Summary of vision feedback events

1. Background

RPS and The King’s Fund are developing a vision for pharmacy professional practice. In mid-August 2022, themes for the vision were published for open consultation on the RPS website. Alongside the consultation, individuals were offered the opportunity to attend virtual feedback events (see Appendix A) to discuss the themes and the development of the vision.

Six general feedback events open to anyone working in pharmacy or the wider healthcare system, as well as patient organisations were held. In addition, deeper dives into the themes were held jointly with the Association of Pharmacy Technicians UK, UK Clinical Pharmacy Association, The College of Mental Health Pharmacy and the Neonatal and Paediatric Pharmacy Association.

Discussions at the events centred on the six themes for pharmacy professional practice, the three- to five-year goals for each of the vision themes, and discussion around what practice could look like in ten years if the vision themes were achieved. The enablers and barriers to the development of professional practice were also discussed. Notes were taken at each of the events and this paper summarises the main points of discussion with a focus on what is missing from the themes, what may require more emphasis and the three- to five-year goals. The paper is to support discussions at the project advisory group meeting on 12 October 2022.

2. Discussion themes

Discussion from the virtual feedback events is summarised using the following themes.

Community pharmacies as health hubs
Pharmacies as high street heath hubs was generally well received and it was felt this could be expanded to cover the supply of medical equipment (heart monitors, stoma bags etc), as well as potentially offering other services in pharmacies such as physiotherapy and support for diagnostics such as phlebotomy services. Within the health hub addressing inequalities was seen as key, including how professionals communicate with people (e.g. people with learning or communication difficulties, or different languages) and considering the role of technology to support this. The potential for community pharmacy teams to provide support for self-care and pharmaceutical public health in community pharmacies was emphasised. There was also support for pharmacy teams to reach out into community groups and communities.

Ability to refer to specialist pharmacy services directly
Place based or ICS level availability of specialist pharmacists as a ‘centralised’ resource for pharmacy teams and the wider MDT was highlighted as a way of sharing resources, for example mental health or paediatric specialists. The aim being to enable direct referral of people to specialist pharmacy services, or provide healthcare professionals with access to specialist advice. Technology was highlighted as a key enabler of this through virtual consultations with for example community pharmacies providing consultation rooms with virtual connections to specialists. Linked to this was the need for pharmacists in primary care and community pharmacy to have the same base level of knowledge in specialist areas as care becomes more integrated in particular around more complex care and medicines used in, for example, paediatrics.

Integration with the wider healthcare team across system, place and neighbourhood
Although this features in the vision themes, integration with teams across a system was highlighted repeatedly. The need to join up with the wider primary care team was a feature of most discussions, in particular the importance of ‘sharing the care’ and not duplicating what other professionals might be doing. The importance of a shared record that gives ‘one version of the truth’ to enable care to be delivered by teams was stressed.

Linked to this was the need to enable other professionals to support aspects of medicines use especially in patients’ own homes, for example, medicines reconciliation by therapists or teams administering in patient’s homes as part of virtual wards.

Integration of pharmacy teams across a system
On the theme of integration, the need to blur the lines between pharmacy teams in different sectors was stressed repeatedly. A ‘one pharmacy team’ approach to care across PCNs was highlighted and joint training hubs in PCNs that include community pharmacy was proposed. The need for IT in secondary care to better connect with primary care and community pharmacy was highlighted.

Better use of skills within pharmacy teams
Another area highlighted repeatedly is the need make the best use of skill mix within the pharmacy team. Pharmacists cannot expand their roles unless the rest of the pharmacy workforce is upskilled and coming through to allow for this. From counter assistants in community pharmacy, through to manufacturing technicians in aseptic services and pharmacy technicians working as medicines Safety Officers, the role of the entire pharmacy team was seen as crucial. The importance of all team members working at the top of their licence and the need to encourage people to think of pharmacy as a career and support them once in their roles was stressed. The future potential for pharmacy technicians to support and deliver more clinical services was highlighted, including the Discharge Medicines Service, Structured medicines Review Supply and administration under PGD and prescription screening. The potential for pharmacy technicians to prescribe as part of future aspirations was highlighted.

Patient experience and access to care
Getting the basics of supply right, in particular when there are shortages of medicines across all settings or the medicines are complex and made is specialist centres. This has a huge impact on patient experience. Linked to this is the availability of specialised medicines and the need to standardise processes so that patients being seen in highly specialist centres providing care across ICSs can access the same treatment regardless of the ICS in which they are located.

Medicines governance and medicines safety
The need to get the basics right around medicines governance and medicines safety especially as new roles emerge, for example, independent prescribing and new services like virtual wards develop around patients and across ICSs. It was felt that this is a core pharmacy role that cannot be neglected and must be in the vision. Linked to this was the need to acknowledge in the vision roles that are not patient facing but underpin patient safety and service delivery such as technical services, education and training, medicines safety and governance. In addition the need for a safety net around autonomous prescribing was highlighted with a gap around skilled staff to support to enable and support new prescribers.

Data, technology and innovation as enablers
Discussions around this theme highlighted some additional areas for potential inclusion such as pharmacy services in the metaverse as another way to access care. The need to look at how we communicate as technology develops for example transmitting the data generated by wearables or ‘insideables’ to support remote monitoring and the data protection necessary around this agenda. Technology, such as, ‘see what I see’ glasses is developing rapidly to support consultations and education and training.

Science and research as enablers
It was felt more was needed on science as an enabler for the delivery of the vision of pharmacy, reflecting that advanced medicine technologies come from science and there is a leadership role needed to enable their use in practice. The need to build on changes during the pandemic that enabled pharmacists to be Principal Investigators in clinical trials was also highlighted. Linked to that was the need to ensure that pharmacists are research ready from graduation so they can take those skills into foundation training. This is particularly relevant on the pathway to credentialling for consultant roles where research is a core pillar of practice. Alongside that there was a feeling that we needed more on genomics possibly in the three- to five-year goals around upskilling the workforce.

Education and training
The need to stress the development of all four pillars of professional practice (clinical, leadership, education and research) in initial and foundation education and training for pharmacists was highlighted. The lack of clear career pathways toward, and succession and job planning for advanced practice and highly specialist clinical roles like consultant pharmacist was also highlighted, along with the need to develop clear pathways to consultant roles for pharmacists working in primary care and community pharmacy.

For pharmacy technicians the need to map out a post qualification education and training framework with requirements linked to advanced practice was discussed, along with the need for a structured post-qualification education and training plan for pharmacy technicians and bridging qualifications for pharmacy technician trainees.

Leadership opportunities and development
This was highlighted as needing to start much earlier in careers with more exposure to leadership roles in training and early years and embedding a culture that inspires confidence in these roles.

3. Feedback on the three- to five- year goals

Several of the virtual events provided comments on the three- to five-year goals that support the six vision themes. The comments are summarised here underneath the goals included in the consultation.

Goals for theme 1

Supporting people and communities to live well for longer

Pharmacy teams actively tackling pressing heath inequalities in their communities at neighbourhood and place level, for example, the Core20PLUS5 priorities working in partnership with other local organisations
Community pharmacy teams routinely providing screening for early detection and prevention programmes for long-term conditions linked with general practice
Pharmacy teams integrated into local clinical patient pathways with established roles and referral routes.

Comments on the goals:

Goal 1. Include a specific mention of digital poverty? Health inequalities is a big issue in the context of mental health and part of that is digital poverty, some people don’t have a phone, how do we engage with them
Goal 1. No mention of children in the Core20PLUS5 goals, these need to include children. Inequality of access to medicines from children could be a specific goal for paediatrics
Goal 3. Mention a goal around the Community Pharmacy Consultation Service specifically?

Goals for theme 2

Enabling people to live well with the medicines that they choose to take

Pharmacists prescribe, optimise and deprescribe medicines within a patient’s pathway as autonomous professionals working in their areas of competency
Pharmacist prescribers across the system, regardless of setting, are responsible for the management and monitoring of people’s uncomplicated long-term conditions (e.g. hypertension or asthma) as part of a multidisciplinary team
The expertise of specialist, advanced practice and consultant pharmacist roles are developed across the system to fully utilise their skills.

Comments on the goals:

General comment. Do we need a goal around how clinical supervision might work for pharmacist prescribers in primary care and community pharmacy.
Goals 4 and 5. These goals feel like current practice to some people we need to be clear why they are there, are they around levelling up across pharmacy and replicating more widely? Do we need them to be more ambitious? Add in a goal around direct referrals?
Goal 4. Do we need a goal around upskilling the existing workforce for historic non-prescribers?
Goal 5. Delete uncomplicated, pharmacists are equipped to deal with a wider scope of practice. Consider adding in pharmacy technicians working within guidelines. Add in a long-term mental health condition like depression. Be clear that we do not duplicate we build systems where the patient is seen once and we share information around that consultation
Goal 6. Make it a pharmacy technician trajectory as well as pharmacists. Add in pharmacy technician roles to be developed across the system here.

Goals for theme 3

Enhancing patient experience and access to care

A Pharmacy First equivalent available in all community pharmacies in England providing a first point of care to the public supported by prescribing pharmacists and the wider pharmacy team
Greater integration of supply models between hospitals and community pharmacy facilitated by technology and skill mix
Utilisation of independent prescribing, supervision and skill mix alongside any regulatory changes that might enable greater diversification of roles and delegation within pharmacy teams to enhance patient experience and access to care.

Comments on the goals:

General comments. This is all about access to care there needs to be a goal around patient experience and shared decision making. Add a goal about ICBs having shared integrated roles that enable better access to care? Add a goal about IT and information governance to enable access to care or enhance patient experience? Are we being visionary enough? we need to get the medicines to the patient wherever they may be, for example, people with drug dependency can access via a hub medicines and mobiles using a hand scan or children requiring medicines from tertiary centres able to access them close to home.
Goal 8. Is this realistic given VAT issues around prices? Make this broader to include other ways in which medicines can be supplied e.g. homecare
Goal 9. Delete independent prescribing it doesn’t fit the context of the goal which is about enabling pharmacy teams to respond better to patient needs.

Goals for theme 4

Our pharmacy people

A comprehensive pharmacy workforce strategy for pharmacy that includes pharmacists, pharmacy technicians and pharmacy support staff. The plan should take account of the fact that by 2026 all newly qualified pharmacists will be prescribers and need access to practice and educational supervision, training, and career development opportunities
Pharmacists and pharmacy technicians have protected learning time with equality in development opportunities, and access to funding for professional development and leadership training
An increase in the number and quality of training placements for undergraduate pharmacists and pharmacy pre-registration trainee pharmacy technicians
Roles developed within skill mixed multidisciplinary teams that make use of the skills of the entire pharmacy team including historically assigned responsibilities.

Comments on the goals:

General comments. The goals need to reflect the entire pharmacy workforce. Include a goal around EDI. Can we have a goal on exploring ways to enable people from diverse backgrounds to entre pharmacy? E.g. biomedical scientists having a fast-track apprenticeship to become pharmacy technicians?
Goal 1. Include students in here. Do we need to say specifically we need something on workforce numbers, how many of each now and how many we need for the future? The second sentence should be a separate goal
Goal 2. Protected ‘and structured’ learning time is needed along with protected time for research needed for advanced and consultant level practice
Goal 3. Would we class this as one of the key goals for this section?

Goals for Theme 5

Data, innovation, science, and research

Interoperability with read write access to patient medical notes across the healthcare system with effective communication pathways
More opportunities for pharmacy teams to be part of funded research programmes and play a more active role in action research studies
Pharmacy teams involved in the development and introduction of new medicines and new services into the NHS.

Comments on the goals:

General comments. There is no goal around innovation, we need to upskill the workforce in primary care about genomic testing could this be a 3/5 year goal?
Goal 5. Need to add to this goal that interventions made by pharmacists need to be captured and that data used to inform service design and clinical care. There are systems already that allow this e.g. system one, do we need to be more specific or ambitious?
Goal 6. Make this a more ambitious statement about embedding research into early careers and ensuring there are opportunities to be part of funded research programmes for credentialling but also to be PI/CIs. Can this statement be explicitly about primary care as well as secondary care and working better together on research? Protected time for research?
Goal 7. This is a big statement to capture everything but is it clear this includes research right through to implementation and assurance? We need to talk about leading and bringing it all together.

Goals for theme 6

Collaboration, integration and leadership

An increase in the number of consultant pharmacist leadership roles across the system
Support for pharmacy technicians to become systems and national leaders
Pharmacy teams involved in ICS strategies and planning of services
Support for initiatives across the system to promote integrated working.

Comments on the goals:

Goal 8. Not just about consultant pharmacists, talk about advanced or credentialled roles; including those which are not patient facing, there are operational roles and specialist/technical roles as well. Be clearer that this is about system wide roles working across organisations not in one organisation
Point 9. Make this about developing pharmacist and pharmacy technician leaders from early years to become systems and national leaders within and outside of pharmacy
Goal 10. Could this be more specific? Pharmacy should be leading this. ICBs have identified which areas need targeted care from pharmacy teams and are commissioning integrated pharmacy services for their communities
Goal 11. Can the goal be to have shared integrated pharmacy roles in ICBs with each organisation owns part of the role? A foot in primary care, foot in secondary care, foot in community pharmacy?

4. Barriers and challenges in the current context

Some discussion at the virtual events centred around the need to acknowledge where pharmacy is now and how the vision can help pharmacy teams to move forward from now. The main themes discussed are highlighted here.

Capacity in the here and now
In general, most people in the focus groups agreed with the themes and where the future of pharmacy practice should be heading, however there was concern that the capacity for pharmacy teams to deliver on the vision in the here and now is a challenge. There is a severe recruitment challenge in many areas for pharmacists, pharmacy technicians and support staff. The lack of staff and the ongoing recovery from Covid is challenging many services so that whilst the aspiration might be to develop the pharmacy team so that they are all working at the top of their licences, delivering the service becomes a priority and the workforce are filling gaps to deliver core day-to-day services and maintain patient safety.

Levelling up services and skills
There was broad agreement in the groups that there are differences across pharmacy in delivering the services and care described in the vision and also within the three to five-year goals. For some on the calls the vision and goals felt like a big step, for others it felt like current practice. This was true for teams within sectors, as well as across pharmacy as a whole. The tension between developing an aspirational vision with three to five-year goals that help services move forward when teams are at different places in terms of how their services was acknowledged. The specific issue of levelling up the current pharmacist workforce to become independent prescribers was also raised along with the challenges with finding Designated Prescribing Practitioners. In addition the skills and knowledge base of pharmacists working in community pharmacy in more specialist areas need to be levelled up to ensure a standard base level of knowledge when developing integrated pathways.

Funding
All of the groups mentioned funding as a key issue to developing pharmacy professional practice. The community pharmacy contractual framework was identified as a significant barrier to the development of integrated services through community pharmacy with renumeration substantially still linked to dispensing volumes. Funding concerns were also present in discussion around the development of primary care services, with questions around the additional roles in general practice scheme and the sense that secondary care is ‘dumping services’ into primary care without a funding stream.

Appendix A Feedback events on consultation themes

The following feedback events were held on the themes published in the consultation. Unless stated all events were held in the evening.

1 September. Open feedback event. 11 attending
6 September. Open feedback event. 9 attending
20 September Open feedback event. 6 attending
22 September. Day time deep dive with UK Clinical Pharmacy Association. 9 attending
22 September. Deep dive with College of Mental Health Pharmacy. 22 attending.
26 September. Deep dive with Association of Pharmacy Technicians UK. 13 attending.
27 September. Day time open feedback event. 23 attending
27 September. Open feedback event. 23 attending
4 October. Deep dive with UK Clinical Pharmacy Association. 5 attending
5 October. Deep dive with Neonatal and Paediatric Pharmacists Group. 6 attending