Modernising Pharmacy Careers Review of Post-Registration Career Development Discussion Paper PRO FORMA FOR CAPTURING RESPONSES TO STAKEHOLDER QUESTIONS Please complete and return to: MPCProgramme@dh.gsi.gov.uk Organisation name: United Kingdom Clinical Pharmacy Association (UKCPA) Pro forma completed by: Chris Green (Chair, UKCPA) and Sarah Carter (General Secretary, UKCPA) Contact details: chris.green8@nhs.net; general.secretary@ukcpa.com Stakeholder Question 1 Do you share our vision for the future of pharmacy services? (Question taken from page 6 of discussion paper) N/A UKCPA represents the largest number of clinical pharmacists in the UK, with over 2300 members. UKCPA is the largest clinical practitioner group in the UK and represents the professional interests of our members in addition to being a key education and training provider for both members and non-members. Last year, excluding our two annual symposia, we provided 414 education and training places through 11 national workshops. In addition UKCPA provides a governance infrastructure for 18 specialist practice groups encompassing trainee and advanced level practitioners in mainly clinical, patient-facing service environments. Pharmacists entering the profession post-registration do not have all the skills required to practice. We advocate the need for post-registration foundation training for all pharmacists; we see this as crucial and which is supported, in our view, by senior practitioners and managers. Community-based early years also needs structured foundation training in order to meet new service demands. This foundation training should be competency-based and linked with accepted models for other health-care professions. Practitioners who are capable at managing complex patient groups need to be identifiable. Our members therefore recognise the need for a national system of professional recognition of advanced levels of practice. This should be a leadership function of a partnership of practitioner groups and the Royal Pharmaceutical Society (RPS) (for clinical and non-clinical environments), quality assured by expert practitioners, and not a regulated process. We advocate for the need for structured workforce planning for advanced practice at local, regional and national level. Workforce planning is essential to identify the care needs of the population, use that to determine the workforce required, and to train practitioners to meet those workforce requirements. UKCPA and its sister organisations should work with the professional body in order to feed into the workforce planning being developed by HEE and the Centre for Workforce Intelligence. 1
We advocate for a robust evidenced-based practitioner development structure embedded into careers, using current evidence-based practitioner development frameworks for practitioner support (for example, GLF and ACLF, of which we are firmly of the view that they are development tools, not assessment tools). We would also like to see pharmacists applying science (pharmaceutics, pharmacology, pharmacokinetics) to assure safe clinical use, and pharmacy technicians taking responsibility and governance of safe storage and supply. Community practice needs to not only grasp the public health agenda but also take up the challenge of clinical management (review, monitoring and prescribing) of medicines in the community. Education and training leadership will be vital, but crucially this has to be rooted in the practitioner community. Whilst public health is an essential role for all healthcare professionals, the unique contribution of medicines expertise, through clinical management of medicines and optimisation of their use, should be enhanced. UKCPA would advocate that each consultation around medicines should promote healthy living and public health. 2
Stakeholder Question 2 Do you agree with our view of the multiple levels of responsibility for the professional development of the future pharmacy workforce? If not, what alternative views do you have? (Question taken from page 8 of discussion paper) NA Responsibility and accountability for education and training and development must lie with the profession. Regulation for minimum standards needs to be a clearly separated vision from aspiration for excellence beyond these minimum standards. Our view is that leadership bodies, including UKCPA and the Royal Pharmaceutical Society, bear primary responsibility to provide this vision and associated leadership. 3
Stakeholder Question 3 Have we accurately described the range of activities undertaken by the pharmacy workforce? (Question taken from page 12 of discussion paper) Reference: What Stakeholders told us the current pharmacy workforce Discussion Paper: Figure 1: Summary of titles and groupings of competence for the pharmacy workforce, p.10 There needs to be more explicit reference to commissioning, homecare, GP working and clinical procurement and specialist clinical services. 4
Stakeholder Question 4 Have we accurately summarised the current professional development in the early years of professional pharmacy practice? (Question taken from page 13 of discussion paper) Discussion Paper: Figure 1: Summary of titles and groupings of competence for the pharmacy workforce, p.10 5
Stakeholder Question 5 How should the process of developing the pharmacy workforce change to enable pharmacy to develop in an era of commissioned services? (Question taken from page 14 of discussion paper) NA Answer: We advocate for the need for structured workforce planning for advanced practice at local, regional and national level. Workforce planning is essential to identify the care needs of the population, use that to determine the workforce required, and to train practitioners to meet those workforce requirements. The range of tasks undertaken by current staff is often too great in terms of responsibility for patient care. We need pharmacists to take on only the high level (clinical) responsible tasks and allow pharmacy technicians and unregistered staff to take on their appropriate roles. UKCPA and its sister organisations should work with the professional body in order to feed into the workforce planning being developed by HEE and the Centre for Workforce Intelligence. 6
Stakeholder Question 6 What are your views on the future funding of post-registration pharmacy education and staff development? (Question taken from page 15 of discussion paper) NA Answer: Whilst registration as a pharmacist requires completion of an undergraduate degree there will always be a need for post-registration training to enable practitioners to advance and specialise. Funding for post-registration education and training should be accessible and equitably and transparently distributed. It should be quality assured by expert practitioners and as well as advancing clinical skills it should also be focussed on research and development, leadership and management skills, and continuous improvement methodologies. Core aspects to education need to be part of the centralised criteria set by which LETB s commission services, otherwise education standards (and hence pharmacists capability / competence) in one geographical area will be very different from in another geographical area. This would limit workforce flexibility, an absolutely key attribute required of pharmacy workforce in the future. This is a role for the RPS or UKCPA and other leadership bodies. At advanced level, we advocate the need for a national system of professional recognition of advanced levels of practice, which should not be a regulated process, but a partnership of practitioner groups and the Royal Pharmaceutical Society (RPS) (for clinical and non-clinical environments), again, quality assured by expert practitioners. Practitioners should also expect to take some responsibility for their own professional development, as in other professions. 7
Stakeholder Question 7 What do you consider the role of appraisal for performance assessment and staff development in corporate organisations? Who should be involved and what is the role of senior corporate staff? How could appraisal be implemented in small businesses and for the locum workforce? (Question taken from page 20 of discussion paper) Discussion Paper: Figure 2: Competencies in the pharmacy workforce, p.17 Discussion Paper: Box B: Leading & Managing Key Elements, p.18 Answer: Employers or senior staff should take care to ensure that staff appraisals are objective and meaningful. Performance assessment should be a combination of peer review, expert review and patient or client feedback, in order to give a 360 degree view of the member of staff, and ideally, multidisciplinary. It is important that all pharmacists, whether working in the NHS or as locums, have their performance assessed in order to instil confidence in their ability to provide patient care. UKCPA and other leadership bodies need to ensure that employers are aware of the full range of evidence-based workforce training available. 8
Stakeholder Question 7 Proposal 1 Do you agree with the following proposal for future work? We are suggesting that, as a matter of priority, the MPC Programme Board undertakes a more detailed piece of work, as part of the wider HEE strategic advisory programme, to look at early years development, performance management and capability assessment for pharmacists and pharmacy technicians. (Question taken from page 19 of discussion paper) Discussion Paper: Figure 2: Competencies in the pharmacy workforce, p.17 Discussion Paper: Box B: Leading & Managing Key Elements, p.18 We feel that it is important that early years and foundation training needs to be formalised, but not regulated (by GPhC). It should be an employer or professional expectation. However, it needs to be clear how it can map into GPhC revalidation. Much work has, however, already been mapped by practitioner leadership groups, around the use of the GLF across the UK in the early years, and we, amongst others, provided evidence of this to MPC in 2011. We would wish to see this more in evidence in the MPC report. 9
Stakeholder Question 8 In terms of professionalism, to what extent do the competencies described in Figure 2 and Box B apply to pharmacy technicians? (Question taken from page 23 of discussion paper) Discussion Paper: Figure 2: Competencies in the pharmacy workforce, p.17 Discussion Paper: Box B: Leading & Managing Key Elements, p.18 Answer: 10
Stakeholder Question Early Years Framework UEA Proposal 1: Do you agree with the following proposal for immediate development, based on the UEA evaluation, suggesting that: work is started to review and re-cast the GLF and pharmacy technician framework in line with the development guidance produced as a result of the UEA evaluation a process is developed which establishes a consensus amongst employers about how such a framework should be used and how practitioners and their managers will be supported in using the framework the process for development, validation and adoption of any redrafted GLF needs to reflect a national and cross sector perspective from the outset a more formal mentoring structure for post-registration pharmacist/ pharmacy technician development should be introduced and funded to support the utilisation of generalisable professional development frameworks. as a next step any review of the GLF should make clear links between using and doing research and distinguish that clearly from leading research. (Question taken from page 21 of discussion paper) Reference: Proposal for immediate development, based on the UEA evaluation, p.19 Discussion Paper: Box C: Learning points for development and use of frameworks, p.21 Discussion Paper: Figure 4: Developing competence within mid-career posts, as part of recognised clinical leadership posts, p.33 The GLF is an evidence-based practitioner development tool. We would fully support the development of the GLF into a nationally recognised post-registration framework but point out that it is already used extensively and successfully across the UK. A review of its contents and application may be a worthwhile exercise, but there needs to be clear and valid reasons for this. Redrafting the tool will not solve the issues of implementation by inexperienced supervisors. The tick-box criticism is misplaced, as in areas where the GLF is routinely used, this is not seen as a problem. Any practitioner development tool needs to be properly implemented and based on workplace supervision using trained mentors, and evidence-led evaluation of capability. The GLF is clearly understood to be a development tool, or road-map, not an assessment tool. This distinction should be made clearer in the MPC document. We believe that the mentoring aspects of the profession, therefore, need special attention. Mentors require considerable support, development and assessment to ensure the quality of mentoring is high and consistent across time and pharmacy teams. It would be beneficial to introduce mentoring skills early in a practitioner s career or even at undergraduate level. 11
Early Years Framework comments cont: We agree that an early years framework such as the GLF needs to be applicable nationally and across sectors. However, there must be an acknowledgement that different skills are used in different sectors and therefore the competencies included in the framework must be genuinely core to a pharmacists work, regardless of geographical location or sector, and/or there may be a need for context specific sections for each sector of practice. UKCPA supports the GLF based on holistic evidence and experience across a range of practice in the UK. We agree that an enquiry-driven profession such as pharmacy needs a better focus on research and evaluation in the early years and would support the inclusion of research in a framework. 12
Stakeholder Question Proposals 2 & 3 Proposal 2: Do you agree with the following proposal for future work? We are suggesting that the MPC Programme Board, as part of the HEE work programme, undertakes a significant piece of work to: evaluate current post-registration learning, development and assessments relevant to the delivery of medicines optimisation and consider whether a single formative assessment can be designed and piloted to inform development of flexible education and training for the medicines optimisation workforce consider whether registration, including the work-based summative assessments carried out by designated medical practitioners, as a prescriber can be achieved in a more flexible, but safe way consider how relevant supervised practice might be delivered to meet the current requirements for registration as a prescriber in a primary care setting, to reflect where patients are likely to require care: in care homes, their homes, GP practices and community pharmacies We would see this 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 and/or the prescribing legislation is developed and reformed (Question taken from page 27 of discussion paper) We are unclear as to the meaning of a single formative assessment how can it be formative if it is a single assessment? The language of this proposal needs clarification. Career development is a continuous process: reliance on a formative assessment is reductive and not based on evidence. 13
Stakeholder Question Proposals 2 & 3 Proposal 3: Do you agree with the following proposal for future work? We are recommending that: any work to develop competence in consulting amongst pharmacists should include teaching, learning and assessments relevant to delivery of public health messages and brief interventions There may be a need to review underpinning professional and core knowledge and to update accordingly to ensure an understanding of public health context, recognising that this is already included in the prescribing syllabus (Question taken from page 28 of discussion paper) Discussion Paper: Box D: Detailed competence statements for consulting, p.25 Discussion Paper: Box E: Detailed competence statements for consulting, p.26 Reference: Proposal for MPC/HEE future work programme: Proposal 2,p.27 Reference: Proposal for MPC/HEE future work programme: Proposal 3,p.28 Reference: Medicines Optimisation Building the Workforce Reference: Core professional and clinical knowledge This proposal seems very narrow in scope, especially as the underlying prescribing syllabus is well defined in the single prescribing framework, and that this latter already maps to the GLF which clearly includes consultation. The aims and purpose of this proposal need further clarification. 14
Stakeholder Question Proposals 4 Proposal 4: Do you agree with the following proposal for future work? We are recommending to HEE that: as part of its consideration of developing the medicines optimisation workforce, and the MPC Programme Board in its continuing work programme, should consider the implications for pharmacy technicians post-registration development of pharmacists spending more time with patients, whether in the pharmacy or elsewhere (Question taken from page 28 of discussion paper) Reference: Proposal for MPC/HEE future work programme: Proposal 4,p.28 Discussion Paper: Fig.3: Areas for possible development, over and above the core aspects of professionalism, p. 29 Discussion Paper: Box F: Safe and effective pharmacies, p.29 Yes. Provided it has a brief that the outcomes should support and develop pharmacists in what they are doing, not restrict their activities because it is deemed that pharmacists need to supervise the technician s activities. 15
Stakeholder Question Proposals 5 Proposal 5: Do you agree with the following proposal for future work? We are recommending to HEE that: as part of the workforce development review to support delivery of medicines optimisation, in consideration of the development of the capacity and confidence of pharmacists to work effectively, attention to the role of pharmacy technicians may be helpful (Question taken from page 29 of discussion paper) Reference: Proposal for MPC/HEE future work programme: Proposal 5,p.29 We agree that the skill mix needs a more mature discussion. This means better, more formalised technician training to provide the foundation for liberating pharmacists from the dispensary bench. There should also be a distinction between pharmacy technicians and accredited checking pharmacy technicians as they have different roles in the pharmacy team. 16
Stakeholder Question Proposals 6 & 8 Proposal 6 & 8: Do you agree with the following proposal for future work? We are recommending that: for the technical workforce, and each subspecialty within it, workforce planning for pharmacists and pharmacy technicians is undertaken at a national level by HEE, and that the training and development needs for specialisation are considered in the context of the development of learning and development of health care scientists work is undertaken in relation to delivery of the new integrated MPharm programme and in relation to any changes to the early development to deliver medicines optimisation so that intercalated training and rotations are offered to students and newly qualified pharmacists, who wish to pursue careers in the technical and scientific careers in considering the programme of academic development grants and developing the academic workforce, joint academic posts linked to clinical research should be developed. This should be linked explicitly to the development of QP specialists as a wider cadre of research leaders consideration is given to how consultant pharmacists might develop in the future, as the initial post holders mature and develop different portfolios in teaching or research, and balance that will expert practice at regional /national leadership roles and responsibilities (Question taken from page 28 of discussion paper) Reference: Proposal for MPC/HEE future work programme: Proposal 6 & 8,p.28 First paragraph: We agree, ensuring input from the professions involved. Second paragraph: Care should be taken as all students need to get a basic understanding of clinical, technical and scientific aspects of pharmacy. At undergraduate level they may not know where their future career will be, so the process should support flexibility and the building of transferable knowledge and skills experience and behaviours. 17
Proposal 6 & 8 comments cont: Third paragraph: We would support the development of academic posts linked to clinical research, but this should not be limited to QPs or junior academic grades. Fourth paragraph: MPC might also like to think about a registrar grade for planning purposes. 18
Stakeholder Question UEA Proposals UEA Proposal: Based on the UEA evaluation, do you agree with the following proposal for immediate development? We are recommending that: the ACLF should continue to form the basis for the development and achievement of advanced and specialist level practice development of an ACLF-equivalent framework be considered for pharmacy technicians, to be used as a professional development framework (Question taken from page 31 of discussion paper) Discussion Paper: Figure 4:Developing competence within mid-career posts, as part of recognised clinical leadership posts, p.33 Reference: Proposal for immediate development, based on the UEA evaulation,p.37 We agree that the ACLF should continue to form the basis for the development and achievement of advanced and specialist practice. We would also support using the ACLF for pharmacy technicians. A review should be taken before work is commenced on developing an equivalent ; we do not envisage a vastly different framework as the ACLF may be sufficiently generic to be appropriate. We know that GPhC would support a joint framework and that it is used already. We would like to add that we believe that Consultant practice needs national accreditation, that it needs to be a training post and needs to be facilitated into community settings/outreach for medicines optimisation and reducing hospital admissions. We support the vision for national professional recognition models which are professionally led, and are a professional aspirational, not regulated. 19
Stakeholder Question Proposals 7 Proposal 7: Do you agree with the following proposal for future work? We are recommending that: MPC should undertake further detailed work to address the development of formal joint teaching and learning appointments and the provision of appropriate post-graduate teaching and learning qualifications HEE invests in developing a programme of funding to develop the research workforce amongst mid-career practitioners that is designed to provide training to enable competition for senior projects and programme grants and the establishment of a cadre of research leaders with senior university appointments (Question taken from page 39 of discussion paper) Discussion Paper: Figure 4:Developing competence within mid-career posts, as part of recognised clinical leadership posts, p.33 We welcome the above proposals, but would not limit to any grade or point in career: joint teaching and learning posts and supporting research should be available to all practitioners. 20
Stakeholder Question 9 Do you consider that there should be a programme of work on the roles and responsibilities of senior professional leaders such as trust chief pharmacists and corporate superintendents? (Question taken from page 35 of discussion paper) Discussion Paper: Section 7, Clinical and professional leadership, p.31 Answer: We would support the recognition of exceptional clinical leadership in all our senior professional leaders. 21