By Clare Thomson, the Chief Pharmaceutical Officer's Clinical Fellow at RPS
In 2015, I became a non-medical prescriber in secondary care, working within a heart failure multidisciplinary team with doctors and specialist nurses, and I began to manage a clinical caseload of patients. This was a change in practice for a hospital pharmacist – traditionally seen as working on the ward completing medicines reconciliation, answering queries, and facilitating discharge of patients.
In 2016 I completed a master’s module in advanced assessment skills for non-medical prescribers. Realising the importance of examining patients, especially in cardiovascular care like heart failure, I recognised the need to enhance my skills. Although unfamiliar with advanced clinical practice initially, I discovered it was a natural trajectory for specialized nursing. Notably, I was the sole pharmacist among nurses aspiring to complete their MSc on the course.
Alongside clinical progression, I took on more responsibility within the pharmacy team – managing and supervising others, leading on quality improvement, and audits. I was lucky to connect with other heart failure pharmacists nationally, forming a pivotal peer support network. This has been an essential part of my career journey – reflecting and learning from others and collectively pushing the boundaries of pharmacy practice.
Expanding clinical skills in cardiovascular care
In 2021, I wanted to expand my clinical skills in cardiovascular care and broaden my NHS experience so I moved into primary care. My main scope of practice remained cardiovascular, but I began to see acute presentations and manage more complex multi-morbid patients with complicated polypharmacy.
Navigating the portfolio path: A gateway to Advanced Pharmacy Practice
In 2022, I eagerly joined the portfolio route initiated by (then) Health Education England, becoming part of the pilot pharmacist cohorts. This innovative approach allowed me to showcase advanced practice without requiring a full master's qualification, a crucial consideration with my responsibilities as a parent of two young children.
While clinical practice and education align well with pharmacy, leadership and research present ongoing challenges. Completing a portfolio is a marathon, not a sprint and the evolution of a profession does not happen overnight. For the purpose of research I was able to reflect on accomplishments I already had made but probably hadn’t celebrated, such as posters at a conference and my primary care pathway QI project. I also sought guidance from my portfolio mentors.
High-quality care needs leadership at all levels. Evidence shows that the quality of care and organisational performance is directly affected by the quality of leadership and the improvement leaders create. This is not yet commonplace across the NHS, but again I reflected on projects I had been involved with – successes and failures, and what challenges I had faced. I sought out opportunities – linking in with the hospital team, for example, and being invited to meetings to discuss local patient pathways in primary care.
Some of this has been in my own time, and the portfolio itself involved dedicated time to upload evidence, write reflections and ask colleagues and peers for feedback.
Would I do it again? Yes. Visualising your own journey and where you are now has been professionally so rewarding.
Why is advanced practice important – and what’s next?
We need to embrace this for three main reasons.
For the profession: There is now a progressive spectrum of curricula across Post-Registration Foundation, Advanced and Consultant levels for pharmacists working across all sectors of practice. We need to share skills, educate others and succession plan.
For individual pharmacists: With a clear career structure, this will hopefully lead to better retention and improved job satisfaction. We need to support the emerging workforce.
For patients: As the pharmacy profession is changing, we need to assure patients of who they are seeing and their (recognised) expertise. We need to showcase what we do and what we can do.
Read about the RPS Core Advanced Pharmacist Curriculum.
Read more RPS blogs.