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The big interview — NES Postgraduate Pharmacy Dean: Professor Anne Watson

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Professor Anne Watson

What does your role involve on a day-to-day basis?
I’m really passionate about my job as the Postgraduate Pharmacy Dean, at NHS Education for Scotland (NES). My days are so varied and interesting, and I really get to be at the heart of important debates about pharmacy education. Starting early in our NHS careers, I think we all really aspire to make a difference….and I’m very lucky to be able to contribute to that.

There’s so much changing in health and social care right now, and at NES we’re driving forward pharmacy education and policy to reflect that changing landscape. That means close working not only with NES pharmacy and other professional colleagues, but also across Scotland and the rest of the UK. It involves me travelling all around Scotland, although mainly in Edinburgh, and often in London…so lots of travelling! A day in our Glasgow office is always good too – to reconnect with the team and plan for the future.

What is your career background?
My background is very much in the West. I studied my undergraduate degree at the University of Strathclyde (too long ago to mention) and then undertook my pre-registration training at the old Southern General Hospital in Glasgow. I then managed to get a post as a junior pharmacist in Glasgow while undertaking my MSc in Clinical Pharmacy at the University of Strathclyde.

Thereafter, I progressed my career in Glasgow, ultimately being appointed as the Head of Pharmacy Education & Training for Glasgow Hospitals with a joint appointment as a Teacher Practitioner at the University of Strathclyde. I moved to NES as an Assistant Director in 2004 before being appointed to my current role in early 2016, after Rose Marie Parr left to become the Chief Pharmaceutical Officer. I am very proud to have also kept an appointment as a visiting Professor at the University of Strathclyde.

I’ve also worked closely with the regulator throughout my senior educational roles both on the GPhC Board of Assessors and more recently as part of the Accreditation panels for both MPharm and independent prescribing courses.

Why did you choose education?
When I look back I was always interested in helping and supporting others in developing themselves so it was a natural progression for me to continue this into pharmacy education. Early on in my career I volunteered to take some pharmacy students with me to the rheumatology wards that I worked on. I really enjoyed that, so decided to look for ways to combine an educational role with my clinical work.

I have benefited from being able to balance a long working relationship with the University of Strathclyde with my clinical roles. The role within NES was my ideal extension of this and has also allowed me to strengthen my links with Robert Gordon University as well as Strathclyde. It lets me get involved directly in pharmacy training across Scotland as well as commission and influence pharmacy educational policy at both Scottish and UK level.

When was the last time you spent some significant time in a community pharmacy?
It’s important to keep abreast of how things are on the ground, so that’s why I really appreciate the feedback we get from stakeholders such as Community Pharmacy Scotland. Despite the fact that it’s some time since I worked on the front line, their input and that of colleagues is invaluable in making sure the needs of practising pharmacists are built into the work that we do here at NES.

What needs to improve in community pharmacy?
Community pharmacy has done a fantastic job in managing minor ailments through MAS, so I think it is ideal that within Scotland we are currently looking at how we can extend it. I also think community pharmacy has a key role in supporting out-of-hours demand for healthcare.

More broadly, I think that community pharmacists can maximise their expertise in medicines, particularly in managing patients with long-term conditions. If the pharmacist has more time to focus on clinical input then we can make a huge impact on the use of the medicines and monitoring of patients with long-term conditions. But to make this shift happen we’re going to have look at things such as electronic transfer of data, robotics, scanning technology and of course appropriate numbers of trained staff and their skill mix. I’d love to see some form of protected learning time for pharmacists and pharmacy technicians to allow us to build on the clinical skills of the workforce to take on these more clinical roles.

A passion of mine is the role of pharmacists as prescribers. I think we have a huge role to play here, both as pharmacists working in this capacity within GP practices, and also within the community pharmacy setting itself.  This applies not just to managing a caseload of patients in a clinic format but also dealing with acute requests for medicines.

NES recently launched Effective Management of Over the Counter (OTC) Consultations. Is consistency of advice an issue in community pharmacy?
Consistency has always been an issue. As professionals, we have always known this anecdotally, but recent academic research and the Which? report have really highlighted this. That’s why we were delighted to launch this resource for community pharmacy, on behalf of the Scottish Government, as a refresher training initiative.

These resources were primarily aimed at medicines counter assistants, but can be utilised by any member of the pharmacy team. Every community pharmacy in Scotland received a pack of the resources and I’m delighted with the excellent response we’ve had, with many requests for extra packs.

What can we do better?
I think consistency is the key here.

Research has demonstrated the importance of gathering relevant information during OTC consultations. This enables the pharmacy team member to make the most appropriate recommendation regarding treatment. By doing this in a consistent manner we can ensure that all patients receive the most appropriate advice and choice of medicine – or not.

I also think that we could perhaps look at communication skills using proven evidence-based techniques with regular feedback on practice. The use of effective communication and consultation skills ensures patients are more likely to receive safe and appropriate treatment.

Are pharmacist independent prescribers (PIPs) key to the future of community pharmacy?
I believe they are one of the keys – lots of issues could be sorted out by a prescribing pharmacist for acute conditions. By educating patients to go to their pharmacist first we could reduce some of the burden on GPs and save time for patients themselves.

Prescribing pharmacists are also in an ideal position to monitor and prescribe repeat medicines for patients with long-term conditions. However to allow all this to happen we need to free up the pharmacist’s time and this requires better e-health connections, the use of the appropriate skill mix of staff and appropriate technology to assist with the dispensing process.

In terms of increasing the numbers of PIPs, are you pleased with progress so far?
We are pleased with the progress in the numbers going through training at both Robert Gordon and Strathclyde University, but we need to build on those who have been trained to use their skills – some of this relates to confidence, and some relates to the opportunities or support to prescribe within a multidisciplinary environment.

The numbers coming through to be trained as prescribers has mainly been limited by the issues of staff being released to undertake the training and also by the problems in finding appropriate Designated Medical Practitioner (DMP) support. Perhaps the recent GPhC Consultation to allow the scope of DMP to other prescribing practitioners ie Designated Prescribing Practitioners (DPP) may help with this.

I think the evolving clinical and prescribing role of pharmacists in all sectors and particularly in the whole primary care agenda will open up these opportunities and we as NES just need to ensure we can offer support to do this.

Do we know how many use their qualification?
More than half use their prescribing skills on a regular basis – we can tell that through self-reporting. But putting it into practice really matters – it’s something that we want to work with the service to increase .

There has been a significant shift in funding towards pharmacists working in GP practice. Do you think this is causing a ‘brain drain’ from community pharmacy?
There’s less ‘brain drain’ from community pharmacy than you might expect, as we’re seeing a lot more combined GP and community pharmacy posts, or sessional working. I think this retains the link between GP practice and community pharmacy.

At NES, we provide a learning pathway for pharmacists and pharmacy technicians to support them moving into roles in GP practices. We’re seeing a mix of experience from all sectors although about half of those so far have come from community pharmacy.

It is an evolving picture which we intend to monitor so that we can influence workforce planning and the pipeline of pharmacists coming through from undergraduate education and the Pre-Registration Pharmacist Scheme in Scotland.

Can you explain a bit about what the recent study, which benchmarked PIPs against final year medical students revealed and what it means for the future?
The Prescribing Skills Assessment (PSA) is used by nearly all medical schools in the UK as an assessment of the prescribing abilities of final year medical students just before they go out into practice. We wanted to look at how pharmacist prescribers would compare in this online assessment. They were comparable in their abilities overall, which we expected, although sometimes the more experienced and specialist pharmacists were weaker in their prescribing abilities in more general areas as perhaps would be expected with more specialist senior medics.

We now plan to undertake a similar study with 4th year undergraduates from both Schools of Pharmacy and also all PRPS trainees in Scotland to see how they compare in their generalist prescribing abilities.

Dr Ailsa Power, Associate Postgraduate Dean, NES; Professor Rose Marie Parr, Chief Pharmaceutical Officer for Scotland; Professor Anne Watson, Postgraduate Pharmacy Dean, NES; Fiona McMillan, Principal Lead – Vocational Training & Leadership Development, NES; Aileen Bryson, Practice & Policy Lead Scotland, Royal Pharmaceutical Society; Seonaid McIntyre, Educational Development Facilitator, NES

Can you explain a bit more about the NES/RPS project led by Heather Harrison — the scoping and development of a Foundation Vocational Training competency framework (FVT competency framework) to support career progression in the community pharmacy sector?
We want Foundation Training to be flexible and transferable across all boundaries of care to support cross-sector appointments as well as portfolio working/careers.

That’s why although we have developed and managed VT Foundation training for hospital pharmacists since 2007, we recently built on this by adding Foundation training in Primary Care (GP Practice). We also reached the first milestone of a pilot to create one Scottish Foundation Framework for early career pharmacists working in any sector – with ‘core’ competencies for all as well as ‘sector’ specific competencies.

We also realised that there is a gap within the community for early careers pharmacists to be supported in their development. As a result, Heather Harrison is leading on the final element – integrating community pharmacy sector competencies to the framework which we hope will be complete and piloted from September 2017.

I really believe that the training we offer in Scotland is exceptional. I was delighted this was recognised when NES were recently awarded RPS Foundation School status. This means that trainees who now successfully complete any of our NES VT Foundation training programmes will automatically receive RPS Foundation status, if they are RPS members.

Is the way people access CPD changing? How is NES responding to that?
People are leading busy lives and, as a result, are definitely increasing their demand and use of digital technology in terms of e-learning resources, attending live webinars and watching webcasts in their own time. We are adapting to this in terms of how and what we offer, but we still have demand for face-to-face training events and some paper-based resources.

We are also seeing a bigger demand and a confidence of pharmacists in attending multi-professional training. We support this in a variety of ways – live events in the evenings and at weekends (mainly with GPs), live webinars where the professionals can interact together to ask questions and discuss and also at the increasingly popular Practice Based Small Group Learning (PBSGL) events.

I think that NES are in an ideal position to support these changes as we are a multi-professional educational organisation and can easily facilitate this. My motto is ‘learning together, makes better working together’. NES are also going through a significant digital transformation which should support all of the technological advances we require to support the education of the future healthcare workforce.

How can we get more grass-roots pharmacists to the NES conferences?
I think it’s an issue, and we’d like to see more of them. Our conference focuses on educational developments for the profession so mainly attracts more senior pharmacists involved in education or development. Often, grass-roots pharmacists are more likely to attend the clinically-focused events — perhaps they don’t see it as directly relevant to their day job? We would be delighted to see more grass-roots and early careers pharmacists also attending the conferences as we would welcome their views on developments we have underway.

This year is quite unique as we have been aligned with the NES Medical educational conference with up to 800 people attending with medical educational interests or roles. It also includes GP practice managers and GP practice nurses so it’s ideal for our pharmacists working in GP practice roles and support to come along.

Should we have funded CPD (protected learning)?
I think we need to have wider discussions within the profession to see how we can take this forward but I would be supportive of this, especially as pharmacists are becoming busier and busier and need to have time to keep up to date and develop.

How do you see community pharmacy developing?
The future of community pharmacy is exciting with lots of developments coming. I think we need to develop the clinical and prescribing role of the pharmacists while maximising the use of technology and the appropriately trained skill mix within the pharmacy to be able to take on these new roles in supporting the GP workload and the demand on out of hours services.

As the national organisation for NHS educational development I think we need to support early career pharmacists in developing them into confident generalist pharmacists who can work across sectors of care and perhaps support the portfolio careers that younger pharmacists seem to like. However, we shouldn’t stop there. We can help support community pharmacists and pharmacy technicians in a career development framework. Encouraging advanced roles as both generalists and specialist services means they can be recognised for their development of clinical services rather than just in a managerial way, as it has been in the past.

I think we need to work in a much more multi-professional way in future and recognise our specific role that we have to offer in the healthcare team. What better way to encourage this than to ensure healthcare professionals work together in the learning environment?

The future is bright and is probably one of the best times for the pharmacy profession to be recognised. We need to be ready to grasp every opportunity with both hands and I am absolutely committed to NES supporting this from an educational viewpoint.

 

 

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