Webb lays out priorities for clinical pharmacy era in speech

Opinion

Webb lays out priorities for clinical pharmacy era in speech

The pharmacy leadership commission announced by England’s new chief pharmaceutical officer David Webb at the Clinical Pharmacy Congress last week might have made the headlines, but his speech was significant in setting out, as he put it, the future direction of the profession and, as the new head of the pharmacy professions, his personal priorities for the next few years. As such, it’s worth a read.

“There's a lot going on in pharmacy and in the NHS at the moment. Most of it is really exciting and positive. Some of it is challenging. We’re on the verge of a new era of clinical pharmacy. Delivery of the future is in everybody's hands.

I [intend] to be a chief pharmaceutical officer for all members of our two professions, and for all parts of the NHS. To be approachable and inclusive, and to appreciate your contributions as we move forward through the next few years working together to improve patient care. 

I understand that the pandemic years have been incredibly tough for everyone. And there are now immense pressures across the system that I recognise. I want to sincerely thank you all, and your colleagues and teams for the work you have been doing for the last two years. Life has been extremely difficult. It has also been transformative for the role of pharmacy in the NHS. 

I've always been really proud of the pharmacy teams I've worked in and some of the practice those teams has delivered has been at the leading edge and sometimes beyond the leading edge. But I’ve been particularly struck on the visits I’ve made so far by the integrity, professionalism and the commitment of the teams on those visits.

After the amazing contribution of my predecessor, Keith Ridge, and the team, and with the advent of integrated care systems, impact of technology and data and the reforms to initial education and training, we are truly at a pivotal moment where there are real opportunities for pharmacy professionals in all parts of the NHS if we get things right.

Pharmacy professionals everywhere have emphatically shown that they are delivering the NHS Long Term Plan priorities, supporting the NHS to deliver through incredibly difficult times and now supporting the recovery. We've demonstrated, collectively, we can deliver as teams across the system. This has given us a huge amount of credibility as we further integrate pharmacy into the NHS and pathways of care.

Over the next four years, we're going to see a great deal more change as a result. We will all need to be ready to harness the possibilities as they arise, so that we can work together to ensure that patients get the very best possible care from us as an integrated team wherever we are in the system.

Most fundamental change in decades 

At the core of this will be the most fundamental change from our profession in decades. Every pharmacist will be a prescriber on registration from September 2026. This totally transforms the profession landscape from now and we need to frame everything we're doing with this in mind.

Developing our professional practice to incorporate this is a key priority for me and for my team. This includes considering how independent prescribing can be used within an ICS to help them deliver their objectives. 

The NHS Long Term Plan ambitions, including the move to ICSs, have been driving changes in our professional practice and providing strategic impetus to everything we're doing across pharmacy and medicines. As we all know, integrated care boards and integrated care partnerships will be statutory entities from July 1. These new organisations, and the committees that come with them, change our whole health care landscape. It is not just about the language we use.

They give us the potential to form partnerships to deliver integrated services across a large population. Using population health management approaches and much more besides. I encourage you, as pharmacy professionals, to step into these spaces and to demonstrate your leadership. You have so much to offer.  

New ways of working, new relationships and a fresh look at how services are organised and provided at a local level will provide a myriad of opportunities to use the skills of pharmacy professionals more, and that includes independent prescribing.

I can envisage a time when it will be common for pharmacists to manage many long-term conditions within ICS pathways of care. Nationally, we can set the conditions for all that to happen, but it needs to be system-led and locally delivered if it is going to come together and work for the benefit of patients.

To support the change to the system and what it means for us as pharmacy professionals, we are enabling pharmacy leadership at every level within this new architecture. This includes funding from the pharmacy integration programme for 42 new community pharmacy clinical lead posts in ICBs and a new senior pharmacy integration regional lead post in NHS E&I. I'm really delighted to say that the first ICB directors of pharmacy and medicines optimisation have been appointed, so congratulations to Raliat Onatade at NE London, Yousaf Ahmad at Frimley and Linda Honey at Surrey who have been appointed to these essential roles, and to those who have worked hard to make this a reality. I hope to see many more people in place soon.

Workforce and skills

So clearly, to be able to thrive in the new landscape we need to continue to deliver on reforms in initial education and training for both professions, carry out reforms to provide assurance of post-registration practice, which we are currently exploring with the GPhC, continue to develop our existing workforce and address our recruitment and retention challenges.

I hear your messages on workforce pressures from secondary care through to community pharmacy especially and acknowledge that this is the case for many professions within the health and social care system. While the number of registered pharmacists, for example, is growing each year, the availability of pharmacists does vary significant across the country and across employers. 

We are doing all we can nationally to mitigate these problems. It's also imperative that leaders and employers work together across systems to deliver on these workforce development initiatives, create recruitment and retention solutions and make inter-sectoral rivalries a thing of the past. 

At a national level, NHS England and Improvement is working closely with ICSs, employers and colleagues in Health Education England on workforce planning for the whole pharmacy workforce and the wider NHS workforce and applying this across each of the 42 ICSs in England. But it's equally important for all employers to make sure they are training enough pharmacists, pharmacy technicians and support staff to meet their needs.

To help meet the changing demands of healthcare and patients, it’s vital all pharmacists are equipped with the skills and knowledge to ensure patient safety, work flexibly and provide clinical leadership when delivering NHS services in healthcare teams. Changes [in train] will ensure that pharmacist professional education is aligned to other health care professionals and that pharmacy professionals and their teams are better positioned to be further integrated into healthcare delivery. This will also provide the public and the wider NHS with confidence around patient safety as those new developments are introduced.

Technicians enabling pharmacists

Developing the role of pharmacy technicians is crucial, including the ability to operate under patient group directions [PGDs]. This will enable pharmacists to move to a mainstream independent prescribing role and help us meet some of our workforce challenges. Developments in the use of skill mix and hub and spoke will underpin the increasing clinical role for more pharmacy professionals and enable that clinical future we are all seeking/ 

We are starting to see the enabling legislation come through, for instance, extending the dispensing errors defence to hospital pharmacists and the regulations to allow the GPhC to  set out the responsibilities of superintendent and responsible pharmacists. These were laid before Parliament recently and there will be more to follow. 

Our inclusive pharmacy practice programme, which involves 16 partner organisations, is  leading change and developing resources for pharmacy professionals to enable us to address health inequality and increase diversity and representation, this of itself will support workforce retention. I have a national inclusive pharmacy practice advisory board to advise me, which meets every two months and includes senior leaders including Dr Bola Awolabi [NHS clinical director for health inequalities], Dr Habib Naqvi [director, NHS Race and Health Observatory] and, of course, Dr Mahendra Patel.

I've recently established an improving practice and engagement group to help reach frontline pharmacy professionals and promote both inclusive pharmacy practice principles and also case studies of good pharmacy practice. The diversity and representation in my senior team and in the regional pharmacy team is increasing and we have a working group to drive forward a programme of change internally. I hope it's starting to feel different and please be assured that this is a central priority for me. By addressing some of the inequalities in our own profession, I hope we will inspire and generate ideas from parts of the profession who often feel that they don't have a voice, which will enable us to improve patient care.

I was delighted when Matthew Elswood and Peter Pratt were appointed as national specialty advisors for mental health pharmacy, leading on workforce and medicines respectively to benefit patient care. I’ll be visiting a mental health pharmacy team next week to hear more about this important area, including learning disability and autism. The recruitment of 260 specialist mental health pharmacists into community teams to support people with severe mental illness is ongoing and will help us to develop better multi-professional working to support people with these conditions. As prescribers, they will provide a huge increase in access and capacity.

A blueprint for leadership

Because of this exciting future, we'll need strong professional leadership to guide, support and enable the transformational change that I’m describing. That’s why the four UK chief  pharmaceutical officers are establishing a commission to produce a blueprint for the purpose and functions for professional leadership in pharmacy for the future. This is to ensure we have the right support in place for the profession, for patients, for the NHS, to work with the regulator and the government. 

Not least we will need this leadership to make sure the move to independent prescribing is safe and effective and that everything that will make it so, is in place. It will also bring the profession with us on this journey.

Medicines optimisation to benefit patients and communities is the prize and the ultimate goal of all this work. If pharmacists routinely prescribe, they can run specialised clinics as well as do routine prescribing and importantly deprescribing in a way that may help address issues before they become problems. 

The NHS has provided unprecedented resources nationally and in PCNs to lead the  optimisation of medicines across populations. And medicines optimisation, as a part of population health management and as an approach in integrated care will deliver on all of these priorities: polypharmacy, medicines safety, value, sustainability, mental health and parity. Clinical pharmacists in PCNs especially, will need to continue to focus on patient facing medicines optimisation priorities across these important agendas.

To help and support the transformation and integration of medicines optimisation, we are putting in place an operating framework to enable the system to function. This will include a national medicines optimisation executive group at the highest level in NHSE&I. This will be supported by regional medicines optimisation committees and we hope ICS integrated medicines optimisation committees, so that we have straight line of sight and consistency of approach on medicines. 

It’s not just about robots 

As an example of one of the things we’re aiming to achieve, I want to focus on the next stage of the aseptic and NHS manufacturing medicines transformation work. This is critical to the NHS recovery and delivery of the Long Term Plan. Following our experiences of the pandemic, we've set up and infusions and special medicines board chaired by Professor Tim Ferris, the national director for transformation, to build on the success of the aseptic services work.

Our ambition is to move from the production of 4 million doses per annum to 40 million ready to use doses that are able to be taken out of the hospital and closer to home and also free clinical time at ward level. The aim of the hubs is that they make high volume standardised products, creating capacity in the hospital spoke sites for more bespoke, complex and innovative medicines that require aseptic preparation. We have been successful in getting some capital for the aseptic hub development. These are the larger, licensed units serving one or more ICS areas and this is great news. 

A key part of this work is the development of a commissioning framework to support elective recovery and better patient care. Accelerating this programme will allow more care to be given out of hospital as well as within, and in every aspect of that care pharmacist prescribers will have a big part to play.

Community pharmacy essential 

During a very challenging time, community pharmacy has been delivering impressive results for patients and community pharmacy colleagues are a key part of the overall direction of clinical pharmacy practice in the future. They are an essential part of the ICS vision. As an example, general practice has already become the highest volume referral pathway to the Community Pharmacist Consultation Service, now at over 7,000 referrals per week and growing.

On prevention, the blood pressure checks service already involves over 6,800 pharmacies and is also growing rapidly and is increasingly being seen as a key part to address health inequalities in our most deprived populations.

It’s hugely positive to see the growing confidence everyone has in community pharmacy, with more pharmacy integration programme pilots already on the way and several more in the pipeline. These are just the tip of an iceberg in terms of opportunity once indepedent prescribing becomes mainstream. Where we currently have to operate on PGDs, pharmacist prescribers will be able to offer an entire episode of care which will be much more convenient and accessible for patients. It will also be under their responsibility as a recognised professional and prescriber. 

We are already actively working on developing opportunities to use prescribing in community pharmacy. We're offering three thousand funded places for independent prescribing this year and this will provide us with valuable experience on how best to expand independent prescribing among existing pharmacists in community pharmacy. Working with employers and all our partners, we are aiming to deliver fufilling roles across all sectors for new and existing registrants.

With all of these developments there will be even greater need for research and evaluation to prove the benefits, identify and manage the risks and demonstrate cost-effectiveness. We need a strong cadre of clinical academics to lead that research and enable future development. For this reason I was delighted this week to launch the UK-wide call for evidence on clinical academic careers in pharmacy. The findings will inform proposals for developing the clinical academic workforce, so please do take the time to give us your views through the survey.

Final messages. The next few years are pivotal to us as a profession, to all professionals in pharmacy and to our patients. Therefore, it is essential that all of us get the right working relationships in place nationally, at system level, and locally to enable us to achieve our ambitions. I’ll be doing this on your behalf and hope you will join me and contribute your support and energy for the road ahead.”

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