In an interview with EJHP Mark Borthwick, Chair of the United Kingdom Clinical Pharmacy Association (UKCPA) and Consultant Pharmacist in Critical Care, John Radcliffe Hospital, Oxford talks about his views on the future of hospital pharmacy and clinical pharmacy services.
Q1) What are the challenges facing clinical pharmacy today?
A1) There are many: developing and spreading innovative practice, combating silo working, obtaining and retaining recognition for the work we already do, establishing and utilising research networks, keeping abreast of the flow of information to stay up-to-date. All of these require resource and commitment from pharmacists, no one else will do it for us.
Q2) What would you say to hospital pharmacists, especially in Europe, who don’t see the need for clinical pharmacy services?
A2) Clinical pharmacy services improve patient outcomes. Mortality and morbidity rates are improved, and costs are reduced or managed. This has been shown in numerous studies. Pharmacy provision is as much about information and using the product in its most effective way as it is about the actual product itself. As experts in medicines, we are well placed to know the nuances of why drug A gives a different outcome to drug B, we can balance the risks to give a recommendation based on our knowledge. If we have the confidence in our own abilities, then of course we should prescribe and take full responsibility for our decisions through our actions.
Q3) How can the level of research into clinical pharmacy services be increased? Who should be doing this research?
A3) We can improve the level of research by raising the expectation on pharmacists to do it. This can be done at undergraduate level and so build a workforce with the skills and belief that this is something they should do. That could take some time to feed through into tangible results. For those already working as pharmacists now, we can do something as simple as audit or start to group together to build networks. I find that groups of pharmacists are quite capable of coming up with ideas and working out how to do projects even with limited funds. Such groups naturally become more ambitious with time, building on successes and learning as they go along. They don’t have to meet physically either, they can be virtual groups linked by electronic communication lines. Research should just be part of the job, so that means pharmacists should do it, wherever they work.
Q4) Do you think European wide hospital pharmacy standards can work in reality?
A4) Such things have the feel of a self-fulfilling prophecy about them. If we all believe they will work, then they will work. If we think ‘that’s too hard, it will never work’, then it won’t work. I think the reality is it’s hard, but completely possible.
Q5) What would you say to those contemplating joining the hospital pharmacy profession?
A5) Hospital pharmacy is a rewarding career that requires every bit of your attention, intelligence and patience to do well. It is entirely possible to be half hearted, but then you will find it is not rewarding. If you like to learn and like to make a difference, then there are ample opportunities to do so. I came from several years in community practice and found that my thinking was radically altered by working in hospital, in a good way. By working in the same space as doctors I realised they did not know it all, that they made mistakes and that I could stop them from doing so. More than that, I realised that my knowledge complemented theirs; together we made decisions that were more beneficial to patients and made care plans that took account of a wider variety of factors than if the plan was created by just one of the professions.
Q6) What do you think needs to be done to increase collaboration with other healthcare professionals?
A6) This links back to my previous answer; share the same space. At undergraduate level subjects such as physiology, pharmacology, biochemistry subjects could all be taught across multiple professional groups. After qualifying, there should be no need to separate all continuous professional development activities, some of these can continue to be shared. Pharmacists must not be shy to approach working parties and invite themselves along to relevant initiatives (journal clubs, stakeholder meetings, guideline development groups, etc). Pharmacists are quite capable of making their own professional treatment guidelines and disseminating to other professions. Such activity thrusts home to other professionals just what they are missing out on when pharmacists are excluded from projects that are being set up. In my experience such exclusion is never malicious, it’s just an oversight that is easily rectified with a bit of noise. Set up your own working party and invite other professions to join, lead by example.
Q7) Where do you see the profession in 5 and 10years time?
A7) Difficult question, when I think back 10 years ago, we did not have competency frameworks, we did not have consultant pharmacists, we did not have prescribing pharmacists. So much has changed radically in the UK that I may be in danger of not speculating wildly enough when looking forward.
In 5 years time we will definitely have a formal system of recognition of the different levels of pharmacy practice in the UK. Pharmacists will be developing themselves in a more structured way to meet the needs of patients and the health service. This will be across the profession, from pharmacies on the high street to consultant level practice in hospitals. Patients will benefit as a result, and many of the clinical skills hospital pharmacists have will be transferring to the community pharmacy setting.
In 10 years time clinical pharmacy will be the norm in the high street, just as it is in UK hospitals at the moment. Pharmacists will be working on solid research questions and improving the health of the nation. Community pharmacists will be offering a range of services to complement that of community based doctors. This may well include the use of in-pharmacy diagnostic tests as the age of personalised medicine arrives and the population begins to use medicines that are most effective for their genetics and lifestyle, etc.