for change, and the gaps and constraints to pharmacists and pharmacy technicians in acquiring the necessary competencies, skills and experiences to ensure high quality patient care The above report will include a Pharmacy Career Development Pathway map outlining the various career pathways that professionals take, across all fields of pharmacy, including the interfaces with other professions. Outcomes 42

43 9. The review work will result in the following outcomes: Stakeholder buy-in for the review of pharmacist and pharmacy technician postregistration career development Establishment of a common understanding of pharmacist and pharmacy technician post-registration education and training needs across all sectors in pharmacy, including academia Identification of the options for change and the opportunities, gaps and constraints to pharmacists and pharmacy technicians in acquiring the necessary competencies, skills and experiences to be effective in their roles. Membership 10. Membership of the Review Team is intended to be representative of all relevant interests within Pharmacy. It has been separated into a Project Board Team and five sub groups with special interests. The five sub groups include (1) Pharmacy patient facing, (2) Academia, (3) Technology & Scientific, (4) Technicians and (5) Partners 11. The Project Board Team will be comprised of a subset of MPC Programme Board members and govern the project work as a whole providing strategic oversight and a reporting line up to the MPC Programme Board. The Project Board team membership is drawn from members of the Board who expressed an interest in contributing to this workstream with the intention of bringing together those who have specific expertise in relation to post-registration career development. 12. The five sub-groups (1) Pharmacy - patient facing, (2) Academia, (3) Technology & Scientific, (4) Technicians and (5) Partners, will provide in depth knowledge and input on their areas of specialism feeding into the work as appropriate. 13. As appropriate, the Project Board team will be supplemented by a representative(s) from each of the five sub groups to inform discussions and provide specific feedback/advice from their sub group to inform discussions. 15. Members are requested to: attend meetings regularly or provide a deputy, and respond to written requests for input in a timely manner; bring the views and experience of their area to the discussions but also consider the wider interests of other fields and the MPC programme; members have responsibility for co-ordinating views across their areas and bringing these views to bear on discussions with review team meetings. 16. Keith Wilson and Helen Howe will be co-chairs of the Review Team. They are accountable to Keith Ridge SRO for the MPC Programme, Chief Pharmaceutical Officer, Department of Health, Medicines Pharmacy, Industry Group. 43

44 17. Periodically, the membership may be subject to review. The Review Team may also invite others to attend particular meetings as appropriate eg to share specific expertise or represent views of other parties with an interest. Roles and Responsibilities of the Review Team 18. The Project Board Team will be responsible for: governing the work including providing strategic oversight and guidance; managing the project risks and issues; assuring the quality of outputs of the Review Team; reporting to the MPC Programme Management Team and Programme Board on the progress and activity in the workstream. 19. The Review Team, as a whole, will be responsible for the following: shaping the methodological approach for the review; shaping and providing input on a literature review of post-registration career; development in other medical professions; collecting data through oral and written evidence (including conducting; interviews) to build the evidence base to inform recommendations; providing direction and advice to the analytical work being undertaken by the MPC programme team; shaping and informing a review of current career development frameworks; critically assessing the gathered information; providing a recommendations report and written feedback to the MPC Programme Board on post-registration training and career development. 20. The specialist sub groups within the Review Team will be required to provide their expert advice, guidance and input on their area of specialism. Meetings 21. The whole Review Team will meet twice a year to initiate and end the Project. The Project Board meetings and each of the Sub Group meetings are expected to take place 5-6 times a year, (however, it should be noted that the timeliness of meetings will be subject to ongoing review as the project progresses). In the interest of being productive and fostering team working in each of the groups, these meetings will be conducted face to face where at all possible in London and are likely to take 3-6 hours (i.e., 10:00 15:00). 22. The Review Team meetings are to be delivered in this way to ensure that discussions at each meeting are productive, output focussed and time is used as efficiently as possible, with the right set of people in the room at the right time. 23. The Review Team Secretariat will be provided by Christian Fenn. The agendas and papers will be circulated at least 3 working days before each meeting and draft minutes and actions circulated 5 working days following the meeting by There will be a number of standing agenda items: Review of actions from previous meeting 44

45 Progress update on activities Current Issues Risk Review Reports / position papers to Programme Management Team/Programme Board AOB. Wider Engagement and Working Practices 25. The size of the Review Team is limited to enable it to function effectively. However, as appropriate, the Review Team will engage with a wider group of stakeholders on specific issues and may ask individual members to lead such discussions and to report to the Review Team on the outcome. 26. In addition, the Review Team may commission time-limited working groups to consider specific issues in detail and to develop papers or reports to the Review Team or Programme Management Team/Programme Board for discussion. 45

46 Annex 2 MPC WORKSTREAM II REVIEW TEAM MEMBERS Helen Abbott Gurjit Bajwa Beth Barrett Ian Beaumont Sue Brent Samantha Butler Sue Carter Beverly Ellis Richard Goodwin Sukhjit Grewal Dr Ann Hartley Nigel Hodges (QP) Philip Howard Sandra Hutchinson Stephen Langford Mimi Lau Professor John Marriot Hiten Patel NVQ Programme Manager, Buttercups Training Ltd Pharmaceutical Development and pre-registration pharmacy tutor, Pfizer Pharmacy Education and Training Lead Technician, Education Commissioning, Development and Quality Team, NHS Midlands and East Director, Quality Control North West, Stepping Hill Hospital Director of Pharmacy, Wolfson Unit, Regional Drug & Therapeutics Centre Clinical Ward Pharmacy Technician, King s College Hospital NHS Foundation Trust, London Head of Prescribing & Pharmacy, West Sussex PCT Principal Radiopharmacist, Royal Liverpool University Hospital Pharmacist, Guy s & St Thomas's NHS Foundation Trust Head of Education and Training, National Pharmacy Association Head of Staff & Graduate Development Centre for Staff & Graduate Development, Aston University Chairman of the RPS Qualified Persons Panel of Assessors (AstraZeneca) Consultant Pharmacist, Leeds Teaching Hospitals NHS Trust & Honorary Senior lecturer at University of Leeds Group Training Manager, Rowlands Pharmacy Pharmacy Production Director, Calderdale and Huddersfield NHS Foundation Trust Director of Professional & Training Services, Numark Ltd Professor of Clinical Pharmacy, University of Birmingham Managing Director of PharmaPlus 46

47 Derek Pearson Karen Rice Gillian Risby Raminder Sihota Anthony Sinclair Dr Andrea Taylor Peter Thomas Steve Williams Barbara Wensworth Modernising Scientific Careers - Professional Advisor - Physics & Engineering, MPCE - Head of Department, Nottingham Universities Hospitals Business Development Manager & Chair of Bolton Local Pharmaceutical Committee, Cohens Group Yorkshire Lead for Pharmacy Technician and Support Staff Development, Pharmacy Practice and Medicines Management Group, School, of Healthcare, University of Leeds Head of Pharmacy & Healthcare Learning & Development, Boots Chief Pharmacist, Birmingham Children s Hospital NHS Foundation Trust Director of Taught Postgraduate Programmes in the Department of pharmacy and Pharmacology Department of Pharmacy and Pharmacology, University of Bath Community pharmacist and tutor for the pharmacy technicians' course Consultant Pharmacist (Medicine & Medicine Safety), University Hospital of South Manchester NHS Foundation Trust Freelance tutor (recently retired from post as Course Tutor BTEC Pharmacy Services, Bradford College) Workstream Leads Helen Howe Professor Keith Wilson Workstream II Lead, Chief Pharmacist, Cambridge University Hospitals NHS Foundation Trust MPC Workstream II Lead, Professor of Pharmacy Practice, University of Aston WSII Project Board Professor Ian Bates Dr Chris Cutts Tess Fenn Ryan Hamilton Nominated Representative of Royal Pharmaceutical Society on MEE and MPC Boards Director, Centre for Pharmacy Postgraduate Education, University of Manchester Education Officer, The Association of Pharmacy Technicians UK/ Guy s and St Thomas NHS Foundation Trust President, British Pharmaceutical Students Association 47

48 Louise Hemmings Gino Martini Jonathan Mason David Webb Immediate Past-president, British Pharmaceutical Students Association Director of Development for Asia-Pacific, Japanese & Emerging Market R&D, GlaxoSmithKline National Clinical Director for Pharmacy Community, Department of Health Director, East and South England Specialist Pharmacy Services WSII Partner Group Steve Acres Colin Adair Damian Day Catherine Duggan Janet Gilbertson President, Association of Pharmacy Technicians UK Northern Ireland Representative, Director Northern Ireland Centre for Pharmacy Learning and Development, Queens University Head of Education and Quality Assurance, General Pharmaceutical Council Director of Professional Development & Support Royal Pharmaceutical Society Wales Representative, Wales Principal Pharmacist - Education, Training and Personal Development, Royal Glamorgan Hospital 48

49 Annex 3 EXPERT PANEL MEMBERS AND ADVISORY GROUP MEMBERS FOR INDEPENDENT EVALUATION OF THE ROLE, DEVELOPMENT AND IMPLEMENTATION OF FRAMEWORKS FOR POST-REGISTRATION PROFESSIONAL DEVELOPMENT IN PHARMACY Expert Panel Professor Alan Brown Professor Michael Eraut Professor David Guile Advisory Panel Professor Alan Brown Institute for Employment Research, University of Warwick Emeritus Professor (Education), School of Education and Social Work, University of Sussex Reader in Lifelong Learning, Faculty of Policy and Society, Institute of Education, University of London. Institute for Employment Research, University of Warwick (role on panel: expert on competency frameworks external to pharmacy) Professor Graham Davies Professor of Clinical Pharmacy and Therapeutics, Kings College, London (role on panel: expert on competency frameworks pharmacy) Steve Howard Professor Liz Kay Dr Chris Green Steve Russell Marc Donovan Director of Professional Standards and Superintendent Pharmacists, Lloyds Pharmacy (role on panel: superintendent) Clinical Director Medicines Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust (role on panel: senior hospital manager) Director of Pharmacy Countess of Chester NHS Foundation Trust (role on panel: senior hospital manager) HR Business Partner, Guys and St. Thomas Hospital (role on panel: senior human resources manager) Head of Professional Capability, Boots UK (role on panel: senior human resources manager) 49

50 Annex 4 MPC WORKSTREAM II: REVIEW OF POST-REGISTRATION CAREER DEVELOPMENT STAKEHOLDER ENGAGEMENT ACTIVITY Oral evidence gathering Stakeholder organisations were invited to attend oral evidence gathering sessions. The organisations that provided evidence were: 1 Association of Pharmacy Technicians UK (APTUK) 2 Association of Teaching Hospital Pharmacists (ATHP) 3 British Pharmaceutical Students Association (BPSA) 4 Centre for Pharmacy Postgraduate Education (CPPE) 5 Council of University Heads of Pharmacy Schools (CUHOP) 6 General Pharmaceutical Council (GPhC) 7 Guild of Healthcare Pharmacists (GHP)/Unite 8 Medicines and Healthcare products Regulatory Agency (MHRA) 9 NHS Pharmaceutical Aseptic Services Group 10 NHS Pharmacy Education and Development Committee (PEDC) 11 Pharmaceutical Services Negotiating Committee (PSNC) 12 Pharmacists Defence Association (PDA) 13 Pharmacy Voice 14 Royal Pharmaceutical Society (RPS) 15 The Academy of Pharmaceutical Sciences (APS) 16 United Kingdom Clinical Pharmacy Association (UKCPA) 50

51 Stakeholder engagement events Stakeholder organisations were invited to attend stakeholder engagement events, informed by the discussion paper. Stakeholders in attendance were: London, Friday 13th July Professor John Smart Chair, Council of University Heads of Pharmacy (CUHOP) 2 Dr Catherine Duggan Director of Professional Development and Support, Royal Pharmaceutical Society (RPS) 3 Sarah Jones Education and Skills Manager, Association of British Pharmaceutical Industry (ABPI) 4 Professor Luigi G Martini President, European Industrial Pharmacists Group (EIPG) 5 Rob Darracott Chief Executive, Company Chemists' Association (CCA) 6 Matthew Shaw Centre for Pharmacy Postgraduate Education (CPPE) 7 Dr Richard Needle Chief Pharmacist, Colchester Hospital University NHS Foundation Trust, Regional Chief Pharmacists Network 8 Virginia Watson President, National Association of Women Pharmacists (NAWP) 9 David G Miller President, Guild of Healthcare Pharmacists/Unite 1 0 Mark Borthwick UK Clinical Pharmacy Association (UKCPA) 11 Rachel Kenward Association of Teaching Hospital Pharmacists (ATHP) 12 Liz Fidler NHS Pharmacy Education & Development Committee (NHS PEDC) 13 Gail Fleming Vice Chair, NHS Pharmacy Education & Development Committee (NHS PEDC) Regional Chief Pharmacists Network 14 Ben Rehman Chair of UKMI Education and Training Working Group, UK Medicines Information (UKMI) 15 Graham Davies Joint Programmes Board (JPB) for London, East and South East England 16 Christine Burbage Pharmacy Superintendent, Superdrug Stores plc 17 Alastair Buxton Head of NHS Services, Pharmaceutical Service Negotiating Committee(PSNC) 18 Marshall Davies Chair, Pharmacy Practice Research Trust (PPRT) 19 Colette McCreedy Medicines and Healthcare products Regulatory Agency (MHRA) 20 Malcolm Dash Medicines and Healthcare products Regulatory Agency (MHRA) 21 Tess Fenn Vice President, Association of Pharmacy Technicians UK (APTUK) 51

52 22 Rachael Lemon Editor, Association of Pharmacy Technicians UK (APTUK) 23 Alison Shelton Board Member, Dispensing Doctors' Association 24 Julie Martin Head of Healthcare Scientist and Pharmacy Education, University Hospitals Southampton NHS FT, Regional Chief Pharmacists Network 25 Professor Richard A Lerski Director of Medical Physics, Institute of Physics and Engineering in Medicine 26 Jenny Dorey Pharmaceutical Adviser, NHS South of England, Regional Chief Pharmacists Network 27 Manjit Nahal Learning & Development Manager - Pharmacy Network, Lloydspharmacy 28 Phil Butson Chairman, Pharmaceutical Quality Group 29 Debbie Street Lead Pharmacist Education and Training, Oxford University Hospitals NHS Trust, Regional Chief Pharmacists Network 30 Barry Jubraj Joint Programmes Board (JPB) for London, East and South East England 31 Sue Jones Principal Pharmacy Technician Manager, Education and Development, EKHUF (Pharmacy Technician representative) 32 Susan Sanders Regional Chief Pharmacists Network - London 33 Catherine Davies Education Officer - APTUK 34 Melanie Boughen Specialist Pharmacy E, T, & D Services Manager, NHS East of England (NSC), University of East Anglia (Pharmacy Technician representative) 35 Duncan Rudkin Chief Executive Officer, General Pharmaceutical Council (GPhC) 36 Martha Pawluczyk Registration and International Policy Manager, General Pharmaceutical Council (GPhC) 37 Deborah Evans Director of Pharmacy, National Pharmacy Association (NPA) 38 Denise Taylor President, College of Mental Health Pharmacy (CHMP) 39 Clive Jolliffe Pharmacy Professional Development Manager & Preregistration Manager, Morrisons 40 Jane Brown National Institute for Health and Clinical Excellence (NICE) 41 Dr Cliff Collis Professional Registers & Training Manager, Society of Biology 42 Stephen Tomlin Neonatal and Paediatric Pharmacist Group (NPPG) 43 Nisha Desai Head of Medicines Management, Central Essex Community Service, Primary and Community Care Pharmacy Network (PCCPN) 44 Judy Croot NHS Education and Training Commissioners (East of England) 52

53 45 Peter Rhodes Chair, NHS Pharmaceutical Aseptic Services Group (NHS PASG) Manchester, Monday 16th July Dr Chris Green Chair, UK Clinical Pharmacy Association (UKCPA) 2 Paul Maltby British Nuclear Medicine Society (BNMS) Administration of Radioactive Substances Advisory Committee (ARSAC) UK Radiopharmacy Group (UKRG) 3 Professor Malcolm B R Partridge Association of Teaching Hospital Pharmacists (ATHP) 4 David Thomson Lead Pharmacist, Yorkshire Cancer Network, BOPA (Oncology Pharmacists) & Faculty of Cancer Pharmacists 5 Margaret J Allan Head of Programme Delivery and Pre-Registration, Wales Centre for Pharmacy Professional Education(WCPPE) 6 Nicola Roe Pharmacy Services Development Manager, Rowlands Pharmacy 7 Richard Hey Director of Pharmacy, Central Manchester University Hospitals NHS Foundation Trust, Regional Chief Pharmacists Network 8 Mimi Lau Director of Professional and Training Services, Numark 9 Mark Jackson Chair, NHS Pharmaceutical Quality Assurance Committee 10 Steve Acres President, Association of Pharmacy Technicians UK (APTUK) 11 Raminder Sihota Head of Pharmacy & Healthcare Learning & Development, Boots 12 Steve Ashmore Committee member, UK Renal Pharmacy Group 13 Caroline Waterfield Deputy Director of Employment Services, NHS Employers 14 Mark Koziol Chairman, Pharmacists' Defence Association (PDA) 15 John Murphy Pharmacists' Defence Association (PDA) 16 Anna Prygodzicz Education Commissioning Manager, Regional Chief Pharmacists Network (Chief Pharmacist Network - South Central) 17 Alison Pritchard NW Lead for Pharmacy Support Staff Training & Development, NW Workforce Development Team - NHS North West (Pharmacy Technician representative) 18 Kathryn Giles Design Specialist - Pharmacists, Learning & Development, Boots 19 Jasmin Patel Boots 20 Joanne Taylor Community Pharmacy Technician - independent (Pharmacy Technician representative) 53

54 21 Fin Mc Caul Chairman, Independent Pharmacy Federation (IPF) 22 Rob Liddington Lt Col, Med Strat & Pol - SO1 Pharm, Headquarters Surgeon General, Ministry of Defence (MOD) 23 Alison Budd Adviser, National Clinical Assessment Service (NCAS) 24 Dr Ellen Schafheutle Lecturer in Law & Professionalism in Pharmacy, School of Pharmacy & Pharmaceutical Sciences, The University of Manchester, Pharmacy Law and Ethics Association (PLEA) 54

55 Written stakeholder feedback Stakeholders were invited to submit feedback in response to the discussion paper via the MEE website. Stakeholders who provided detailed written feedback were: 1 Barry Jubraj Based: Chelsea & Westminster Hospital NHS Foundation Trust & UCL School of Pharmacy 2 Tony Cartwright Pharmaceutical Regulatory Consultant 3 United Kingdom Clinical Pharmacy Association (UKCPA) 4 NHS Pharmacy Education & Development Committee Submitted by: Chris Green, Chair & Sarah Carter, General Secretary Submitted by: Trevor Beswick, Chair 5 Dr Helena Herrera Based: University of Portsmouth 6 Northern Ireland Centre for Pharmacy Learning & Development (NICPLD), Queen's University Belfast 7 College of Mental Health Pharmacy Submitted by: Colin Adair & Laura O Loan, Assistant Director for Vocational Programmes Submitted by: Andrew Down & Dr Denise Taylor, President 8 Helen Middleton Based: Pharmacy Professional Development Manager, London Pharmacy Education & Training 9 Gareth Nickless Based: Wirral University Teaching Hospitals NHS Foundation Trust & Liverpool John Moores University 10 The Association of Pharmacy Technicians UK (APTUK) 11 London Pharmacy Workforce Group (LPWG) Submitted by: Catherine Davies, Education Officer Submitted by: Susan Sanders, Director 12 Locum Voice Lindsey Gilpin 13 UKCPA Critical Care Group (CCG) Submitted by: Cathrine McKenzie, Richard Bourne and Mark Borthwick 55