Health CommitteeWritten evidence from the NHS Pharmacy Education and Development Committee (ETWP 106)

Introduction

The Committee exists to provide co-ordination in pharmacy education, development, and training within National Health Service (NHS) organisations primarily, but not exclusively, in secondary care. Members of the committee usually have responsibility for education and training across a geographical area equivalent to several counties and between them cover all staff groups within pharmacy and the whole of the UK. Further information about the work of NHS Pharmacy Education and Development Committee is available at http://www.nhspedc.nhs.uk/

Overview

1. The NHS PEDC generally welcomes the key principles of the government’s plans proposed in the White Paper “Liberating the NHS: Developing the Healthcare workforce” and agrees that there are potential benefits in a new system which is more flexible and responsive to the changing needs of the service providers and new patterns of healthcare delivery. We also welcome the proposed improvements for workforce planning and commissioning of healthcare education and training at national level.

Right Numbers of Appropriately Qualified/Trained Healthcare Staff

2. The committee is keen to ensure that, in order to maintain the supply and quality of key elements of the pharmacy NHS workforce, current arrangements are underpinned and maintained during any transition period.

3. The NHS spends in excess of £12 billion pounds on medicines (70% primary care and 30% secondary care). Pharmacists and pharmacy technicians are central to delivering the QIPP agenda in relation to medicines management. Medicines are one of the most common healthcare interventions. Not surprisingly medication related incidents are the third most commonly report incident reported to the NPSA, and the GMC’s own study shows there are errors on 9% of all prescriptions written by junior doctors in hospitals. The report also identifies that pharmacy staff are the main safeguard, which prevents these errors reaching patients.

4. The pharmacy workforce is large with over 43,000 pharmacists and 18,000 pharmacy technicians registered with the General Pharmaceutical Council (GPhC). There is also a large workforce of qualified (but unregistered) pharmacy assistants. The NHS pharmacist workforce has remained broadly the same in the last 12 months but the numbers of pharmacy technicians has continued to rise. This is set against a backdrop of decreasing numbers of pharmacy technicians in training.

5. The professional input of the pharmacy workforce contributes to improved medicines use at the level of the individual patient and the organisation. It is recognised that one of the greatest risks to patients in relation to their medicines is at the point of transfer of care, and indeed NICE has issued guidance on medicines reconciliation to minimise these risks. A recent systematic review of the literature has shown that the pharmacists reduce these risks and indeed result in net savings of £3,000 per 1,000 prescriptions written.

6. Community pharmacy services are playing an increasingly important role in public health and services in smoking cessation and sexual health are embedded in many communities. Yet despite this and their significant numbers, the wording of the proposals still implies they outside of the NHS. As services move from hospital to community settings, the need for joint training and workforce planning is essential.

7. There is not sufficient information in the government plans as to how existing infrastructures for commissioning and delivery of Pharmacy education and training would fit into the new structures. The committee feels that existing expertise should be appropriately utilised to inform the new ways of working. Our experiences with previous organisations such as the Workforce Development Confederations, has resulted in working models, which we have maintained and developed. The resulting SHA-wide Pharmacy Education Programme Boards or Education and Training Committees, may be useful examples to use in delivering the planned changes and would link to the Deanery structures.

8. The NHS PEDC currently facilitates a national staffing establishment and vacancy survey for all levels and bands of pharmacy staff in primary and secondary care. It would be useful to have some reassurance that there will be systems in place to enable this data to be fed into the CfWI and HEE to inform future commissioning of pharmacy education and training in terms of numbers needed to train.

9. The NHS PEDC seeks reassurance as to the mechanisms by which the CfWI and the HEE would be able to provide clear guidance to each LETB in terms of strategic commissioning intentions at a national level. It’s also important that each LETB is adequately resourced and has adequate expertise to perform their functions effectively. There should be systems in place to ensure that each LETB is accountable for their commissioning decisions to the CfWI and the HEE and that their performance is objectively assessed via a national monitor such as the CQC. The current funding of training for pharmacy staff varies considerably and in times of budgetary constraints for providers, training places become vulnerable. Short term local losses of training posts, can have very long term impacts on service provision. Some very specialised training fails to attract funding. An NHS wide overview of training is therefore essential.

Training curricula reflecting the changing nature of healthcare delivery

10. The NHS PEDC welcomes the government’s plans to promote improved communications and collaborative working between employers/service providers and education experts to ensure that the training curricula reflect current models of healthcare delivery. This has always been a priority in pharmacy education and training programmes commissioned by the NHS.

11. We also agree that the curricula of all education & training programmes must carry appropriate accreditation and conform to national standards (set by regulatory/professional bodies) to ensure consistency and transferability of skills to different settings.

12. The NHS PEDC would like more clarity as to how the proposed government’s plans would ensure timely development of curricula. This would necessitate a more flexible commissioning process to enable close links between employers and healthcare education experts eg via joint appointments between the NHS and HEIs. We have examples of Programme Boards developing the curricula to respond to new ways of working, and to help drive these by their post-registration training.

All healthcare providers (both NHS and non-NHS) should play their part in workforce development

13. The NHS PEDC seeks assurance that this is a feasible aspiration for the pharmacy profession where only one third of the workforce is employed directly by the NHS. The other two thirds are predominantly based in community pharmacies delivering NHS services. It is not clear as to how the new system would ensure that independent pharmacy employers (community pharmacies and private hospitals) would play their part in workforce development via payment of appropriate levy as well as equitable engagement in training of the workforce. A significant part of the pharmacy workforce is supported professionally by the MPET levy funded national Centre for Pharmacy Postgraduate Education (CPPE) based at the University of Manchester.

Multi-professional and multi-disciplinary leadership and accountability

14. The NHS PEDC acknowledges that the government plans give sufficient emphasis on multi-professional and multi-disciplinary leadership and accountability. It would be useful to have more details as to how this would be achieved across the full range of healthcare professions/specialties and grades. The use of care pathways may be one way in which multi-disciplinary training can be developed and in particular, doing so across care boundaries.

High and consistent standards of education and training

15. The NHS PEDC fully supports the proposed introduction of an “NHS Educational Outcomes Framework” to ensure consistently high quality standards of healthcare education and training around the country. We feel that there needs to be more clarity as to how these standards will be implemented and monitored across the country on an equitable basis. More information is also needed regarding the accountability structures for LETBs and how “poor performance” would be addressed.

Development and re-skilling of existing workforce

16. The NHS PEDC welcomes the government plans to support ongoing development of healthcare staff and also provide funding for re-skilling of the existing workforce where appropriate. It is our hope that the proposed new structures ie LETBs and local partnership groups will be able to deliver this aspiration fairly and equitably across the different healthcare professions. This will only be achievable if the groups overcome issues around professional “silos” and achieve the culture shift towards multi-professional working. At this stage we also seek reassurances that the existing variations between different regions will be minimised via robust national steer from the HEE and CfWI.

Open and equitable access to all careers in healthcare

17. The NHS PEDC welcomes these principles.

December 2011

Prepared 22nd May 2012