Next steps

Next steps

The introduction of a clinically based leadership role in pharmacy is greatly welcomed and supports the establishment of a flexible career pathway for pharmacists, benefiting patients by providing access to experts across localities and ensuring that good practice and expertise are disseminated. However, at present there is no formal mechanism for career development from the general level/early years of practice to higher-level practice. While these developments are much needed, it is crucial that they take account of the need for a flexible workforce and avoid the overspecialisation seen in the medical model.

The Department of Health guidance for consultant pharmacists has the key to flexible service development through use of the ACLF, which describes a majority of practice areas that are applicable to all pharmacists wishing to develop their practice. This is particularly relevant as most patients are supported by community-based pharmacists, whether in retail outlets or primary care, and there is a need for advanced generalists to fulfil these roles for more complex patients.

While the medical model of registrar development is well established, it suffers from the ‘silo effect’, where practitioners are required to undertake a complete registrar programme again if they wish to change specialities. A more flexible approach would be to engage the networks of expert phar-macy practitioners, whether general or specialist, in producing a curriculum of practice for advancing practitioners, up to consultant level, allowing those practitioners who wish to progress to complete the curriculum, however they choose to (which may be self-directed learning and/or through courses). If the practitioners also submitted evidence of achievement in the five non-expert clusters of the ACLF, this could then be assessed by the experts and contribute to the establishment of professional designations as nationally recognised levels of practice, reflecting these achievements. The Royal Pharmaceutical Society (the professional leadership body for pharmacy) has adopted this approach and is working with networks of expert practitioners to achieve this.

This discussion has focused on the NHS hospital sector. However, it has been shown that this can apply to primary and community pharmacy practitioners. The concept of higher-level practice also exists in industry, as the qualified person, and in academia through postgraduate Masters and Doctorate-level qualification, and it is not known whether there is benefit to establishing consultant-level practice outside the NHS.

Already those using the restricted title ‘consultant pharmacist’ are showing leadership in non-medical prescribing, where there is an external perception that all consultant pharmacists are prescribers (which is not the case). Leadership in risk management initiatives and managing antimicrobials has achieved outcomes for patient benefit. Consultant pharmacists are engaging in research into specific drugs such as melatonin, disease states such as delirium, broad therapeutic areas such as gene therapy and participating in technology appraisals for national bodies.