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Former Project Manager
DH Pharmacy Unit
Northern and Yorkshire Region
Allied Health Professions
Leadership Development Programme
Huddersfield Royal Infirmary
Introduced in 2003 in the Vision for pharmacy in the new NHS,(1) consultant pharmacists posts aim not only to improve patient care but also to enhance pay and career opportunities and retain professional experience in the NHS.
In 2005, the Department of Health (DH) published Guidance for the development of consultant pharmacist posts,(2) which outlines the role of the consultant, the competency framework underpinning the position and the process for developing posts locally. The guidance has been written to accommodate all areas of practice in the managed service in acute hospitals and primary care trusts in England.
Pharmacists have been successful in developing clinical and specialist roles in hospitals and primary care for a number of years. Within the context of expanding practice and service changes driven by the modernisation agenda, nonmedical consultant posts have been introduced into a number of other professions (in 1999 for nursing and in 2000 for Allied Health Professions [AHPs]). Fundamental changes to service delivery and design are leading to wide-ranging opportunities for all health professionals, and pharmacists are well positioned to fulfil some of these new and innovative roles.
In recognition of the developing pharmacy practice, the introduction of a consultant pharmacist role is a natural progression that will help to create a more varied career structure and appropriate recognition of expert practice. With service improvement and patient care central to the drive for change, consultant pharmacists will help to ensure that the highest level of pharmaceutical expertise is retained within the NHS and that these high level skills are used effectively.
The national agreement for these posts will not bring with it any new funding; therefore, posts will have to be funded from within existing resources – for example, by redesigning or reconfiguring services or negotiating additional activity as part of new local service strategies. The success of the new roles will depend, at first, on organisations identifying a local need for consultant posts and monies to support them. Then it will depend on soundly integrating the new postholders into service environments that provide sufficient professional support to allow them to flourish.
The role is a combination of four main functions, all of which are important and inextricably linked. This diversity will enable the postholder to play a comprehensive role in modernising services. While all consultant pharmacist posts will include the same four main functions, it is the variation in interpretation across different specialties and organisations that will result in significant similarities in the posts nationally and subtle differences at local level. The underpinning guidance, including the Advanced and consultant level competency framework,(2) is aimed at ensuring the transferability of the posts nationally. The real benefit of the consultant role is in the combination of skills the consultant brings to the post, providing not just the professional expertise but the skills to utilise this expertise to best effect by researching, educating and encouraging others to develop their roles. The four main functions include:
It will normally be expected that the consultant pharmacist will spend about 50% of their time in expert professional practice in a clinical or nonclinical setting, the remaining time being split between the other three functions. The amount of time spent in each of these activities at any time will vary, depending on the service needs. Consideration should be given to how the “expert practice” function will be employed, as there are different ways of interpreting “expert practice”. McEvoy and Johnson(3) describe micro and macro levels of expert practice dependent on whether the consultant is utilising skills on a one-to-one basis with patients (micro) or across a broad area (macro) – for example, how teams or specialties deliver effective services. Difficulties can arise when organisations adopt a superficial understanding of what is meant by expert practice and fail to see the constraints that a narrow view places on the potential contribution of the consultant.
Defining and measuring “expertise” in relation to role competencies is a factor that all professions will have to address. A structured approach is needed that offers guidance both to those aspiring to be consultant pharmacists and to those who are employing them. The Advanced and consultant competency framework, which is appended to the guidance,(2) describes the competency threshold for advanced and consultant posts. It outlines the competency levels that applicants should be able to demonstrate at each level and consists of 34 competencies within six clusters:
The full framework and guidance on its use can be downloaded from: http://www.druginfozone.nhs.uk
The leadership role of the consultant post is crucial and, taken within the context of potentially having little or no management responsibilities, will be through vision, influencing, negotiation, advocacy and role modelling. It is difficult to separate out the leadership function from the other three, as it is integral to the way individuals behave within the role as a whole and how they facilitate and inspire others to achieve them. Their sphere of influence, however, is extensive and not limited to the local health
economy. Their level of expertise will offer opportunities to influence nationally and, in some cases, internationally. At all levels, the consultant pharmacist will be expected to challenge service structures and identify professional barriers that are seen to inhibit effective and efficient service delivery. Over the longer term, they will be influential in cultural change. Two important challenges facing new consultants will be how to manage the organisational expectations of making an immediate impact and balancing the local and national requirements of the role.
In addition to professional expertise and leadership, the combination of the education function with research and evaluation will enable the postholders to influence the integration of evidence-based practice, service redesign and workforce planning. Links with universities will be key to this process, especially in the establishment of practice-based programmes, supporting the development of research skills and supervising research projects in pharmacy practice. It is envisaged that, by encouraging closer, cooperative relationships between academic and health organisations, consultant pharmacists can play a key role in helping to deliver a more “research-aware” workforce (as outlined in the StLaR HR project(4)) and in facilitating the introduction of evidence-based practice more quickly into local services.
Within the framework of the post and the four functions outlined above, organisations that employ consultant pharmacists should consider the capacity of the postholder. They will be expected to elicit significant change in a complex environment, initially from new posts that have no precedence. The job, in reality, has to be achievable, and both the organisation and the postholder will have to balance competing priorities and personal needs.
At first glance there would appear to be some overlap between the role of the consultant pharmacist and that of the service manager, and indeed this debate still takes place within nursing and the AHPs. It is true that there is some overlap, but this also provides the clue as to how the role can be successful in practice. The consultant pharmacist role should complement that of the chief pharmacist, by providing a dynamic link between operational initiatives and strategic direction within the service environment. Utilising the different skills and positions within the organisation in this way will help to bridge the gap between the managerial and professional agendas, which are often at the heart of service modernisation.
An important early lesson from both nursing and the AHPs was the need for communication about the role. Tensions have been evident when new consultant posts have been introduced, particularly around the scope of the role and the lines of accountability. This can become a problem not just for the postholder but also for colleagues working with the consultant. To enhance the chances of successfully integrating the consultant post within a department, a balance has to be found between clearly defining the parameters of the post and allowing the flexibility needed to ensure that the consultant has enough freedom to act across service and professional boundaries. This loose/tight tension is a further challenge facing postholders and organisations but one to be expected at the leading edge of practice.
So, how might consultant pharmacist posts be effectively developed? The case of need for each post must be developed locally and the post integrated into existing services. Strategic Health Authorities will be responsible for putting in place an approval panel that will have to assess the business cases for new posts. Some posts may be designed to work within a single organisation, but there may be instances where a consultant post could be used more effectively across a number of organisations – for example, within the NHS and academia. Regardless of the geographical and organisational remit of the post, it is of paramount importance that the job is supported by stakeholders and clearly defined in terms of role, expectations and accountability arrangements. Lack of stakeholder support was a major contributory factor to the attrition rate in other nonmedical consultant posts.
Learning from the experience of nurses and AHPs, engaging senior healthcare colleagues in the development of the post is essential in the planning stage and reinforces the notion of the need to communicate the remit of prospective posts clearly and widely.
These new posts have the potential to make significant changes to pharmacy practice and the career framework. However, in order to achieve this, the introduction of the posts has to be watched carefully. The introduction of AHP consultants has proven to be slow, with only 25% of the posts “committed to” by the government in 2004 recruited by April 2005. The only evidence available for this is anecdotal, the reasons varying from lack of available finance to a shortage of enthusiasm by service managers to develop posts.
Further work is needed to establish the real causes. The wider implications of introducing consultant posts for the pharmacy profession, including the factors that impact on the development of and recruitment to the posts, will require further scrutiny in the future.
The introduction of the consultant pharmacist post is timely and constitutes an exciting prospect for the profession. These posts are an alternative opportunity for pharmacists looking to develop their career into specific areas of professional expertise and for organisations that are committed to drive change in service delivery and practice. There is no precedent in pharmacy for these posts, and the early postholders will be breaking new ground. In order for them to be successful, the posts have to be designed, managed and integrated in a way that makes them achievable and a valuable asset to improving services for patients.