By Neil Trainis

The Welsh government has today said it accepts the recommendations of a review by the Royal Pharmaceutical Society into the care provided by pharmacy teams in hospitals which it warned urgently needs to be transformed as patient demand and workforce pressures increase.

The review, commissioned by the Welsh government, came up with 36 recommendations under seven broad areas; Patient-centred care, multidisciplinary team working, pharmacist prescribers, workforce, leadership, quality and governance and technological advancements.

Cautioning that more must be done to ensure hospital pharmacy clinical services continue to meet the changing needs of patients and the NHS, the RPS said patient-centred care involved pharmacy teams being routinely integrated into every multidisciplinary team and pharmacy teams optimising patients’ medication in pre-admission or pre-habilitation services.

It said pharmacy teams must be available in all emergency departments and integrated into patients’ assessment procedures and be involved in their hospital discharge planning. The review also called for an urgent review of workforce and systems involved in the supply of hospital medicines so pharmacy professionals can deliver “patient-centred services.”

When it came to multidisciplinary team working, the RPS said pharmacy teams can “improve patient outcomes, increase value and reduce harm from medicines” when they are integrated into multidisciplinary teams.

It said pharmacists should be prescribers and “actively prescribe to meet the needs” of patients while governance frameworks and organisational structures should be introduced so pharmacist prescribers can “expand their scope of practice.” Clinical placements to prepare pharmacy students to practice as prescribing pharmacists, the review added, should be created.

The review also said pharmacy workforce plans should be developed at local and national level alongside multidisciplinary teams “and aligned to Welsh government and NHS priorities.” It added the education and training of pharmacy teams including undergraduates should be “further integrated in wider healthcare training” and pharmacy technician roles should be supported by “a post-registration development structure.”

Leadership, the review said, needed a strategy for advanced and consultant pharmacist roles at local, regional and national levels while pharmacy needed better representation within health boards and trust senior leadership teams. Talks at board and board committee level should include ways of improving the quality of medicines use.

On quality and governance, the RPS urged the government to ensure all NHS organisations in Wales that employ pharmacy professionals have a pharmacy professional assurance and governance framework in place.

The review also recommended several technological advancements including ensuring hospital pharmacy services lead on new therapeutic technologies such as pharmacogenomics while clinical informatics pharmacy professionals should head up digital developments in health boards and at Velindre University NHS Trust.

Digital advancements, the review said, should be supported by “adequate investment in hardware, software and the pharmacy informatics workforce.”

As NHS care evolves, change is needed, says minister

In response to the review, the Welsh government outlined 60 “actions” across four areas which the minister for health and social services Eluned Morgan said would provide “a blueprint to transforming hospital clinical pharmacy services” and help it achieve its ambition of having a pharmacy service which is designed around patients' needs by 2030.

Those four areas include enabling pharmacy professionals to practise in areas where they add most value, developing hospital pharmacy teams to deliver outstanding clinical care, strengthening quality, pharmacy leadership and governance at all levels and realising the potential of digital, automation and other technologies to transform the provision of pharmaceutical care.

“As the provision of NHS care evolves, change is needed to ensure hospital pharmacy practice continues to be the catalyst for clinical developments and consistently maximises the unique contribution pharmacists and pharmacy technicians can make to improving healthcare and tackling the challenges the wider health and care system faces,” Morgan said.

RPS director: Review will empower pharmacy teams

RPS director for Wales Elen Jones, who led the review, said its recommendations “will empower pharmacy teams to meet these challenges effectively.”

“Collectively for pharmacy teams, implementation should lead to greater prominence within NHS boards and trusts with empowerment to take the leader on all aspects of safe and effective use of medicines,” she said.

“While for individual pharmacy professions, implementation will lead to their expert skills and knowledge being recognised and utilised to the full.”