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Modernising Pharmacy Careers Programme Science and Technology Helen Howe MPC Workstream II Co-Chair September 2011 1 MPC Programme: Scope Teaching, learning and assessment, pre and post registration, including continuing professional development, career development and workforce planning for pharmacists, pharmacy technicians and the pharmacy teams, current and future, working in all aspects of practice in England. Drivers for change Demographics – an ageing population making disproportionate use of NHS resources Growth in prevalence of long term conditions such a diabetes and heart disease Relatively high level of errors at all stages in the use of medicines Public health a priority for the government Funding restraints – the need to focus on productivity without compromising quality of patient care Recognition by pharmacy employers and education providers of the need to co-operate more closely to deliver a pharmacy workforce fit for purpose Patients & their medicines: no decisions about me without me Picker Institute (patient survey): • There has been a decrease in the percentage of people who said they had been given enough information regarding the possible side effects of their medication; 59% said this compared to 61% in 2005; likewise a smaller percentage than in 2005 said they had been given enough information on how to use their medication Healthcare Commission (2009): • While.....a greater proportion of patients report full involvement in decisions about their care and treatment, this is not reflected when it comes to specifically dealing with medication. There has been no increase in the proportion of people who “definitely” felt involved as much as they wanted to be in decisions about the best medicines for them. This has consistently been around 60% over the last few years • Medicines still most common therapeutic intervention and biggest expenditure after staff, but, for example: • 30 to 50% not taken as intended • Literature suggests 4 to 5% of hospital admissions due to preventable adverse effects of medicines • Medication errors at unacceptable levels • Medicines wastage in primary care: £150m per annum avoidable • NHS Atlas of Variation • Relatively little effort towards understanding clinical effectiveness of medicines in real practice • The importance of the pharmaceutical industry to UK Plc Medicines utilisation in practice Policy Context: Public Health Healthy Lives, Healthy People Public Health England –a national public health service A return of public health leadership to Local Government Professional leadership nationally and locally Dedicated resources for public health at national and local levels Focus on outcomes and evidence based practice supported by a strong information & intelligence system

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Modernising Pharmacy Careers

Programme

Science and Technology

Helen Howe

MPC Workstream II Co-Chair

September 2011

1

MPC Programme: Scope

Teaching, learning and assessment, pre and post registration,

including continuing professional development, career

development and workforce planning for pharmacists, pharmacy

technicians and the pharmacy teams, current and future,

working in all aspects of practice in England.

Drivers for change

• Demographics – an ageing population making disproportionate use of NHS resources

• Growth in prevalence of long term conditions such a diabetes andheart disease

• Relatively high level of errors at all stages in the use of medicines

• Public health a priority for the government

• Funding restraints – the need to focus on productivity without compromising quality of patient care

• Recognition by pharmacy employers and education providers of the need to co-operate more closely to deliver a pharmacy workforce fit for purpose

Patients & their medicines: no decisions about me without me

Picker Institute (patient survey):

• There has been a decrease in the percentage of people who said they had

been given enough information regarding the possible side effects of their

medication; 59% said this compared to 61% in 2005; likewise a smaller

percentage than in 2005 said they had been given enough information on how to use their medication

Healthcare Commission (2009):

• While.....a greater proportion of patients report full involvement in decisions about their care and treatment, this is not

reflected when it comes to specifically dealing with medication. There has been

no increase in the proportion of people who “definitely” felt involved as much as

they wanted to be in decisions about the best medicines for them. This has consistently been around 60% over the

last few years

• Medicines still most common

therapeutic intervention and biggest

expenditure after staff, but, for

example:

• 30 to 50% not taken as intended

• Literature suggests 4 to 5% of

hospital admissions due to

preventable adverse effects of

medicines

• Medication errors at unacceptable

levels

• Medicines wastage in primary care:

£150m per annum avoidable

• NHS Atlas of Variation

• Relatively little effort towards

understanding clinical effectiveness

of medicines in real practice

• The importance of the

pharmaceutical industry to UK Plc

Medicines utilisation in practicePolicy Context: Public Health

Healthy Lives, Healthy People

• Public Health England –a national public health service

• A return of public health leadership to Local Government

• Professional leadership nationally and locally

• Dedicated resources for public health at national and local levels

• Focus on outcomes and evidence based practice supported by a strong information & intelligence system

Pharmacy

• Community pharmacies: valuable & trusted public health resource e.g. Healthy Living Pharmacies

• Public Health England influence CPCF development through NHSCB

• Local authority health & well-being boards to produce pharmaceutical needs assessment (PNA), alongside JSNA

• Inform pharmaceutical services commissioning by NHSCB & local public health commissioning

• Chief Pharmaceutical Officer to discuss all aspects of pharmacy with the public health community

7

Improving knowledge & skills in public health

• Science and practice of public health

• The three domains of public health: health protection, health improvement, health and social care quality

• Awareness of the Faculty of Public Health core competences and functions

• Behaviour change –models of consultation

Dahlgreen and Whitehead representation of the wider determinants of health

Education policy - England

• ‘Equity and Excellence: Liberating the NHS’ - White Paper (July 2010) sets out the Government’s proposals for the NHS

• 'Liberating the NHS: Developing the healthcare workforce' (December 2010), sets out proposals to establish a new framework for developing the healthcare workforce

• Employers to have greater autonomy and accountability for planning and developing the workforce

• Greater professional ownership of the quality of education and training

• Education commissioning led locally and nationally by the healthcare providers, through MEE/Health Education England (HEE)

• All providers of healthcare services will pay to meet the costs of education and training.

• ‘Students at the Heart of the System’ White Paper (June 2011) sets out proposals for a radical reform of higher education.

Who does what

• Set and monitor statutory proficiency and education and training standards: Regulator

• Approve courses, tutors, qualifications leading to registration: Regulator

• Draft a curriculum: Education providers

• Deliver education and training: Education providers

• Accredit, quality assure post-registration courses and qualifications: Professional bodies, trade bodies, unions

• Agree professional development frameworks: Professional bodies, (employers)

• Identify CPD needs: Pharmacists, pharmacy technicians, employers.

• Define job roles: Employers

• Undertake workforce planning: Employers, MEE

MPC work programme

The Modernising Pharmacy Careers programme is focussing onaction to deliver its objectives in three major work streams:

• WSI – Education and training (Pre-registration) led by Rob Darracott and Anthony Smith

• WSII – Developing Pharmacy Careers (Post-registration) led by Helen Howe and Keith Wilson

• WSIII – Cross-cutting projects such as Workforce Planning led by Keith Ridge.

12

Structure and governance of MPC

REVIEW OF POST

GRADUATE CAREER

DEVELOPMENT

WORKSTREAMS II – REVIEW TEAM

MEE

MPC PROGRAMME DIRECTOR

Sue Ambler

MPC PROGRAMME SUPPORT TEAMMaria Murray

Kellie-Espie-Whitburn

MPC PROGRAMME BOARD

Keith Ridge CPO

(Co Chairs)

PROFESSIONAL

STANDARDS &

REGULATION

LEAD(S):

HELEN HOWE

KEITH WILSON

LEAD(S):

HELEN HOWE

KEITH WILSON

WORKSTREAM II

POST REGISTRATION CAREER

DEVELOPMENT

MPC PROGRAMME MANAGEMENT

TEAM

EDUCATIONAL CASE

FOR CHANGE

WORKSTREAMS I – REVIEW TEAM

REVIEW OF PRE-

REGISTRATION

EDUCATION &

TRAINING

WORKSTREAM I

PRE REGISTRATION EDUCATION &

TRAINING

WORKFORCE MODEL,

NEW WAYS OF WORKING

& NEW TECHNOLOGIES

WORKSTREAMS III

LEAD(S):

KEITH RIDGE

WORKSTREAM III

WORKFORCE

LEAD(S):

ANTHONY SMITH

ROB DARRACOTT

LEAD(S):

ANTHONY SMITH

ROB DARRACOTT

MSC

MMC

MDC

13

Workstream I

A review of current arrangements for pharmacist education and pre-reg training

14

Aim of the review

• Identify strengths and weaknesses in the current education and pre-registration training as a foundation for enhancing delivery of clinical, leadership, professional and scientific aspects of pharmacy careers

• Determine changes required to ensure that newly registered pharmacists can practise safely and effectively and are appropriately prepared to undertake further post registration development

• Identify emerging options for implementing required changes, together with supporting evidence for any preferred option

• Highlight implications of options for pharmacy education and training in other parts of the UK.

• A continuous period of formation with registration and graduation at the end of year 5

Early exposure to practice to support students to make more informed choices about their future careers in pharmacy

Closer collaboration between higher education institutes (HEIs) and employers to support the initial formation of pharmacists, and to pave the way for their subsequent professional development

Better integration of the teaching, learning and assessment of science that allows students to contextualise their learning

Additional teaching and learning in relation to developing clinical decision making e.g. communications skills, case-based learning and clinical skills training.

Principles underpinning reform Five-year MPharm programme

We propose: • a single five-year period of teaching, learning and assessment leading to graduation and registration

• that universities and employers are jointly responsible for thedelivery of a five-year integrated programme, including joint sign-off of completion of training

• that the current 12 month work-based placement should be divided into two major placement periods.

• Total length of time on major practice placement should be not less than

at present (52 weeks), though our further discussions have also

considered whether two major practice placements need to respect the

current academic year timetable, or could partly occupy what are

currently the long summer vacations.

• There must be 6 months in patient-facing practice in Year 5 to ensure

compliance with European Directive requirements for the registerable

qualification.

• The logistics for students, employers and the schools of pharmacy would

become unmanageable if more than two major practice placements were

introduced

• The placement period in Year 5 should lead directly into registered

practice

• Capacity issues mean that, ideally, the two placements for the students at

different stages of development should not have substantial crossover

within the calendar year.

Principles to develop practice placement options Placement timing

Major placements in Semester 1 of Year 4 and Semester 2 of Year 5

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep

Year 1

Year 2

Year 3

Year 4

Year 5

Semester 1 Semester 2 Vacation

Our preferred option for dispersed practice placements is a six-month placement at the beginning of year 4 and a six-month placement at the end of year 5 of the five-year programme.

Five-year MPharm programme

We propose: • a single application process for the major practice placement(s), with the full involvement of employers locally in the process of selection.

• that pharmacy is integrated into local infrastructures established to manage quality in major practice placements

• that a ‘Pharmacy Dean’, be responsible for signing-off satisfactory completion of assessments in the work-based placements and be accountable to the regulator for that function.

Integrated curriculum

We propose: • that all schools of pharmacy, working with employers adopt the principles of integration and assess the merit in the principle of a spiral curriculum

Clinical teaching

We propose: • that the five-year MPharm programme should be eligible for at least 12 months funding as a clinical subject in addition to theexisting funding as a science based subject

• that there should be an urgent review of the pharmacist academic workforce including opportunities for pharmacists to undertake PhD and post doctoral research, with access to supportgrants specifically for pharmacists

• that visits to the pharmaceutical and bio-technology industries, work-shadowing opportunities and visiting industrial lecturers should be included in the curriculum.

• Students and graduates – additional fees and students loans, loss of pre-reg salary

• Schools of pharmacy- clinical academic workforce, curriculum redesign, research, international students

• Employers (NHS and non-NHS)

• Regulator

• Careers in academic and research

• Careers in industry

• Devolved administrations

Potential impacts of proposals

WSI Progress update

• January-March 2011: Meetings with pharmacy organisations. Feedback

from discussions used to further refine proposals for reform

• March 2011: Report with recommendations for reform of pharmacist pre-

registration education and training presented to MPC Programme Board

• April 2011: MEE endorsed submission of the proposals to the Secretary of

State (SofS) subject to their implementation being funded in a way that is

sustainable, but also at least cost neutral overall across government.

• June 2011: Report and proposals submitted to SofS

• July 2011: SoS has asked the Department of Health (DH), Department of

Business Innovation and Skills (BIS) and the Higher Education Funding

Council for England (HEFCE) to consider the cost-effectiveness, affordability

and sustainability of the proposals.

• September 2011: Workstream Leads met with SoS to discuss further

24

Workstream II

A review of post-registration career development of pharmacists and pharmacy

technicians

Aim of the Review

To provide advice and recommendations to the MPC Programme Board on developing the registered pharmacy workforce across allfields of practice, to allow patients, the public and the NHS tobenefit more completely from the unique contribution that the pharmacy workforce makes to health, well being and patient safety.

Key points to note

• Not just about pharmacists

• Looking at both informal and formal aspects of training, education and learning opportunities- this is about career development as a whole

WSII Objectives

• To map current post registration pharmacy workforce career pathways

• To identify existing models, and future post-registration career

development in the wider medical field and health policy, and identify

opportunities to apply elements of these to pharmacy

• To review how current post registration formal and informal training,

education and learning opportunities/provisions support pharmacy

professionals to develop the competence, lifelong learning and leadership

skills needed to be effective in delivering services to patients and

contribute to innovation and development in the pharmaceutical industry

• To engage stakeholders, obtain a comprehensive evidence base, and build

a common understanding, at a strategic level, of needs for post-

registration education and training in the future pharmacist and pharmacy

technician workforce

• To scope current post registration frameworks, standards and regulations

and how these are applied.

27

Structure of the Review Team

WORKSTREAM II REVIEW TEAM (FOR PHASE 1)

Each sub group is comprised of experts in their field: Responsible for providing their expert advice, feedback and input on their

area of specialism. The sub groups will be central to the process of gathering and critically analysing data on post registration

career development, and engaging more widely with practitioners as appropriate

PARTNER GROUP ACADEMIA GROUP

PHARMACIST

GROUP

(PATIENT-FACING)

Comprised of MPC Programme Board Members: Responsible for governing the project and reporting

to the MPC Programme Board. The Project Board will be supplemented by representatives from

each sub group (below) as appropriate, to inform discussions

SCIENTIFIC/

TECHNOLOGY

GROUP

TECHNICIANS

GROUP

PROJECT BOARD TEAM

28

Roles and Responsibilities:Project Board

• Governing the work, including providing strategic oversight and guidance

• Managing the project risks and issues

• Assuring the quality of outputs of the Review Team

• Reporting to the MPC Programme Management Team and Programme Board on the progress and activity in the workstream

29

Roles and Responsibilities:Review Team

• Shaping the methodological approach for the Review

• Shaping and providing input on a literature review of post registration career development in other medical professions

• Collecting data through oral and written evidence (including conducting interviews); evidence base for recommendations

• Providing direction and advice to the analytical work being undertaken by the MPC programme team

• Shaping and informing a review of current career development frameworks

• Critically assessing the gathered information

• Providing a recommendations report and written feedback to the MPC Programme Board on post registration training and career development

Roles and Responsibilities:

Specialist sub groups

• To provide their expert advice, guidance and input on their area of Specialism

• To provide draft sections for reports

Partner Group

• Sense check and feed into the outputs generated by the expert sub groups.

• Assisting the Review Team to contextualise the work (including a national perspective).

30

Objectives: Sub groups

31

• To review the major questions for the workstream

• What structures/provision currently enable the pharmacy workforce to develop professionally in your field?

• What are the gaps and constraints and how can we address them?

• How will future policy/ health care provision impact professional development within the pharmacy workforce?

• How will the pharmacy workforce be enabled to achieve professional development in the future to meet the needs of patients and the public?

32

WSII Approach & ActivitiesDescriptionActivity

Search, review and analyse available literature on post-registration career development to understand how pharmacy and other related professionssupport and develop professionals to ensure they remain confident and competent practitioners

Seek and review oral evidence from representatives of key stakeholder organisations to understand and map career pathways of pharmacy professionals (including technicians), summarise findings and draw conclusions

Seek and review written evidence from key stakeholders to understand and map career pathways of pharmacy professionals (including technicians) - summarise and draw conclusions from

written evidence.

Test conclusions from review of oral and written evidence with stakeholders from across the pharmacy profession

Reviewing & analysing current arrangements using available literature1

Gathering and reviewing oral evidence2

Gathering and reviewing written evidence

Testing conclusions with stakeholders4

3

Draft and finalise the report on the Review of Post

Registration Career Development which will bring together all the work of the review, identify examples of career development models applicable to pharmacy and options for change to improve the structures. Analyse implications for formal and informal training and education.

Drafting Final Recommendations Report5

WSII core questions

33

1. What structures/provision currently enable the pharmacy workforce to develop professionally in your field?

2. What are the gaps and constraints and how can we address them?

3. How will future policy/ health care provision impact professional development within the pharmacy workforce?

4. How will the pharmacy workforce be enabled to achieve professional development in the future to meet the needs of patients and the public?

Core questions used to generate content by specialist sub-groups and oral evidence gathering sessions.

34

Phase I: Activity Timeline &Milestones

JAN FEB MAR APR MAY JUN JULY

PHASE 1 ACTVITY

Review current arrangements in pharmacy – review what

happens now in pharmacy (current state of play /current arrangements in place)

Planning oral gathering process, booking in meetings, briefing RT members on how to conduct interview process

Report

Series of evidence GatheringPanels (oral)

Planning written gathering process, writing survey/

collating contacts/emails

Summary findings outlining models/ recommendations for improvement to support pharmacy career development

Written evidence Gathering (survey?)

Collating evidence & writing report

Collating/ evidence & writing report

Agreeing shape and core questions for Written Evidence Gathering process– sign off from MPC PB

Summary findings

KEY

Project Milestone/ Deliverable

Stakeholder panelsSurveys/ Questionnaires

3

Review CPD models in related/wider medical field and see how/if these can be applied to pharmacy

1b

Agreeing shape and core questions for Oral Evidence Gathering process – sign off

from MPC PB

2

Review of current competency

frameworks – detailed analysis of the strengths/

weaknesses of existing pharmacy frameworks supporting professional career development

1

c

By 1st

15, 16th,17th Jun

Communications Web Update/ Tools

Web Update/ Tools

Web Update/ Tools

1a

First Review Team Meeting

28th Jan

35

AUG SEP OCT NOV DEC JAN FEB

PHASE 2 ACTVITY

Testing conclusions

from evidence gathering with stakeholders

Review Team to write up final WSII Report and recommendations

Summary findings

4

5Final Report

Paper summarising stakeholder feedback on proposals – to be presented to Project Board 2nd November

Final MPC Programme Board 1st

Close Down Project BoardMeeting

Full Review Team Meet to close project

30th Nov

Final WSII Report (including recommendations) is signed-off Summary paper

worked into a final report incorporating stakeholder feedback

Phase II: Activity Timeline & Milestones

Slippage.....

If there is any slippage, (ie a final report is not presented to the MPC PB on 1st December) approval for the report will not possible until early 2012. The MPC/MEE as it is currently formed may become an executive body and the governance/ process of approval may change.

Final WSII Report presented to the MPC PB.

Final Review Team Meeting

2nd Nov

CommunicationsWeb Update/ Tools

Web Update/ Tools

Web Update/Final Report

KEY

Project Milestone/ Deliverable

Stakeholder panelsSurveys/ Questionnaires

WSII Progress update

• January-April 2011: Review Team and Specialist sub-group meetings to generate content using four core questions.

• June – July 2011: Key stakeholder organisations attend oral evidence gathering sessions with Review Team members

• July 2011: Outputs from sub-group meetings and oral evidence sessions collated and reviewed by Workstream Leads to identify themes and gaps

• July 2011: Specification developed for independent review of competency frameworks. Tender now agreed and detailed arrangements being finalised.

• Summer 2011: Review of data from sub-group discussions and oral evidence sessions has shown gaps we will now address. Focus will be on seeking information from correct groups.

• November/December 2011: Review team and other WSII project groups to discuss draft report; GPhC and stakeholders toconsider emerging recommendations.

And the Pharmaceutical Scienceand Clinical Technical Specialities group?

• Scope was pharmaceutical science and technology in healthcare/industry

• Oral evidence was taken from• NHS Pharmaceutical Aseptic Services Group

• MHRA

• The Academy of Pharmaceutical Science

• Great input from your colleagues– Vision was of an effective use of research and scientific advice to advance policy

and public service

• Overlaps with the MSC programme of work for HC Scientists

Emerging headline ideas

• Propose a national lead commissioning function for training

• Opportunities to work together with MSC

• Professional ownership needed of a career pathway for clinical technical staff

• Career path should be integrated with clinical pharmacy and no early specialisation

• Consultant Clinical Technical Specialists too

• QP training needed pre-registration

• Deanery support for network training supporting access to capital intensive sites

38

39

Workstream III

Workforce Planning

Pharmacist Workforce Model

WS III progress

• MPC working with Kings College, London to update the 2003/04 pharmacy

workforce model

• The model was originally developed on behalf of the Department of Health

(DH) and the Devolved Administrations (DAs) by the Royal Pharmaceutical

Society of Great Britain (RPSGB).

• Kings College London (KCL) research team tasked with completing

validation of the initial assumptions, analysing trends and updating the

model for England only.

• A Project Advisory Group (PAG) was established with members from all

sectors of pharmacy to provide advice and key data to the KCL research

team.

• Project due for completion in early Autumn 2011.

• Updated pharmacist workforce model work will provide a strong

foundation for the work of the MPC PB, and the pharmacy components of

the work of the Centre for Workforce Intelligence (CfWI).

• The model, and its workforce planning outputs, will provide essential

information needed to enable modernisation of the workforce, including,

but not limited to, the case for educational change and the link between

commissioning and service development.

Contact us

By e-mail:

[email protected]

Website:www.mee.nhs.uk

By post:Modernising Pharmacy Careers, Programme OfficeRoom 453, Skipton House80 London RoadLondon SE1 6LH