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Professional practice in a changing environment


Ray Fitzpatrick,
Consultant Editor

The delivery of healthcare is changing faster than ever before. An ageing population, increased life expectancy and higher patient expectations are placing increasing pressure on cash-limited healthcare systems. Therefore, innovative ways of healthcare delivery are being developed with more empowerment of a wide range of healthcare professionals to provide a more team-based approach to patient care.

Pharmacy technicians are a valuable resource in the hospital, and their roles are extending to release pharmacists to take on more clinical duties. Ward-based technician services aimed at speeding up discharge and facilitating use of patients’ own drugs in hospitals are becoming increasingly widespread. In this edition we hear about pharmacy technicians taking responsibility for controlled drugs, which has traditionally been the pharmacist’s role. The pace of change is so fast that the regulatory framework often lags behind practice, particularly in the hospital. In the UK, the Royal Pharmaceutical Society of Great Britain (RPSGB) has recently reissued guidance on the safe and secure handling of medicines in hospitals to reflect modern hospital pharmacy practice.(1) This was a major piece of work taking many years to reach agreement with all the stakeholders, but already practice has moved ahead. As I write this editorial, new healthcare practitioners such as cardiac perfusionists are emerging who are involved in administering medicines, for which a regulatory framework in relation to medicines management does not yet exist. In the absence of any national framework it is incumbent on the organisation to develop protocols and standard operating procedures to support extended roles.

Pharmacists liberated from the dispensary are now better placed than ever before to take on more clinical roles. Although clinical pharmacy was being practised in UK hospitals in the 1970s, it was not officially endorsed in the UK until the late 1980s.(2) More recently, primary legislation in the UK has allowed pharmacists to prescribe under an agreed management plan, as supplementary prescribers, and consultation is now underway to allow pharmacists to become independent prescribers and consultant pharmacists. This change in legislation is long overdue, as pharmacists have been managing patients’ warfarin treatment in hospital anticoagulant clinics for over 20 years. Patients, too, are being empowered to take more responsibility for their own health, including managing their medicines. In this edition, one article analyses the significant economic benefits of just a small increase in responsible self-medication. However, to maximise the pharmacist’s contribution in this area, regulations need to allow pharmacists to respond to minor ailments with appropriate therapeutic agents. Furthermore, clear standard operating procedures need to be in place, particularly if pharmacy support staff are involved in the process.

There will inevitably be a lag time for the regulatory framework to catch up with developments in practice. This presents pharmacists, and hospital pharmacy managers in particular, with a dilemma. Do we support these extended roles and develop local frameworks to facilitate safe practice, or do we allow the lack of a regulatory framework to prevent these practice developments? On the one hand the regulatory framework is there to safeguard the welfare of patients, but on the other hand history has shown, as discussed here, that developments in practice drive changes in the regulatory framework. This is the essence of professional judgement, for which there is no clear-cut answer, other than the principle that we must be guided by what is best for the patient.


  1. The safe and secure handling of medicines: a team approach. London: Royal Pharmaceutical Society of Great Britain; 2005.
  2. Health services management. The way forward for hospital pharmaceutical services, HC (88) 54. London: Department of Health; 1988.

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