Pharmacy management

Pharmacy management

The National Health Service (NHS) is sometimes criticised for employing excessive numbers of managers whose existence diverts resources away from front-line clinical services. In reality, hospitals are extremely complex organ-isations that depend on experienced, well-trained managers and clinicians with good management skills for the development and delivery of high-quality, efficient and patient-centred services. Hospital pharmacy depart-ments, albeit on a much smaller scale, are also complex, offering a wide selection of services provided by professional, technical and support staff often over a number of different hospital sites and in community clinics. Pharmacy managers, working at different levels in the department, make a critical contribution to patient care by applying a wide variety of skills, expertise and experience to the delivery and development of clinical and support services that are compatible with the overall aims of the hospital.

Overall managerial responsibility for the pharmacy service will rest with the NHS trust’s chief pharmacist who will be accountable to a senior manager, often one of the executive directors. The chief pharmacist will also be accountable to the trust’s board of directors for all aspects of medicines management, including the safe procurement, storage, handling, distribution and use of all medicines throughout the hospital. This responsibility encom-passes the need to ensure that all practice involving medicines complies with current legislation, NHS rules and regulations, and nationally accepted statutory clinical protocols and good practice guidelines. This includes the regulatory standards for medicines management introduced by the Care Quality Commission in 2010. Also included are corporate governance requirements that necessitate probity and financial control within all aspects of the organisation’s day-to-day business. Additionally, the chief pharmacist will be responsible for pharmacy’s contribution to the clinical governance agenda. This requires that all patients receive the highest possible standard of care, that practice is evidence-based, delivered by appropriately trained and qualified staff and that risks to patients during their treatment are minimised. Chief pharmacists are expected to take action if any aspect of the medicines-handling process in their organisation is not congruent with the aims of clinical governance and to escalate issues of concern within the organisation as required.

Effective management of pharmacy services demands high levels of lead-ership and team work. The chief pharmacist is not only required to lead the pharmacy service but also to act as an advocate for and representative of the service within the organisation as a whole. This will often mean that the chief pharmacist will spend considerable periods of time contributing to the wider trust agenda, becoming a respected part of the trust senior management team.

The two broad types of management that occur are generally referred to as strategic and operational management. As staff progress up the management ladder there should be an increasing shift away from substantially operational management to a significant element of strategic management. Hence, the strategic management role performed by the chief pharmacist should receive far more emphasis and time, and much of the operational workload should be delegated to deputies or department team leaders. Delegation is not only important to the chief pharmacist, but also ensures that the team can develop their own managerial capabilities. It is critical that the chief pharmacist has a vision about the future direction of the overall pharmacy service and can draw up plans for changing methods of service delivery. However, the entire management team must be developed to be able to contribute to the vision for the whole department and their own areas of responsibility if the vision is to be based on specialist practice, owned by those who will be charged with delivering the vision. In practice, the split between strategic and operational management undertaken by the chief pharmacist will be a balancing act, because, as the responsible person for medicines management, the chief pharmacist will be held to account if something goes wrong. As a result, the chief pharmacist must be confident that the systems and processes governing medicines in their trust are robust and applied in practice. This will require the development of leadership and management skills in members of the pharmacy team. A strong management team is essential if the chief pharmacist is to free up time to develop and market pharmacy services at a corporate level.

Operational management focuses on the wide range of functions which underpin the day-to-day smooth running of the pharmacy department; thus the chief pharmacist’s leadership role will be supported by a team of senior pharmacists and technicians. These staff will take responsibility for major sections of the department, such as patient services, clinical pharmacy services, medicines information, aseptic dispensing, non-sterile and sterile production, quality assurance, procurement and stores. Such managers need to acquire a wide range of skills and expertise and will have the opportunity to attend training courses in order to develop and refine their management skills, but there is no substitute for gaining experience and developing expertise through performing the job, being given new tasks and experiences, and being sup-ported to develop through constructive feedback and open two-way commu-nication with a line manager.

A particularly positive development in the management of pharmacy services during the past decade has been the increasing number of pharmacy technicians and support staff who hold senior management positions within the pharmacy department. This recognises the significant contribution that these staff groups can make to managing key sections of the department, such as the dispensary, procurement, stores and distribution, or having overall site management responsibilities, and is an important means of providing support staff with improved prospects for career progression. This development also allows pharmacists to concentrate on clinical pharmacy services.

In summary, chief pharmacists and their senior management team hold considerable power, insofar as they can determine, negotiate and implement the future direction of the pharmacy service. Not only will a strong manage-ment team be able to make the best use of staff and resources, it will also be able to exert a strong influence beyond the confines of the pharmacy depart-ment in achieving a high profile for the service.