Hospital pharmacy within the NHS

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Chapter: Hospital pharmacy : Hospital pharmacy within the National Health Service

Published in 2000, Pharmacy in the Future was the document dealing with the specific issues relating to pharmacy playing its part in the NHS for the future in England.

Hospital pharmacy within the NHS


Published in 2000, Pharmacy in the Future was the document dealing with the specific issues relating to pharmacy playing its part in the NHS for the future in England. In 2008, Pharmacy in England, Building on Strengths, Delivering the Future set out further plans for pharmacy’s development. A wide range of commitments was made, including those pertinent to hospital pharmacy. The need to ensure safe transfer of care, to develop clinical pharmacy teams across organisational boundaries and the very clear signal that chief pharmacists must focus on safe use of medicines were included. The document also announced the appointment of two National Clinical Directors, for hospital pharmacy and for primary care and community pharmacy. Aspects of this important White Paper will be recurring themes in later chapters.


NHS hospital trusts


NHS hospital trusts do not have one simple organisational pattern. Foundation trusts have specific requirements to develop memberships from which to elect a board of governors. However, the day-to-day responsibility for the trust (its finances, organisation, and so on) falls to a second board the board of directors. Both boards are led by the trust’s chair. The board of directors comprises the executives of the trust and a group of non-executives. The executives are officers of the trust, usually full-time staff with a management responsibility. The non-executives are lay members of the board with a limited time commitment to their NHS role. The non-executives have a role in ensuring that the trust meets its obligations as a public body, and in providing advice and support to the executive. The executive members of the board typically include the chief executive, the medical director, the nursing director and the finance director. Other executives can be a general manager (deputy chief executive, for example) or a human resources lead for the trust. A director of planning and, increasingly, of modernisation may also be included.


The trust will then have a group that oversees its strategic and operational management. This would be the executives joined by other senior managers in the trust. Size and membership of this group will vary between trusts; often there will be clinical representation beyond the nursing and medical directors. A Spoonful of Sugar recommended that the chief pharmacist should have influence at this level; chief pharmacists are more likely to be included if they head a directorate or division, perhaps representing other non-medical groups.


The trust will then be organised into a number of manageable groups, typically divisions or directorates or care groups. Divisions group together a range of services led by a management team or general manager. An example of a division would be surgical specialties, which could include general surgery, orthopaedics, ophthalmology and gynaecology. In larger trusts a division may include over 1000 staff and have a budget of tens of millions, with a drug spend of several millions. A directorate or care group structure would be along similar lines but, as the name suggests, a larger number of smaller groupings. Orthopaedics, child health and general medicine could each form its own directorate. Figure 1.1 shows the divisional structure for Southampton University Hospitals NHS trust in 2010.


The management groupings of the organisation (directorate or division) would typically have a mixture of general, financial and clinical management input. Usually a senior nurse as well as a doctor would be part of the man-agement team. Information officers, planners and governance leads would also support the business of the directorate or division.


Pharmacy's place in a trust


The move to involve doctors in management of trusts in the 1990s often left pharmacy as a loose end. No single structure has emerged as the way in which pharmacy should fit into a hospital’s organisation. In a directorate structure a large pharmacy service could stand alone, headed by the chief pharmacist, although the size of budget, even in larger departments (£5–10 million, excluding drugs), would be small for a typical directorate. Combination with other non-medically led services such as physiotherapy or dietetics has been a path followed in a number of trusts. Chief pharmacists may act as clinical lead or general manager for these groupings. Another model is where a general manager, possibly at executive level, has responsibility for a range of services that includes pharmacy. Grouping pharmacy with other non-bed-holding specialties such as pathology, theatres and radiology in clinical support divisions is also possible. Whatever the structure, it is important that the chief pharmacist has responsibility for the service and the way in which medicines are used in the trust, having access to the executive team when necessary and contributing to the governance group for the trust.


The development of clinical pharmacy has led to staff specialising in various clinical areas. There are examples of pharmacists moving from a central pharmacy service to individual clinical directorates or divisions. This can increase the ability and opportunity of working with the multidisciplinary team and for specialists to feel ownership for their pharmacy service. However, it could lead to a more fragmented service or leave an isolated rump service of the non-devolved part of pharmacy.


Pharmacy needs to be involved not just in the management structure of the trust but also in the wide variety of committees and groups within the trust. Once again, these vary between trusts but will include groups that deal with clinical governance, risk management, patient liaison, clinical effectiveness audit, control of infection, health and safety, and medicines. Pharmacy man-agers and staff need to create informal networks and contacts within the trust to ensure that, as issues relating to medicines arise, appropriate advice and support are sought. Such contacts are just as important as the formal trust structures.


Pharmacy staff


Hospital pharmacy has developed a range of support staff roles. The introduction to this book mentioned several documents that encouraged the development of the technician roles. Ensuring other support staff underpin and allow good use of resources is also important for pharmacy. Pay modernisa-tion was part of revising the NHS: Agenda for Change introduced changes in pay structures and had an impact on career structures. It is possible that there will be greater variation across the NHS as foundation trusts develop local pay structures. The roles and job titles seen in pharmacy at the time of writing are shown in Tables 1.3–1.5.


 Progression through the current grades follows a variety of routes. Aspirations and career pathways do not follow a simple pattern; however, Table 1.6 gives a few examples of career histories based on current senior pharmacists. The Modernising Pharmacy Careers programme will also bring significant changes to the development and career structure for pharmacy staff.

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