Health CommitteeWritten evidence from the Council of University Heads of Pharmacy Schools (ETWP 90)

Background and Summary

1. The Council of University Heads of Pharmacy Schools (CUHOP) represents the collective interests and views of the Schools of Pharmacy. The membership of CUHOP comprises the heads of the presently 26 UK schools of pharmacy which enrol students to read for a Master of Pharmacy (MPharm) degree with the expectation of registering as a pharmacist in the UK. These schools of pharmacy also deliver a range of Clinical Pharmacy postgraduate programmes for NHS and other pharmacists in clinical and technical services pharmacy, GPhC accredited non medical prescribing courses, and research degrees and doctorates.

2. Key issues for Pharmacy Schools relevant to the themes of the inquiry are:

Academic expertise is needed to both inform and transform education and training, any new structures and systems should seek to harness this expertise.

Pharmacy schools need to be true partners of NHS and private healthcare providers and commissioners in primary and secondary care.

Where possible existing structures should be incorporated and developed in to the new system.

High quality education requires national coordination and regulation.

Any infrastructure for managing and assuring the quality of workplace-based pharmacy training must provide clear accountability and responsibility for delivery of quality teaching, learning and assessment.

Curricula cannot be adapted piecemeal to meet local demands. There must be respect for university processes, and an acknowledgment that if something comes in to the curriculum something has to come out.

Quality assurance for pharmacy education and training needs to build on current HEI QA frameworks and the General Pharmaceutical Council (GPhC) standards for pharmacy tutors and premises.

Any workforce planning needs to encompass the full range of pharmacy roles.

CfWI, working on behalf of HEE, should seek to develop long-term plans based on realistic estimates.

Pharmacy and pharmacy education and training must not be overlooked in the development of public health.

3. While many issues raised in our response refer to the context in England specifically, many challenges and solutions we identify are applicable across the UK. Addressing these common challenges will only be possible through sharing information and good practice across the UK.

4. It will be important to keep the Inquiry open until after the DH has published its recommendations for Education and Training, in order that the Committee might receive views on actual rather than speculative plans.

Stable Transition

5. It is absolutely crucial that this be an evolving process, and where possible existing structures should be incorporated and developed in to the new system. Throughout transition, risks should be identified and managed and transparency maintained. This is particularly important in relation to pre-registration training posts (in NHS hospitals and in community pharmacies contracted to provide NHS services) that allow pharmacy graduates to complete their professional training.

6. Academic expertise is needed to both inform and transform education and training, any new structures and systems should seek to harness this expertise.

7. Health Education England (HEE) should be established with close links with the Devolved Administrations to ensure a UK wide oversight is maintained.

8. Action must be taken to prevent loss of education and training expertise in Strategic Health Authorities (SHAs) and Deaneries, especially to support pre-registration and postgraduate training frameworks.

9. Greater care needs to be taken in the establishment of Local Education and Training Boards (LETBs); there should be national requirements to involve Higher Education Institutions (HEIs) and to have an independent Chair. In the absence of national guidance, unhelpful local developments have been reported, with HEIs experiencing:

Active exclusion from discussions about the development of LETBs.

Absence of consideration of quality assurance in LETBs design.

Poor communication between SHAs taking forward plans for LETBs and HEIs.

National Structures

10. Pharmacy education is a continuum from the undergraduate level to retirement, overseen by the GPhC, and involves NHS hospitals and independent providers (contracted to provide NHS services) in the community sector. High quality education requires national coordination and regulation. We welcome the duty on the Secretary of State to maintain a system of education and training in the NHS.

11. Pharmacy schools need to be true partners of NHS and private healthcare providers and commissioners in primary and secondary care—designing new systems together and preparing pharmacists for the myriad of ever-changing roles required of them. For example, pharmacists have an important patient safety role in medication safety and reducing hospital admissions; as well as roles in public health and medicines optimisation through targeted Medicine use reviews and the first prescription service.

12. Health Education England, role, responsibilities and relationships with other bodies:

HEE needs to link to DH directly like the National Institute for Health Research (NIHR) rather than via the NHS Commissioning Board. This will ensure clear lines of accountability, reflecting the Secretary of State’s responsibility to maintain the education and training system.

HEE must be given “teeth” with the right to call on the NHS Commissioning Board for support if local plans cannot be accommodated within national requirements.

HEE should ensure that educational funding is ring-fenced and transparently follows the student. It will also need to establish a process for on-going review, allocation and determination of funding to ensure protection of educational budgets.

HEE should have the responsibility for enforcing duties on providers with financial penalties to enforce compliance. To support HEE in this endeavour the regulators of the healthcare professions (including GPhC), CQC and Monitor must inform HEE of concerns they have picked up.

HEE must have a defined relationship with Health Education National Strategic Exchange (HENSE), with stronger links between both NIHR and HENSE and between HEE and the Office for Strategic Coordination of Health Research (OSCHR), to coordinate and maximise research outputs alongside consideration of education and training.

The Chair of HEE should be a highly regarded senior clinical academic with recent experience of healthcare education. HEE should have a small board that includes non-executive directors with a background in healthcare and academia, and we would wish pharmacy to be represented on this board.

It is vital that HENSE is maintained and its role enhanced, notably with the inclusion of representatives to cover all healthcare professions (there does not appear to be pharmacy representation currently). The Chair of HENSE should work closely with HEE.

HEE would be in a position to look for opportunities for promoting inter-professional education and training wherever appropriate.

13. Pharmacy input at a national level:

Multi-professional oversight of the workforce such as through HEE must be accompanied by single professional oversight, such as currently facilitated by the programme boards. Pharmacy is largely unique in its level of interactions with independent providers; this introduces a layer of complexity to the development of the pharmacy workforce that needs to be considered at a national level.

The Modernising Pharmacy Careers Board, as a driver for enhancing professional education and training at both pre-registration and post-registration levels, involving representatives of professional practise and higher education, should be maintained and strengthened.

In order to ensure true professional leadership, there need to be places for elected representatives of the professions on Programme Boards and HEE.

The Chief Pharmaceutical Officer (CPO) should sit on both HEE and the NHS Commissioning Board.

14. In creating the governance structures account should be taken of the systems in place in the other three nations; there must be strategic oversight looking at developments in all the Devolved Administrations.

Local Structures

15. Many of those best placed to deliver the required professional leadership required are clinical academics from the healthcare professions and those in the related sciences, who have a unique and valuable position of being involved in the delivery of healthcare and health education, and being at the forefront of bioscience and healthcare research. It is essential that academics, educationalists, healthcare professionals and employers work together to create programmes that will be proper foundations for entire careers and which take account of patients’ requirements and the need to embrace scientific advances and innovation in healthcare.

16. Local Education and Training Boards:

As outlined above, less than full academic partnership on LETBs will mean that they fail to flourish and provide the NHS with the innovation it needs.

Whilst we acknowledge that concerns have been raised that HEI involvement on LETBs will produce conflicts of interest. We think it should be recognised that NHS providers commissioning placements from themselves also presents a conflict of interest.

As envisaged in the last review of MPET, a proportion of the Multi Professional Education and Training budget (MPET) should be reserved, and awarded after successful provision of education and training to ensure that high quality is delivered in placements.

In establishing LETBs it will be essential to build on existing local partnerships established through AHSCs, BRCs and BRUs, HIECs and CLAHRCs.

17. Any infrastructure for managing and assuring the quality of workplace-based pharmacy training must provide clear accountability and responsibility for delivery of quality teaching, learning and assessment. This infrastructure must include employer representation and commitment from hospital and community pharmacy and possibly industry, be in partnership with pharmacy schools and properly resourced.

18. To develop a stronger multi-professional approach to postgraduate education and training it will be important to build on what works by enhancing current governance structures; for example by integrating a pharmacy dean into the existing deaneries.

Regulation, Quality Assurance and Outcomes

19. Pharmacy education and training must prepare students and trainees for a wide range of career pathways, and the fast developing healthcare landscape. In order to deliver high quality training and to achieve responsiveness to patient needs and changing service models, NHS colleagues in primary and secondary care together with leaders from the community pharmacy sector and the pharmaceutical industry must be true partners of pharmacy schools, designing new systems together and preparing pharmacists for the myriad of ever-changing roles required of them.

20. Curricula development: curricula cannot be adapted piecemeal to meet local demands. There must be respect for university processes, and an acknowledgment that if something comes in to the curriculum something has to come out.

Pharmacists are a national resource with educational requirements that must meet national and international standards and which, for all pharmacists, must be rooted in a deep understanding of the science of medicine design, mechanisms of drug action and evidence based healthcare.

The role of the General Pharmaceutical Council (GPhC) in curriculum development through setting the requirements for initial pharmacy education and training through the university-based programmes to completion of the preregistration year should be maintained.

In England the Pharmacy Programme Board under the aegis of HEE will be in a position to play a central role in curriculum development in concert with individual HEIs. Equivalent bodies in the devolved nations and UK wide professional bodies such as the Royal Pharmaceutical Society of GB should also be involved.

21. Quality assurance for pharmacy education and training needs to build on current HEI QA frameworks and the General Pharmaceutical Council (GPhC) standards for pharmacy tutors and premises.

22. Education and Training Outcomes Framework: clarity is needed on the relationship between “outcomes” and “domains” in the NHS Education Outcomes Framework and appropriate metrics must be developed if it is to be of practical use.

Workforce Planning

23. It should be recognised that pharmacists are an integral part of the healthcare workforce in the community, in hospitals, in industry as well as through their involvement in public health. Improving the quality and safety of primary and secondary healthcare, delivering the self-care and public health agendas, and secondary care specialisations all require effective pharmacists. Pharmacists, opticians and dentists in the community should not be viewed or treated as peripheral; these professionals are numerically important for workforce planning and contribute greatly to patient care and public health.

24. Any workforce planning needs to encompass the full range of pharmacy roles:

Two thirds of pharmacists work in the community these pharmacists are not employed directly by the NHS, but do perform essential NHS activities. The government wishes to expand the scope of the pharmacist contract to provide a range of new enhance services, including managing chronic conditions, supplementary and independent prescribing, the new medicines service and the “healthy living pharmacies” initiative,

Pharmacists are essential to delivering the self-care and public health agendas (such as vaccinations, sexual health, smoking cessation etc), and secondary care specialisations. In addition a small number of pharmacists work in industry and academia both on a full time and part time basis.

25. Role of healthcare providers: all healthcare providers should have a duty to provide data about the current workforce their future workforce needs. These data must be accurate with a clear indication as to whether they refer to headcounts or full time equivalents. The private sector and otherwise independent employers must also be involved, in particular:

Community providers need to be more open about their pharmacist workforce requirements for training in order to continue to be supported through the Community Pharmacy Contractual Framework.

We emphasise again the importance of understanding the whole pharmacist workforce and not just those employed by the NHS. Whilst providing NHS pharmaceutical services, the majority of pharmacists are neither NHS contractors nor NHS employees throughout their professional careers.

26. Overseas pharmacy students and staff: a key strength of the current system is the quality of the healthcare workers produced in England and the rest of the UK. The UK also currently benefits from the ability to generate wealth from the delivery of high quality healthcare education and training to overseas students.

In pharmacy the numbers of overseas students represent a significant minority and many such students have entered the UK pharmacy workforce, at least for early years’ experience and professional development, as highly capable practitioners. This has been good for them, good for the NHS, good for universities and the UK economy.

We would argue that changes to the immigration system should not remove the attractiveness of studying or working in the UK.

27. Centre for Workforce Intelligence (CfWI) and forecasting future needs:

CfWI, working on behalf of HEE, should seek to develop long-term plans based on realistic estimates.

Workforce planning must take a UK wide approach. When considering “cross-boundary flows” thought must be given to movement within the UK and into the UK from elsewhere.

Pharmacy as a profession attracts large numbers of women and ethnic minorities, so forecasting needs to consider the equality agenda.

The CfWI should take time to ensure that it has accurately determined the nature of the information it is seeking to collect from employers and must require that the data be presented to it in a consistent manner to facilitate accurate and effective analysis.

It would also be advisable for the CfWI to work with the professional regulators, which hold varying levels of data; in some cases it may be appropriate to provide funding to support a regulator to enhance its own data collection.

Greater resources will be needed to allow CfWI to provide LETBs with the information required.

28. Public health workforce:

Pharmacy and pharmacy education and training must not be overlooked in the development of public health, noting that pharmacists working in community pharmacy in the primary care setting are front line providers and readily accessible by the public.

Guidance on transfer of contracts for public health academics is required to ensure the protection of this vital workforce.

We note that the timeline for PCT clusters to produce their plans is by the end of January 2012 and that a consultation on the public health workforce strategy is expected by the end of December 2011.

December 2011

Prepared 22nd May 2012