Hospital pharmacists must adapt to new environments

Deborah Evans 11 July 2017


Altered states: More in demand than ever, hospital pharmacists are having to adapt to a changing environment.


With all the focus on community pharmacy within the profession, it’s important to reflect on some of the significant challenges faced by my hospital pharmacist colleagues. I’ve been involved in hospital pharmacy several times throughout my career, starting with my pre-registration placement, over 30 years ago, at Addenbrooke’s, and when working as a business unit director for GSK.

To understand how much hospital pharmacy is changing to support patients and the NHS, I had a chat with fellow Royal Pharmaceutical Society board member, Aamer Safdar, Principal Pharmacist Lead for Education and Development, Guy’s and St Thomas’ NHS Foundation Trust.


Aamer, what are the biggest challenges that hospital pharmacy faces?

There are funding challenges across the whole NHS. We’re seeing greater strain on hospitals, with more patients attending A&E for problems that could have been managed outside the hospital setting, largely due to significant pressure in primary care. We are also seeing a greater number of complex patients with more than one long-term condition, challenges in social care and increased strain on bed occupancy. This puts pressure on pharmacy services to ensure patients are discharged quickly, while also managing those on multiple medicines.


With so much pressure on the NHS, what are the key drivers for the hospital pharmacy service?

They include the Five Year Forward View, the General Practice Forward View and the Lord Carter review of hospital pharmacy services. One key area of work is to identify variations in medicines spend across hospitals through the utilisation of NHS Benchmarking. This process has identified attainable savings, such as using biosimilars to lower costs.


When I worked in hospital pharmacy, we worked alone, but this is changing. How important is inter-professional working?

We work much more closely with our professional colleagues. Extending integration of pharmacists into clinical teams allows us to share our expertise among fellow clinicians within the hospital, and outside, in primary and social care. Knowledge transfer between pharmacists, whatever sector they work in, is critical as most patient care in relation to medicines is provided outside hospital.


What will enable hospital pharmacy to fulfil its ambitions?

The Lord Carter review intends to review the skill mix of pharmacy staff, while recognising pharmacists as medicines experts, and who should be in attendance on ward rounds and in clinics. Pharmacists should make independent clinical decisions about medicines use, and be able to prescribe and de-prescribe medicines. I believe we will see much more focus on reducing the number of medicines patients are on, especially when they are not of clear benefit.


How can pharmacists improve adherence?

Wherever pharmacists work, they must focus on ensuring patients take and use their medicines appropriately. Education, including independent prescribing and the ability to work in and across teams will be key to success. I also think digital interoperability of systems within hospitals and across care pathways is critical. We need shared access of patient
health records so that we can ensure better clinical information flows between clinicians.


What does the industry need to be thinking about to support hospital pharmacy?

The pharmaceutical industry has a vital role to play in relation to medicines in the NHS and hospital pharmacy, where medicines are often initiated on the wards or in specialist clinics. This should include value-based pricing of new, complex medicines and relationships between commissioners of high-cost medicines nationally, regionally and locally. In addition, the industry should be providing clinical information and support to hospital pharmacists so they can identify the position for these medicines in a therapeutic plan. Ongoing information and support to hospital pharmacists remains vital in order for pharmacists to have the most up-to-date evidence on which to base their clinical decisions and recommendations.   

Deborah Evans is Managing Director of Pharmacy Complete, Board Member of Royal Pharmaceutical Society England and practices in a pharmacy within a GP practice. Go to pharmacycomplete.org or email deborah@pharmacycomplete.org


Counter action

It seems that many of the challenges faced by my hospital-based professional colleagues are very familiar to those faced in community pharmacy – reductions in funding, increased demand on services, managing patients with multiple complex diseases and adding more clinical value, with a view to benefitting patients and the NHS.

Getting the digital connectivity right, supporting pharmacists’ ongoing development towards prescribing and ensuring the availability of excellent information on medicines will all be key.

Pharma is in a strong position to help facilitate the dialogue between pharmacists across sectors, linking community, hospital, GP practice and primary care pharmacists. Such activity has got to be beneficial to the NHS and patients.

I’m absolutely convinced there is an important and continuing role for industry to support the profession, whatever sector they work in.





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