Ultimate guide for Chief Pharmacists (OR equivalent)

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This RPS ultimate guide is for Chief Pharmacists or equivalents working in Great Britain. The content for England in this guide has been developed by RPS and CPPE.

Please note although the current content in this guide is relevant to England, we hope the information will also be useful to pharmacists working in Scotland and Wales.

Scotland and Wales specific content is currently under development and will be published soon.

The role of a Chief Pharmacist in NHS provider organisations has changed significantly in recent years and there is every indication that this role will continue to change in the future, see Keith Ridge’s (Chief Pharmaceutical Officer) message at the RPS Annual Conference 2015 . Pharmacy leaders are required to have the skills to negotiate at Board level, to provide the vision necessary to strategically consolidate the position of pharmacy to play a key role in the NHS of the future and to manage change in a dynamic environment.

Aspiring Chief Pharmacists will come from a range of different backgrounds and experiences. To support pharmacists aspiring to such a senior leadership role, this ultimate guide has been developed offering practical support and comprehensive signposting to help with the roles and responsibilities of a Chief Pharmacist (or equivalent). The guide can also be used by Chief Pharmacists already in the role, senior leaders, people who work with Chief Pharmacists who may be interested or want to know more about the role and the support available.

The content for England in this guide has been developed by RPS and Centre for Pharmacy Postgraduate Education (CPPE). This guide can also be used to support the NHS England, CPPE and NHS Leadership Chief Pharmacist Development Programme .

NHS context

Chief Pharmacists will find the following background information and resources helpful in supporting them with their roles and responsibilities in the NHS.

Royal Pharmaceutical Society Professional Standards for Hospital Pharmacy Services Royal Pharmaceutical Society Professional Standards for Hospital Pharmacy Services

The Royal Pharmaceutical Society (RPS) has published professional standards for pharmacy services in NHS and private hospitals, mental health trusts and community service providers. The standards apply whether services are provided internally or outsourced. They provide Chief Pharmacists with a consistent set of standards they can use as a framework to continually improve services, and innovate in their own organisations and with other partners who deliver local health services. The professional standards are consistent with, and/or may be used to help inform and complement, relevant legal framework requirements and the minimum standards currently required by ‘systems’ regulators, professional regulators and insurers. The RPS had also developed standard definitions for metrics which support benchmarking of hospital services.

Please note the RPS is currently working on updating the standards, further information on this work can be viewed here.

Rebalancing Medicines Legislation and Pharmacy Regulation Programme Board Rebalancing Medicines Legislation and Pharmacy Regulation Programme Board

Through the Department of Health is the Rebalancing Medicines Legislation and Pharmacy Regulation Programme Board Rebalancing. The work of this group is to review pharmacy legislation and regulation. When this group reports it may require significant changes to the roles and responsibilities of Chief Pharmacists in trusts as well as having wider implications for the profession.

Five Year Forward View (5YFV) Five Year Forward View (5YFV)

The current strategy for the NHS in England is encapsulated in the Five Year Forward View (5YFV) which sets out the challenges facing the NHS and describes how care can be delivered through new models of care. A Vanguard Programme is currently running at sites across the UK where models are being put into practice and experiences shared. A key element of the NHS Shared Planning Guidance and the local implementation of the Five Year Forward View are Sustainability and Transformation Plans (STPs) . In 2017 NHS England published the The Five Year Forward View - next steps , which takes stock of progress to date and sets out next steps for the NHS. Hospital Chief Pharmacists need to understand how the strategic direction of the NHS will impact on their organisations and the models of care they will be working within in the future. In particular how their organisations fit into local (STP) and national plans for integrated care.

The RPS has developed a briefing for members on the Next Steps on the Five Year Forward View, which can be viewed here.

Seven Day Services Forum Seven Day Services Forum

The Seven Day Services Forum   has published ten clinical standards to end variations in outcomes at the weekend. Chief Pharmacists are expected to review the delivery of pharmacy services including clinical services over weekends. NHS England has published a report with recommendations to support the transformation of seven day clinical pharmacy services in acute hospitals. The RPS has published a report of seven day services to support Chief Pharmacists implement services.

Right Care Right Care

Right Care is an established NHS programme with the objective of maximising the value that a patient derives from their own care and treatment and the value the whole population derives from the investment in their healthcare. NHS England and Public Health England are taking forward the Right Care approach through programmes to ensure that it becomes embedded in commissioning and public health agendas for the NHS.

Carter Report Carter Report

In February 2016 The Department of Health published a report (the Carter report) highlighting unwarranted variations in the operational productivity and performance of acute hospitals in England. It focuses on three key themes, namely, removing unwarranted variation in clinical practice, delivering efficiencies and improving outcomes for patients. The report includes a number of significant recommendations on hospital pharmacy services and medicines optimisation that will increase clinical pharmacy roles whilst generating efficiencies through the review of infrastructure services and other non-clinical activities. A hospital pharmacy transformation programme is in place to support this coordinated through NHS Improvement – see Trust Context below. Chief pharmacists and the whole organisation in England are required to demonstrate that they are delivering against the report’s recommendations.

 

 

 

Other resources Other resources

For a wider view of how the NHS is developing and current thinking, the Health Service Journal (subscriptions are required) is essential reading. The NHS Managers newsletter and Twitter are also good ways of staying up to date for example through conference Twitter feeds. The Kings Fund , The Nuffield Trust  and the Health Foundation  may provide an insight into the direction of NHS policy.


Trust context

Chief Pharmacists will find the following background information and resources helpful in supporting them with their roles and responsibilities as part of working in a Trust.

Care Quality Commission (CQC) Care Quality Commission (CQC)

The Care Quality Commission (CQC) monitors, inspects and regulates services to make sure that they meet fundamental standards of quality and safety. Chief Pharmacists are expected to ensure that the services for which they are responsible meet relevant  CQC Fundamental standards. This requires Chief Pharmacists to consult and implement, as appropriate, nationally recognised guidance about delivering safe care and treatment, for example RPS Professional Standards for Hospital Pharmacy  or the NICE NG5 Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes (which includes guidance on medicines reconciliation).

NHS Improvement (NHSI) NHS Improvement (NHSI)

NHS Improvement (NHSI) is responsible for overseeing NHS provider trusts, as well as independent providers that provide NHS-funded care. It will hold providers to account and, where necessary, intervene, to help the NHS to meet its short-term challenges and secure its future. NHSI brought together Monitor and the NHS Trust Development Authority. NHSI uses a single oversight framework to identify where providers may benefit from, or require, improvement support.

Implementation of the Carter review (see above) recommendations have been integrated into NHSI core function. NHSI is developing the Model Hospital (described in Carter) and underlying metrics of productivity, efficiency and quality of care to provide one source of data and benchmarks. This includes hospital pharmacy and medicines optimisation metrics. Chief Pharmacists will be expected to record and use these metrics. Each organisation has its own login for the model hospital metrics. Stakeholder briefings specifically from the Medicines Optimisation project team can be found on the Specialist Pharmacy Service (SPS) website .

NHS Benchmarking Network NHS Benchmarking Network

For Trusts subscribing to the NHS Benchmarking Network  the Pharmacy and Medicines Optimisation benchmarking project, linked to both the RPS professional standards for hospital pharmacy and the Model Hospital metrics (see above for detail – NHS Improvement), allows organisations to view their position on the benchmarked metrics via the online tool accessible through the Network website members’ area.

National Institute for Health and Care Excellence (NICE) National Institute for Health and Care Excellence (NICE)

National Institute for Health and Care Excellence (NICE) guidance (technology appraisals, guidelines, pathways and quality standards) is often relevant to pharmacy teams in Trusts and can require Trusts to work across a healthy economy.  For example Chief Pharmacists should be familiar with existing guidance such as the quality standards NG5 Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes medicines optimisation and NG15 Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use , as well as guidance under development.

Organisation Structure Organisation Structure

Chief Pharmacists need to be able to operate at senior levels within their organisations and so need to understand how their organisation functions and the priorities of Board members and other senior decision makers. An awareness of the key governance requirements for Boards will help Chief Pharmacists to understand the context in which the Boards operate . Further detail can be viewed in Monitor : Well-led framework for governance reviews: guidance for NHS foundation trusts (updated April 2015)

It is helpful for Chief pharmacists to be aware of and/or actively contributing to:

  • Care Quality Commission’s latest report
  • The Annual Report
  • The organisation’s strategic objectives
  • Relevant reports from the healthcare regulator (NHS Improvement)

 


Legal requirements, governance and medicines management

Chief Pharmacists are required to ensure staff and medicines are managed in line with relevant legislation and regulations, and that national and professional guidance on medicines governance is followed within their organisations.

General Pharmaceutical Council General Pharmaceutical Council

Chief Pharmacists have responsibilities in relation to delivering the pharmacy service taking the following into account:

Other GPhC standards and guidance you may find useful can be found on the GPhC website.

Medicines and Healthcare Regulatory Agency (MHRA products) Medicines and Healthcare Regulatory Agency (MHRA products)

Controlled drugs Controlled drugs

Medicines Legislation Medicines Legislation

Clinical Trials Clinical Trials

Falsified Medicines Directive Falsified Medicines Directive

Managing conflicts of interest Managing conflicts of interest

Patient safety and errors Patient safety and errors

Patient safety and responsibilities for reporting errors, patient safety incidents and never events, and implementation of guidance:

Standards for other healthcare professionals Standards for other healthcare professionals

Chief Pharmacists work with other professional colleagues ( for example the Medical Director, Chief Nurse, etc ) to ensure good medicines governance, this includes organisational policies and procedures for all aspects of medicines use, monitoring and supporting investigations into medicine related incidents or work on issues such as Duty of Candour.

Awareness of standards of practice for other professions may further enhance and help these interactions:

Witness in a Coroner’s Court Witness in a Coroner’s Court

Chief Pharmacists may be asked to testify as a witness in a Coroner’s Court. You may wish to attend an inquest as a member of the public and observe in order to prepare for this role. Since the Francis Inquiry, Coroners are required to publish reports to prevent future deaths (PFD - Regulation 28 reports). These are published here .

Medical Insurers Medical Insurers

The NHS Litigation Authority (NHSLA) is a special health authority in England that handles clinical negligence claims made against NHS organisations and works to improve risk management practices in the NHS (please note in April 2017 NHS LA brought together their three main functions under the umbrella name, NHS Resolution. They are in the process of replacing the current NHS LA and NCAS websites with a new user-orientated website going live on resolution.nhs.uk in early 2018.). It manages a range of insurance schemes which all NHS organisations and non-NHS providers of NHS care in England can apply to. Organisations are expected to comply with the risk management standards NHSLA Acute, Community, Mental Health & Learning Disability (MH&LD) and Non-NHS Providers of NHS Care Standards - 2013/14 set by NHS LA in order to participate.

 

Medicines Optimisation Medicines Optimisation

NICE guidelines describe medicines optimisation as “the safe and effective use of medicines to enable the best possible outcomes”.

The RPS has created a wide range of resources on medicines optimisation; including good practice guidance, a patient leaflet, and briefings on optimising medicines for a number of conditions.

NICE has also developed a medicines optimisation pathway, covering the decision making processes used to help optimise a person’s medicines; including medicines reconciliation and medication review.

NHS England has developed a Medicines Optimisation Dashboard England, which is designed to help further understand how patients are being supported with medicines use locally.

CPPE has produced the following e-learning programmes relating to medicine optimisation:


Commissioning and financial flows related to medicines

Commissioning is seen as a way of driving quality, efficiency and outcomes for patients, i.e. using the money available to achieve the best outcomes for patients. Most of the NHS commissioning budget is now managed by local clinical commissioning groups (CCGs) . However some highly specialised services are commissioned centrally by NHS England.

Trusts are paid for activity according to a standard national NHS contract and tariff payment system (known colloquially as “The Tariff”) .The national tariff contains the prices and payment rules for commissioners and providers to use over a specified time period. To incentivise high quality and cost effective care the national tariff also contains some Best Practice Tariffs. The price differential between best practice and usual care is calculated to ensure that the expected costs of undertaking best practice are reflected and to create an incentive for providers to shift from usual care to Best Practice. The aim is to reduce unwarranted variation in clinical quality and to encourage best practice. You can view the 2017/18 and 2018/19 National Tariff Payment System here.

Tariff prices generally include the cost of the medicine however there are a number of high cost medicines which are excluded from the national tariff payment system. In most hospital trusts, around 70% of total medicines expenditure is for these so-called “tariff-excluded medicines” and this proportion continues to grow. These high cost medicines are listed as an annex to the national tariff. The use of, and payment for, these medicines often requires active management by the commissioner and the provider Trust.

CCGs may make local decisions not to commission some medicines and procedures unless these are approved by NICE technology appraisal. Chief Pharmacists are expected to be familiar with their area’s local decision-making processes about medicines which may include:

Chief Pharmacists are advised to establish good working relationships with their local CCG pharmacy teams and with NHS England hub pharmacists.

The specialised services commissioned centrally by NHS England rather than by local CCGs can be found here . The manual is a useful document and explains what specific services are commissioned directly by NHS England. Chief Pharmacists are required to be aware of how funding for these services and the medicines associated with them flows (see here) and also of NHS England priorities They should also be aware of how medicines are funded through The Cancer Drugs Fund . A medicines optimisation clinical reference group (MOCRG) supports the work of Specialised Services.


NHS procurement, homecare and outsourcing

NHS Procurement NHS Procurement

Medicines comprise a substantial proportion of non-salary NHS expenditure and as such it is important that medicines procurement is well managed.  There are national, regional and local arrangements in England that are in place to do this.

The NHS Commercial Medicines Unit (NHS CMU) manages national contracts for medicines and since April 17 has been of NHS England Specialised Commissioning. The NHS CMU team work in partnership with the people who buy pharmaceuticals for hospitals across the NHS in England.  The CMU is supported by a Pharmaceutical Market Support Group (PMSG) and a national Pharmaceutical Supply Group (NPSG). The ten pharmacy procurement specialists, each covering a region which approximates to the former NHS England Area Teams, can provide advice and support to Chief Pharmacists and their teams.

Support for procurement is offered in the following areas: homecare medicines; branded medicines; generic medicines; dose banding; blood products; medical gases; nutrition /enteral products; childhood and other vaccines (UK wide); pharmaceutical countermeasures; delivery of procurement savings; securing the benefits of the transition from branded to off patent medicines; information and analysis of expenditure Specialist Pharmacy Service (SPS) The Management of the Procurement of Medicines for Secondary Care NHS Trusts in England summarises how procurement of medicines works in England.

Other useful resources and support for procurement can be found on the Specialist Pharmacy Service (SPS) website.  

Homecare Homecare

Homecare medicines services can be used by Trusts to deliver ongoing medicine supplies and, where necessary, associated care, initiated by the hospital prescriber, direct to the patient’s home.

Chief Pharmacists responsible for homecare medicines in a Trust  should be aware of their obligations around homecare and the professional standards expected of these services (see the RPS Professional standards for Homecare services).

Additional information about homecare services can be found at:

Outsourcing Outsourcing

Outsourcing models are increasingly being used by NHS Trusts as a way of driving efficiency – see the independent report on Productivity in NHS hospitals . A growing number of Trusts are exploring new models of service delivery such as wholly-owned subsidiary companies and community interest companies. Support for contract management of outsourced services can be found on the Specialist Pharmacy Services website .


Technical services

There are a range of technical services for which Chief Pharmacists will have responsibility for whether the services are delivered in house, by other departments in the Trust (e.g. radiopharmaceuticals and Advanced Therapy Medicinal products) or are outsourced to a third party.

Examples of technical services include licensed manufacturing units, licensed and unlicensed aseptic units, quality assurance services and radiopharmacy services.

Chief Pharmacists are expected to familiarise themselves with the legislation, regulatory requirements and reference sources that underpin and support the safe and effective delivery of these services.  They should also be aware of their responsibilities for the variety of unlicensed medicinal products handled and made by these services (see Specialist Pharmacy Service (SPS) Guidance for purchase and supply of unlicensed medicinal products – notes for prescribers and pharmacists ; as well as medical gases ). 

The SPS have published a resource titled “Preparation of Medicines in Clinical Areas by Pharmacy Staff: The Legal and Regulatory Framework” . It outlines that the final decision about the role that pharmacy teams have in clinical areas rests with the Chief Pharmacist and the organisation’s clinical governance committee. 

Specialist advice is available through a range of national pharmacy groups, such as:


Digital medicines strategy, IT and automation

Chief Pharmacists are required to be aware of the ways in which digital technologies are being proposed to support the overall transformation agenda across the NHS, the priorities, how these will impact on medicines optimisation and the opportunities that this presents.  

The National Information Board is responsible for setting the direction of travel with regards to digital technology across the NHS and oversees the work programme. There are currently ten domains and 33 programmes that have been setup to deliver the digital strategy.  Whilst all domains touch on hospital pharmacy, the following two are of particular relevance:

  • Domain E Digital Medicines: which will ‘enable and improve pharmacy decision making and outcomes by providing patients and prescribers with streamlined digital services’.
  • Domain G Paperless 2020: which will ‘create an NHS “paper free at the point of care” by driving up levels of digital maturity and by enabling the NHS workforce to better utilise the benefits of digital technology’.

A key document relating to the use of technology in the acute provider sector is outlined within the Wachter report . It outlines a series of 10 principles and recommendations that are being used to underpin much of the work on Domain G (see above).

Developments that fall into Domain E include; the Electronic Prescription Service (EPS) and clinical informatics linked to medicines such as digitising community pharmacy, e-homecare, clinician to clinician electronic referral (see RPS Hospital Referral to Community Pharmacy: An innovators toolkit to support the NHS in England (December 2014)). The implementation of the Falsified Medicines Directive also falls (in terms of strategic requirements) into Domain E.

ePrescribing sits within Domain G. Support for ePrescribing can be found at ePrescribing toolkit for NHS hospitals website or by talking to one of the Global digital exemplar (GDE) sites many of whom have already implemented.

The implementation of Dictionary of medicines and devices (dm+d) is a core terminology requirement that underpins work across both of the above domains. Domain E is working to support the wider uptake of dm+d within stock control systems to support a wide range of initiatives including reporting, interfacing and medicines optimisation activities.

To drive the digital development, NHS England through Sustainability and Transformation Plans (STPs) has encouraged the development of local digital roadmaps.  Alongside the local digital roadmaps NHS England has introduced digital maturity metrics for providers to use to assess the extent to which their services are supported by the effective use of digital technology.

Several of the recommendations from the Carter review (for example, ePrescribing and medicines administration, accurate medicines coding and modernising the supply chain) also support the digital medicines strategy.

Digital infrastructure is needed to underpin and enable productivity, safety, efficiency and clinical decision making that supports the effective use of medicines. Chief Pharmacists are required to be familiar with both the technology and workforce needed to do this.

Examples of technology enablers include:

  • Scan4Safety
  • Automation – ensuring capability of pharmacy storage systems to meet the Falsified Medicines Directive, business case for ward based automation, Academic Health Science Network evaluation of unit dose dispensing
  • Tools to support compounding and waste reduction in chemotherapy
  • Online clinical decision support tools , for example Blueteq (NHS England's standard electronic contractual prior approval system covering a range of high cost drugs excluded from tariff).
  • The use of fundamental standards for systems for example PEPPOL,dm+d and SNOMED CT

Financial management

The Healthcare Financial Management Association (HFMA) and the linked Future Focused Finance programme produces a range of guides and publications that give a useful overview of NHS finance and help finance teams link with clinical decision makers.

Locally, Chief Pharmacists may consider forming a good working relationship with their Financial Director and the team in finance providing support to pharmacy.

Examples of some operational areas where Chief Pharmacists may want to seek further information and/or support around finance include:

  • Budget setting and forecasting against budget.
  • Business case development: The development of strong business cases are to be able to deal with the pressures and demands of the Trust they are working in.
  • Service Line Management (SLM) : Whilst pharmacy departments do not generate income based on patient treatment, it is useful to understand SLM. It gives a good perspective on income and expenditure at a divisional level and the impact on the Trust’s bottom line financial position.
  • Value-added tax (VAT) in the NHS. With the growth of outsourcing of services such as outpatient dispensing and homecare, Chief Pharmacists need to understand the implications on VAT in the NHS.
  • Cost improvement plans (CIPs): Chief Pharmacists will be expected to deliver CIP targets. Trusts will manage CIP savings therefore it will be useful to discuss this further with the project management team overseeing the programme in the Trust. You may want to network with other Chief Pharmacists to share ideas and review old schemes to identify if further savings can be achieved.
  • Contracting: Understanding how the organisation contracts with CCGs is essential and will enable identification of any savings potential (for example using a block contract). To gain a better insight into contracts and how they are formed you may find it useful to discuss further with the contracting team. This may also help you to input into Commissioning for Quality and Innovation (CQUINs).
  • Business case development: The development of strong business cases are to be able to deal with the pressures and demands of the Trust they are working in.

Human resources (HR)

NHS Employers have a range of resources and support that help Chief Pharmacists to understand their responsibilities around HR and employment law. There are a range of regulations that Chief Pharmacists are required to be aware of, for example the Health and Safety at Work Act and those around diversity and inclusion. You may find it useful to discuss local workforce policies with your Trust HR department.

The Centre for Pharmacy Postgraduate Education (CPPE) has a range of leadership and management resources to support the management of teams and individuals.

As with finance there can be a wide range of operational issues that Chief Pharmacists are required to manage relating to HR, these include (please note this list is not exhaustive):

  • Grievances and industrial tribunals
  • Theft in the department – access, staff search, CCTV
  • Recruitment, retention and vacancy rates and what drives these numbers.

You may find it useful to discuss the above with the Trust HR team and familiarising yourself with any existing policies the Trust may hold on the above or anything additional.


Leadership development

Chief Pharmacists are required to lead in their organisations, lead across health economies and to lead the profession. The NHS leadership academy leadership framework and the complementary RPS leadership development framework can provide a structure to support leadership development. In addition a range of leadership development opportunities exist for Chief Pharmacists including:


Workforce development

Current health policy states that workforce development and planning should be integrated with service and business/financial planning. Workforce development is underpinned by high quality education and training which supports the current and future roles within career pathways delivering services to patients. 

Workforce development should have a system focus i.e. be broad and comprehensive, targeting individual, organisational and structural factors rather than just addressing the education and training of mainstream workers. For instance, new roles may need to be developed in order to deliver a new service. 

Practice placement(s) will play a significant part of a pre-registration trainee pharmacist’s professional development. Thereafter foundation training and the development of advanced practice should be based on a patient needs based approach.

The RPS Roadmap which contains three stages (as outlined in the diagram below) has been designed to identify a pharmacist’s stage of development based on their experience in the workplace, competence and the ability to manage complexity.  It then outlines and provides access to the support and assessment required to be recognised at that stage.  It provides clear direction on how practitioners can continuously demonstrate maintenance at a stage of practice or continue to advance to the next milestone.

 

 

Roadmap revalidation-01

 

 

 


Resources


Getting the support you need/ Further information

Many employing organisations will provide internal support in the form of coaching and other programmes. Coaching is also available via the local offices of the NHS Leadership Academy.

Tapping into local networks (and wider if necessary) is a useful way of obtaining peer support. Connecting with Chief Pharmacists from neighbouring organisations within the local health economy can help with support and to build relationships. Each region/locality has a network of Chief Pharmacists that can be accessed to discuss approaches to pressing issues. In addition the Chief Pharmaceutical Officer chairs the All England Chief Pharmacists Network.

Specialist Pharmacy Services (SPS) provide a useful source of expertise over a range of different specialities.

The Association of Teaching Hospital Chief Pharmacists and the RPS Hospital Expert Advisory Group also provide a mechanism of accessing peer support.


Useful tips

Useful newsletters/forums for chief pharmacists Useful newsletters/forums for chief pharmacists

Networks for Chief Pharmacists Networks for Chief Pharmacists

  • All England Chief Pharmacists Network - A national network with regional networks coordinated by the office of the Chief Pharmaceutical Officer
  • Association of Teaching Hospital Pharmacists - Network of Chief Pharmacists working for Teaching Hospitals 
  • RPS Hospital Expert Advisory Group  - An advisory group to the RPS. Membership by application see website for further details.
  • Regional Chief Pharmacist networks - All regions have established networks for Chief Pharmacists

Social media forums Social media forums

  • WePharmacists - Network with the aim of improving patient outcomes through shared learning and connecting the pharmacy team. @WePharmacists
  • Conference #tags - Most conferences have a #tag to enable those unable to attend to follow discussion on the day
Details
   

CPPE Chief pharmacist development programme

Please note: CPPE are accepting applications for future waves of the programme on an ongoing basis. 

You can find more information on CPPE's chief pharmacist development programme on their website .

 

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