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What kind of pharmacist are you?

We need a new method of appraisal for pharmacists that doesn’t just focus on business measures but also takes into account the impact practitioners have, improves job satisfaction and builds motivation, says Liam Stapleton

Are you a good pharmacist? It is an unusual question and probably one that you haven’t been asked before. Your answer might be “of course I am”, or a more cautious “I think I am”. Perhaps a more realistic answer is “I don’t really know”.

When I worked in community pharmacy, my performance as a pharmacist was never appraised. Appraisals were about business performance – the growth in prescription numbers, say, or medicines sales, delivering services or managing costs. 

No one ever asked about the difference I made to patients’ lives or how I interacted with them. No one asked about my relationships with local doctors. When I was a senior manager I didn’t ask anyone either. 

Business bias

Metrics for assessing pharmacists’ performance have always tended to be focused on business measures but, as we move into a new era in which the role of the pharmacist is more clinical, is this sufficient? Do we need to define what a ‘good’ pharmacist is? And should this be done in terms of competencies or outcomes? 

Can a pharmacist who is liked by their patients be described as good, or do we need to start to measure the impact we have on the people or communities we serve?

In community pharmacy, many people measure themselves on process and volume.
We measure the number of prescriptions dispensed, or the number of flu jabs or services delivered. 

If we look at the dispensing process and break it down, a major part of this can be described as logistics, and a good job is getting the right product at the right time to the right person. These could be described as process measures. 

With the other element of the dispensing process, the element that relies on a pharmacist’s expertise and knowledge – i.e. the clinical input into the process – success is more elusive and difficult to measure. 

Success from this element would probably be best described as an outcome measure, and while difficult, these measures are important as they demonstrate value. The NHS wants both outcomes and volume but delivering high volume without demonstrable value is not an attractive proposition. 

“Community pharmacy will remain focused on process and volume, not quality, unless we measure the contribution we make”

Thinking about the dispensing process in this way encourages us to question what is expected of the clinical support that goes alongside the technical dispensing process. This clinical input can’t be limited to avoiding harm, identifying overdoses or underdoses, or spotting drug interactions. These can be identified by a well-designed IT system. So what should the expectation be of the clinical input when a medicine is handed out to the patient? 

We have the New Medicine Service to remunerate contractors for discussing newly prescribed medications in certain categories – but what about medicines in categories not covered by the service, or follow-up counselling when a patient has taken their medicines for a while? What is the expectation when these are handed out?

When I have asked pharmacists about their successes, they have often talked about making a difference to the lives of people. I still have vivid memories of some of the occasions when I know my involvement contributed a significant benefit for a patient. 

While there is no mechanism or contractual requirement for pharmacists to be appraised as pharmacists, employers should build this into their appraisal processes to recognise the impact their pharmacists have, improve job satisfaction and build motivation. From a commercial perspective, collecting this information will be valuable in demonstrating the value of community pharmacies to the NHS.

As an individual, it can be hard to recognise if you are a ‘good pharmacist’ because community pharmacy is a lonely profession. We don’t have a point of reference to compare ourselves to or to get feedback from. Adopting a clinical supervision approach, working with a colleague to help reflect more deeply on practice, presents the opportunity to help you recognise your successes and areas to improve.

If we think about the old adage, “what gets measured, gets managed”, community pharmacy will remain focused on process and volume rather than quality unless we measure the contribution we make. It is time to take our role seriously.

Liam Stapleton is director of Metaphor Development Limited and an associate clinical lecturer at the University of Lincoln.

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