Unprecedented demand for clinical pharmacy

Source: NHE May/Jun 16

Dr Keith Ridge, chief pharmaceutical officer for NHS England, who also provides support to the Department of Health and Health Education England (HEE), discusses the unprecedented demand for clinical pharmacy. David Stevenson reports.

Following the long-awaited evaluation of the national emergency department pharmacy pilot, which took place last year, HEE has recommended that clinical pharmacy training should be considered as part of national advanced practice planning.


In the 2015 May/June issue of NHE, we reported that HEE was evaluating the results of the pilot, with a report due in the autumn. However, this was delayed until spring this year.

A concluding point in the report found that with additional training, there is potential for independent prescriber (IP) pharmacists, who have at least eight years of training/experience, to “manage up to 36% of emergency department (ED) attendees, where those attendees present with symptoms likely to be seen in the Minors Area of the ED, under the overall supervision of a doctor”. 

Based specifically on completion of a 12-month Advanced Practice-level training course – with modules in clinical examination skills and clinical health assessment and diagnostics – HEE said it is estimated that the achievable level of pharmacist management may be 27% of all cases. 

Significant potential 

Following the publication of the report, Dr Keith Ridge, chief pharmaceutical officer for NHS England, told NHE: “At the moment I would say there is unprecedented demand for clinical pharmacy, and the word clinical is important here. It is a level of demand which I’ve never seen in my career, and I’ve been doing this job in one form or another for a decade. 

“Whether you look in urgent and emergency care in its various forms, in EDs themselves or ED hubs, but also in care homes or GP practices, the demand is there. If you look at Lord Carter’s report on productivity and efficiency, there is this drive towards getting better value for medicines and deploying more clinical pharmacy.” This is something explored in detail by Andrew Davies, director of pharmacy at North Bristol NHS Trust, who helped shape the Carter Review as part of the pharmacy team on page 94. 

Ridge added that the national  emergency pilot study has been “very helpful” in showing the potential of what pharmacists could handle and deliver as a practitioner with advanced clinical skills in ED care. 

“But there are questions of how do you fit advanced clinical pharmacists into multidisciplinary teams to do the things they’re competent and able to do in order to help with the workload and demand,” he said. “I think what the study has shown is that there is significant potential here, and the results speak for themselves.” 

Pharmacists in GP practices 

Discussing the landscape more widely, Ridge touched on the three-year pilot to test the role of clinical pharmacists working in general practice. 

Back in October 2015, NHS England announced an increase in the budget for this pilot, with funding increasing from £15m to £31m. This was to part-fund 403 new clinical pharmacist posts across 73 sites, covering 698 practices in England, supporting over seven million patients. 

Ridge, who was proud of the pilot’s development so far, added that the project partners are in the process of commissioning evaluation. And, once the evaluation is complete, there should be a further deployment of 1,500 co-funded practice clinical pharmacists. He added that a very robust training and development scheme has been developed between HEE and the University of Manchester. 

However, he said that one of the concerns he has in the short term is how “you ensure such initiatives don’t adversely impact on the desire for more clinical pharmacy across the system”. 

“Despite there being an oversupply of pharmacy graduates, I think the number of training places and the way pharmacists are trained needs to be carefully monitored – so we get the transition period right,” Ridge said, adding that the number of university schools of pharmacy has doubled over the last decade. 

Community pharmacy 

Another important area is community pharmacy. As NHE went to press, the Department of Health’s consultation on community pharmacy in 2016-17 and beyond had just closed. According to the Pharmaceutical Services Negotiating Committee (PSNC), the consultation set out a number of proposals for the sector including a reduction in funding of £170m for 2016-17, plans to enable all pharmacies to have access to hub-and-spoke dispensing, and to encourage optimisation of prescription duration. 

“We are in the middle of a consultation around making changes to their [community pharmacy] remuneration. But whether it is in hospital or in community or primary care, the future is, undoubtedly, clinical pharmacy within a multidisciplinary team – perhaps with a caseload in primary care, working with GPs around long-term conditions, said Ridge. 

He added that going forward, for pharmacy and the health sector in general, there is a real task in optimising medicines use and getting best value overall. 

“When we look at some of the issues associated with medicines and their use, we spend £15bn a year on medicines – second only to staff,” said Ridge. “The volume of medicines use has been going up, typically, 5% year-on-year for the last decade. 

“We’ve got older people with more complex conditions, but are medicines being used well? Are we overusing medicine? These are questions that have to be answered.”

Ridge noted that The King’s Fund’s director of policy, Richard Murray, has been commissioned to do a review of the clinical services which NHS England commissions through community pharmacy. 

“The idea there is to have a look back at what clinical services are currently commissioned and a forward look at how, in the context I’ve described, you make the most of pharmacists and their teams and clinical skills,” he said. 

The review, which is expected to be published in October, will then attempt to identify barriers that prevent “maximal utility of community pharmacy and the community pharmacy workforce” in integrated services and recommend how those barriers might be addressed. 

“It will inform a couple of things,” said Ridge. “We have created an integration fund for pharmacy, which is worth £300m over the next five years.” He added that Murray’s review will inform the deployment of that fund, certainly the later years of it, and help to meet the unprecedented demand for clinical pharmacy.

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