South East Medicines Management Education & Development Pharmacy Annual Report 2009/10
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South East Medicines Management
Education & Development
Pharmacy
Annual Report 2009/10
www.semmed.nhs.uk
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MISSION STATEMENT
Our ultimate goal is to ensure that NHS staff who provide modern medicines
management and pharmacy services are able to access superior quality education
and development. In reaching this goal we will have established positive relations
and credibility between ourselves and all our stakeholders whilst delivering the
highest levels of professionalism and experience. We will continually strive to excel
at customer service.
We are committed to a work environment where each person is valued, respected
and has an opportunity for personal and professional growth.
www.semmed.nhs.uk
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Contents Executive Summary .................................................................................................................................................... 3 Quality Management................................................................................................................................................... 3 1. Introduction .............................................................................................................................................................. 5
1.1 Developing a Strategy ........................................................................................................6
2. Planning the Workforce ........................................................................................................................................ 8 2.1 Specialist advice to workforce planners .................................................................................8
2.2 National Vacancy Survey.....................................................................................................8
2.3 Training Pharmacy Staff in Workforce Planning.......................................................................8
3. Developing tomorrow’s workforce – Investing in New Trainees .......................................................... 9 3.1 Preregistration Pharmacist Training.......................................................................................9
3.2 Preregistration Trainee Pharmacy Technicians (previously student pharmacy technicians)........... 18
3.3 Trainee Pharmacy Assistants ............................................................................................. 24
4. Developing the existing workforce – Supporting Qualified Staff........................................................ 26 4.1 Prescribers...................................................................................................................... 26
4.2 Community Pharmacy Project (South East Coast only)........................................................... 27
4.3 Accreditation of pharmacy staff to take on new roles ............................................................. 30
4.4 Review of Training and Assessment .................................................................................... 37
5. Enabling and supporting the workforce ....................................................................................................... 41 5.1 Succession Planning and Developing Leaders ....................................................................... 41
5.2 Developing the Education Infrastructure .............................................................................. 43
6. Providing advice to the Strategic Health Authority ................................................................................. 46 7. Delivering the service ........................................................................................................................................ 47
7.1 Staff .............................................................................................................................. 47
7.2 Information Management – www.semmed.nhs.uk ................................................................. 49
7.3 Finance .......................................................................................................................... 49
www.semmed.nhs.uk
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Executive Summary Given the significant drivers for change not only in the NHS but also specific to the pharmacy
profession, South East Medicines Management Education & Development (SEMMED) facilitated
a project to produce a pharmacy workforce strategic framework in 2009/10. The framework,
“Tomorrow’s Pharmacy Workforce”, was produced by a diverse group representing all sectors
of pharmacy practice, as well as other profession, commissioners and academics. It will be
launched in May 2010 and follows the same structure as the SEC workforce document
“Tomorrow’s Workforce”. It reflects many of the challenges and drivers in this document as
well as more recent developments, most notably the financial crisis.
Education Infrastructure
20 pharmacy staff were accredited as trainers in 2009/10 bringing the total in South East
Coast and Hampshire & Isle of Wight to 47.
A new project was established in Oct 2009 to develop a common accreditation framework and
assessment for all pharmacy staff working in an education supervision role. The project group
comprises representatives from pre and post pharmacist and pharmacy technician tutors as
well as education expertise. In March 2010 the group produced a standard terminology
document defining the terms practice and education supervisor and mapping these to a wide
range of pharmacy roles. The accreditation framework should be drafted and piloted in
September 2010.
Quality Management Centre Review (the Deanery Quality Management process) was implemented for
preregistration pharmacists in 2009. The process was well received by pharmacy employers
and identified some common areas for improvement as well as innovative examples of good
practice.
Preregistration Pharmacists
The SEMMED team successfully recruited 53 preregistration pharmacists into placements in
NHS Trusts and the professional registration rate was 94% which continues to be above the
national average. Retention was above the national average with 77% retained in NHS posts
upon registration. SEMMED supports preregistration pharmacists with a programme of regional
study days and learning resources
www.semmed.nhs.uk
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Pharmacy Technicians
29 pharmacy technicians completed their training in 2009. There are now 43 new trainees in
their first year of training.
82 pharmacy technicians were accredited to undertake roles in checking medicines, medicines
management (medication history taking and device counselling) and consultation.
In keeping with service developments, the medicines management accreditation has been
reviewed to focus more on medicines reconciliation as well as using a more blended approach
to learning including increased use of web based resources.
Community Pharmacy
There have been some notable successes for community pharmacy development.
The PCT community pharmacy leads network continues to meet quarterly to deal with
community pharmacy issues affecting all PCTs such as pharmaceutical needs assessments,
electronic prescription service, local enhanced services and harmonisation of accreditation for
their provision, emergency planning, in particular the flu pandemic and NHS Health Checks.
Five PCTs have received funding from the SHA to pump prime the development of pharmacists
with a special interest. There are 16 pharmacists enrolled on courses to support this
development (see section 5.1.1).
Delivering the service
The service was delivered by the SEMMED team comprising 7.8wte pharmacists, pharmacy
technicians and business and administrative staff. The service was delivered within budget.
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1. Introduction 2009/10 will be remembered as the year that the impending and long-term financial
challenges for the public sector were realised. After a long period of growth, all NHS
organisations are now actively seeking to make substantial savings in their budgets through
improved productivity whilst at the same time maintaining quality.
Pharmacy will be significantly affected – in 2009/10 we saw 14% growth in preregistration
pharmacists as well as an increase in substantive pharmacy posts. In contrast employers are
now reviewing their skill mix with a view to reducing numbers. The implications of this are that
we must continue to strive to optimise skill mix – we are seeing a further expansion in
pharmacy assistant roles- and target staff where they make biggest impact e.g. recent growth
in medication safety support.
The national, regional and local QIPP (quality and productivity plans) highlight a significant
roles for pharmacy in improving the use of medicines – both through reducing cost through
prescribing efficiencies as well as improving the quality of care and reducing waste through
better transfer of information, targeting high risk patients and minimising medicine risk.
Within the pharmacy profession, the Modernising Pharmacy Careers programme commenced in
earnest in 2009. There are 2 work streams – preregistration and postregistration. The
preregistration workstream is seeking to integrate the undergraduate and preregistration
pharmacy year. The principle is supported and the next stage is to recommend a workable
option as well as identify resource to implement any changes. The Head of SEMMED is a
member of this working party. The postregistration workstream is more diverse and not as
advanced.
2009 also saw the introduction of the Responsible Pharmacist legislation. Designed to improve
public safety, the regulations have caused significant challenges to pharmacies where the
dispensary is technician led or medicines are supplied to other organisations.
Locally, SEMMED continued to establish itself as a core Deanery team. SEMMED no longer has
its own stand alone business plan but is an integral part of the Deanery plan. It has also
worked closely in partnership with the Education Team to quality manage preregistration
pharmacist training and to develop the pharmacy education supervision project.
Part of Lord Darzi’s recommendations in High Quality Care for all is that there should be a clear
separation of commissioner and provider function in respect of medical and dental education,
As a result NHS South East Coast has recently undertaken a consultation to inform the future
hosting arrangements for KSS Deanery and SEMMED as well as future proposals to strengthen
education commissioning. We await the conclusions of this but we can expect this to impact
significantly on the Deanery over the forthcoming year.
The following report outlines SEMMED’s activity during the financial year 2009/10.
www.semmed.nhs.uk
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1.1 Developing a Strategy
In June 2009 a working group was established to take forward the production of an SEC
pharmacy workforce strategy. The group comprised multiple stakeholders representing the
SEC geography, all sectors of pharmacy practice, workforce planners, commissioners and other
health professions such as medicine and nursing. The group met twice and reviewed many
drafts virtually. The proposed strategic framework mirrored the lay out of the SEC workforce
framework, “Tomorrow’s Workforce”. Consultation on the “Tomorrow’s Pharmacy Workforce: A
Framework for Action” took place in Jan/ Feb 2010 and the final product was agreed in March
2010. It will be launched in May 2010 after the general election.
The framework outlines 16 areas for action each one divided into local, regional and national
streams. The next phase will be implementation and a dedicated Strategy Implementation
Group is being established.
The strategic direction of SEMMED as a business unit was reviewed in January 2008 during an
externally facilitated workshop with stakeholders representing NHS acute trusts and PCTs, KSS
Deanery, Royal Pharmaceutical Committee, SHA education commissioners and Local
Pharmaceutical Committees. The major changes to the strategy reflect national focus on the
regulation and quality assurance of health care professionals and key themes for business over
the next five years are:
Driving changes in pharmacy skill mix to ensure a value for money workforce
Improving and ensuring robust quality management of placements and
provision of education and training
More multiprofessional education and development – opportunities arising
through multiprofessional deaneries
Maintaining a high profile for pharmacy education within the south east
Increased focus on training pharmacy practitioners to provide services in new
settings particularly increasing emphasis on primary care and working more
closely with community pharmacists and their representative bodies
Transferability of competence assessments between professions as well as
organisations
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Evidence of continued progress in this strategic direction are evidenced through:
Implementation of KSS Deanery Quality Management processes to preregistration
pharmacist training in 2009 and its subsequent publication in the pharmaceutical
press.
Pump priming of Pharmacists with a Special Interest training taken up by 5 PCTs.
There are now approximately 16 PhwSI in training specialising in a range of fields
dependent on the PCT’s commissioning intentions.
Regional transferable accreditation of community pharmacists to provide local
enhanced services (HAG) ahead of the national timetable for implementation
Agreed transferable accreditation in and pre process checking in technical services
across the whole of the south of England as well as pooled training and assessment
resources across the SHAs
SEMMED is not included in the strategic development of pharmacy workforce in NHS South
Central.
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2. Planning the Workforce
2.1 Specialist advice to workforce planners “High Quality Care for All” recommends that PCTs should be more involved in workforce
planning and education commissioning. Within SEC, Local Workforce Partnership Groups are
responsible for the production of workforce plans which are updated annually. These plans
should include an overview of the key drivers affecting both the future demand and supply of
the workforce and a vision for how the workforce will adapt to provide modern health services
that are accessible and high quality. They will directly inform education commissioning. Drafts
of these plans are submitted to the SHA workforce team and ultimately approved by the
Education Commissioning Board.
The SEC Strategic Workforce Planners group comprises representatives of LPGs. In October
2009, SEMMED attended one of their meetings to advise on pharmacy vacancy rates and
significant pharmacy workforce issues.
Nationally the shortage of newly registered pharmacists in the NHS has attracted attention. A
Task and Finish group was established chaired by an SHA Workforce Director to investigate
issues impacting upon recruitment and retention. SEMMED contributed substantially to this
work through the production of reports on recruitment, forecasted demand and retention of
preregistration pharmacists in SEC.
2.2 National Vacancy Survey
Each year, the National NHS Pharmacy Education and Development Committee (SEMMED
represents SEC) produces an Annual Pharmacy Vacancy survey. This covers NHS Acute and
Mental Health organisations and PCTs. The results of this survey have been used to inform
workforce commissioning and pay review negotiations in the past.
In addition SEMMED collated data on behalf of the group on first employment destinations of
newly registered pharmacists and identified reasons for leaving the NHS amongst this group
2.3 Training Pharmacy Staff in Workforce Planning
Once a year the SEMMED team teaches a half day session to senior pharmacists on workforce
planning techniques as part of a management programme.
www.semmed.nhs.uk
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3. Developing tomorrow’s workforce – Investing in New Trainees
3.1 Preregistration Pharmacist Training Unlike other health professions, the pharmacy undergraduate degree programme is funded
through the Higher Education Funding Council (HEFCE) and therefore is not linked to NHS
workforce planning. At present, the rate limiting step between completion of a pharmacy
degree and registration as a pharmacist is completion of a preregistration year in practice. This
is primarily achieved through one of two routes – NHS funded programmes in hospitals and
Primary Care Trusts or community pharmacy programmes funded through a Department of
Health Training grant paid directly to community pharmacy contractors.
SEMMED manages NHS funded preregistration training in the South East and Hampshire. This
service comprises:-
Advice to SHA contracts and commissioning managers on the capacity and
capability of organisations to train preregistration pharmacists
Marketing of NHS careers to pharmacy students
Participation in a national clearing house and centralised recruitment into
preregistration posts
Maintaining a database of trainees in post
Provision of study days and training resources to supplement training provided
at base hospitals
Formative assessment of the clinical competence of preregistration
pharmacists
Troubleshooting training problems
Training new preregistration pharmacist tutors
Supporting a preregistration tutor network
3.1.1 Preregistration Pharmacist Intake August 2008-2009
53 preregistration training places were commissioned; 16 in Hampshire and 37 in the South
East Coast.
Table 3.1 Breakdown of Registration by SHA
NHS South East Coast NHS South Central (H&IOW only)
No of commissions 2008/9 37 16
No of preregistration pharmacists employed
37 16
No registering OCT 2009 37 15
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Two preregistration pharmacists did not sit the exam in June; one South East Coast
preregistration pharmacist started in October and sat the exam in September for the first time;
one South Central preregistration pharmacist failed to provide sufficient evidence of
competence throughout the year. Two preregistration pharmacists failed the exam when they
sat it for the first time in June and re-took the exam in September.
The pass rate for those sitting the exam is 98% which compares favourably with the national
pass rate of 89%.
51 of 53 preregistration pharmacists were entered for the June registration examination. Two
were not entered for the following reasons:
Late starter
Insufficient evidence of competencies
Table 3.2 The Preregistration Exam June/Sept 2009 Summary
SEMMED Region National Figures
No. of Pre-reg’s 53 605
Attempted June/Sept exam (1st attempt)
52 (98%) -
Passed June/Sept Exam (1st attempt)
50/53 (94%)
535 (88%)
Of the two preregistration pharmacists who failed the exam in June, both passed in September. One sat the September exam for the first time and passed.
One did not attempt the exam at all due to insufficient evidence of competencies.
52 of the 53 Preregistration Pharmacists registered by October 2009.
3.1.2 Retention/ First Destination Employment for Preregistration Pharmacists
At the end of the preregistration year, a first destination questionnaire was distributed to all
trainees. The questionnaire asked for their destination data and reasons for their decision.
Of the 52/53 (98%) who completed and returned the questionnaires, 59% (31/52) stated that
they were going to remain in the NHS in the SEMMED region (see table 2.2). The figure for last
year was 60.5%. However, an additional 17% (9/52) of responders stated that they were
going to remain in the NHS and therefore 77% (40/52) of SEMMED trained preregistration
trainee pharmacists will begin their career in the NHS. This is significantly higher than previous
years.
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Table 3.3 Retention Data
Year % stayed in NHS within region
% stayed in NHS
2008/9 59% 77%
2007/8 60.5% 65.1%
2006/7 53% 58%
2005/6 39% 59%
Table 3.4 First Destination Employment for Preregistration Pharmacists
Destination Number/52 (%) National
NHS Hospital 40 (77%) 355 (50%)
Community Pharmacy 3 (6%) 134 (19%)
Further Study/PhD 1 (2%) 25 (4%)
Pharmacist in MOD 1 (2%) 3
Locuming in community 3 (6%) 109 (15%)
Other (taking time out) 2(4%) 16 (2%)
Not known 2 (4%) 48 (7%)
From responses in the questionnaire regarding destination data, it was clear that many moved
to another NHS organisation because of location and a desire to be with family and friends, not
because they had not enjoyed their training year. Of those preregistration pharmacists who
sought employment in another NHS region, all stated that working as a clinical pharmacist,
having close contact with patients and having the opportunity to study at post-graduate level
were important factors in influencing their decision to remain in the NHS.
A number of responders stated that they would have liked to have stayed in their training
Trust if there had been a vacancy at the time of application.
Destinations 2009 %
placement hospital 46
other NHS hospital in region 13
other NHS hospital elsewhere
(decided) 17
www.semmed.nhs.uk
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3.1.3 SEMMED Training Support for Preregistration Pharmacists
2008/9 Preregistration pharmacists completed an exit questionnaire at the end of the
academic year which was divided into three sections:
PART A – Opinions of teaching and assessment provided by SEMMED
PART B – Opinions of training at base hospital and associated placements
o Induction Programme
o Training
o Rotational Supervisors
o Mental Health placement
o PCT placement
PART C – Career plans
o factors considered in choosing sector
Questionnaires were returned by 45 of the 53 (85%) preregistration pharmacists. It is felt that
the reports received gave an honest view of the preregistration pharmacists’ experience and
highlighted a number of areas for improvement both by SEMMED and their base trust.
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PART A – Opinions of teaching and assessment provided by SEMMED
The feedback gave very positive reports on SEMMED training and organisation, with 39
responders (87%) either strongly agreeing or agreeing that they would recommend training in
the South East region to future preregistration pharmacists. On a 5 point Likert scale, the
organisation (av 4.4), enthusiasm (av 4.6) and accessibility (av 4.4) of the SEMMED team
were commended.
The questionnaires also provided narrative feedback from the preregistration pharmacists on
training provided by SEMMED. The exam support day was highlighted as being particularly
beneficial to students. When asked ‘how helpful was the SEMMED regional programme to your
prereg experience and preparation for registration?’ the following responses were obtained:
‘very supportive. Really good tips to survive prereg year. SEMMED folder brilliant –
really useful’
‘The staff were helpful and approachable, I felt at ease at asking both stupid and
sensible questions. Never made to feel stupid. SEMMED has helped prepare me –
possibly may need more community skills’
‘all the study days I attended improved or enhanced my knowledge in those areas and
were relevant in my training year’
‘helped to guide learning and development and clarify the important training points of
the prereg year’
The students were asked to grade SEMMEDs regional programme out of 10, The average
overall mark for SEMMED was 8/10 (40 respondents).
The following issues were identified and amended as detailed:
Preregistration pharmacists requested that SEMMED provide more feedback from
the Objective Structured Clinical Examinations (OSCEs). This is to be reviewed by
SEMMED in the future. OSCE exam dates have been moved to April (from March
2009) to allow the trainees to have completed more of their clinical rotations before
undertaking assessment. The OSCES are being completely reviewed for September
2010 (see section 3.1.4).
An increase in training on responding to symptoms continued to be requested in
feedback received. This topic was addressed at both the Cross Sector Experience
Days and Exam Support Days.
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Many responders felt that further calculations practice would be of benefit, although
only 51% of the preregistration pharmacists indicated they had used the Moodle e-
learning calculation package. The predominant reason why the package was not
used was due to early technical difficulties which have now been addressed.
SEMMED anticipate the use of this system will increase.
PART B – Opinions of training at base hospital and associated placements
28 responders (62%) would recommend training in their base hospitals, while 7% were
uncertain and 3 (6%) would not. This is a slight decrease in those who would recommend (4%
difference) and a significant (14% difference) reduction in those who would not when
compared with last year’s data.
The questionnaire for 2008/9 was expanded to include questions on the various sector
placements occurring throughout the preregistration year and career planning. The results
from this section will be used in the Centre Review process.
For example:
9% of the preregistration pharmacists stated they did not have a PCT placement,
while up to 7% of the trainees had no placement in Mental Health. Some
placements in the PCTs were 10 weeks – which were considered ‘too long’ in
feedback received.
Only 61% of responders said they had a dispensary supervisor, while 23% stated
they did not have a clinical supervisor.
The results from this questionnaire also provided an intense review of each rotational
supervisor. As a result, project work in 2010/11 will focus on developing and accrediting
practice and educational supervisor roles.
3.1.4 Review of Observed Structured Clinical Exams review (OSCEs)
SEMMED have been using formative OSCEs as a formative assessment tool for over 10 years.
There are currently 2 sets of OSCEs –September and April. The first OSCE enables the
preregistration pharmacist to form a baseline of their knowledge and allows the tutor to focus
on areas that need to be improved. The second set of OSCEs allows the student to
demonstrate their learning that has taken place over the year.
The OSCEs have typically posed ongoing challenges, such as determining the pass mark using
the Angoff method.
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In the annual Exit Questionnaire (2009) Preregistration pharmacists requested that SEMMED
provide more feedback from the OSCEs. This triggered a focussed review of both the formative
OSCEs for the preregistration pharmacists and the summative OSCEs for the pharmacy
technicians.
A pharmacist specialising in education attended specialist OSCE training, which resulted in
evidence-based ideas for change being put forward to the OSCE board in January this year.
The proposed changes were received with much enthusiasm and include:
Introduction of a ‘yellow card’ system to encourage consistent professionalism during
the exam
Replacing the Angoff method of ascertaining pass marks with a Regression based model
more suited to smaller numbers of students
Blueprinting of OSCE stations. This will evidently align the OSCE stations to criteria
from national bodies (such as RPSGB)
Reviewing all stations through a readability calculator (SMOG) to ensure students have
the maximum advantage of being able to comprehend station instructions
Using a grading method of assessment for items in the exam rather than ‘essential
criteria’
These changes will necessitate revised assessor and Simulated Patient (SP) training.
3.1.5 Preregistration Pharmacist Intake August 2009- 2010
Table 3.5
NHS South
East Coast
NHS South Central
(H&IOW only)
No of commissions 2009/10 38 18
Number in training 38
16
South Central confirmed 2 extra commissions in January 2009; this resulted in Southampton &
Portsmouth holding interviews outside of the regional recruitment process. Portsmouth failed
to recruit into this position.
Southampton’s extra post failed his undergraduate degree exam in June 09 and the re-sit in
September and will therefore was not able to accept the position offered. One student within
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South Central had a break in training from October 09 due to personal circumstances. This
student recommenced their training in December 2009 and will sit the exam in September
2010.
3.1.6 Preregistration Pharmacist Commissions 2010/11
Table 3.6
NHS South East Coast
NHS South Central
(H&IOW only)
No of PRP commissioned to commence training August 2010 44 20
This shows an increase of six within SEC and two within SC. These extra places are at the
following Trusts:
Ashford & St Peters Dartford & Gravesham Frimley Park Maidstone & Tunbridge Wells Surrey & Sussex Western Sussex Hospitals Southampton Portsmouth
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3.1.7 Pharmacy Undergraduates 2009 (South Central only)
Summer placements for pharmacy undergraduates are funded within Hampshire & Isle of
Wight by NHS South Central. The numbers of commissioned places are shown in the table
below.
Table 3.7
NHS South Central
(H&IOW only)
Trusts hosting placements in 2009 4
Number of placements 2009 16
Number of students participating 16
Number of total weeks funded 64
Placements for 2009
17 placements totalling 68 weeks were funded across 4 acute trusts in Hampshire & IOW.
South Central confirmed funding for all placements requested. Southampton University
Hospitals NHS Trust failed to fill their final place resulting in 16 places filled at a total of 64
weeks.
The Summer Student Scheme Study Day was delivered in the Hampshire and Isle of Wight
region at the end of August. Topics covered included an introduction to the pharmacy team
structure, hospital preregistration training and a session on career structure presented by a
consultant pharmacist. The day was well received by the undergraduates and they found the
presentation by a newly qualified pharmacist and the career pathway information particularly
useful.
The handbook was updated prior to the study day and this will be reviewed again, with input
from the preregistration pharmacist tutors, to ensure that the contents continue to guide the
students through a successful placement.
3.1.7.1 Retention of Pharmacy Undergraduates into Preregistration Pharmacist placements
Seven of the 16 pharmacy undergraduates completing placements within Hampshire & IOW in
summer of 2008 have successfully secured a preregistration placement commencing in August
2010.
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3.2 Preregistration Trainee Pharmacy Technicians (previously student pharmacy technicians)
SEMMED supports trainee pharmacy support staff in the South East and Hampshire through:-
Advice to SHA Contracts and Commissioning Managers on the capacity and
capability of organisations to train preregistration pharmacy technicians
Seeking to commission value for money NVQ training through economies of
scale
Maintaining a database of preregistration pharmacy technicians in post
Setting up, reviewing and monitoring Service Level Agreements with NVQ
centres to provide NVQ registration and support across the region
Troubleshooting training problems
Inputting into the production of an NHS Preregistration Pharmacy Technician
Training Manual
Subcontracting or facilitating the delivery of supplementary training to
supplement that provided at college and in base hospitals
Over the past 12 years, pharmacy services within the NHS have been substantially modernised
and the skill mix reviewed to make the best use of the workforce. As a result, pharmacy
technicians are much more actively involved in duties traditionally undertaken by pharmacists.
This shift continues and, in more recent years, has been very apparent in medicines
management where technicians are actively involved in checking patients’ own drugs, taking
medication histories and counselling on the use of medicines and devices. The outcome of this
is an increased demand for pharmacy technicians. This was recognised by the National
Workforce Review Team in October 2006 which emphasised the changing roles in the
pharmacy workforce and the need to invest in the recruitment and training of pharmacy
technicians. Furthermore, recent guidance by the NPSA/ NICE on medicines reconciliation will
necessitate additional pharmacy technician support in many NHS organisations to ensure
standards are met.
3.2.1 Preregistration Trainee Pharmacy Technicians 2007 – 2009
Table 3.8 shows the number of preregistration pharmacy technicians who were commissioned
in the financial year 2007/8. The majority of students commence training in September 2007
and complete by July 2009. Three students based at East Sussex Hospitals NHS Trust
commenced in January 2008 and completed in December 2009.
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Table 3.8
NHS South Central
NHS South East Coast Hampshire & Isle of Wight
No. of 1st year commissions 2007/9
24 10
No of places filled 24 7
Attrition rate (%) in the 1st year 0 0
Attrition rate (%) in the 2nd year 1 (4%) 1 (14%)
No. qualifying with BTEC/Buttercup award (underpinning knowledge)
20 6
No. gaining NVQ3 July 2009 20 6 No. expecting to gain NVQ3 March 2010
3
No. of technicians retained in substantive NHS posts
21 5
Other (e.g. locum) 1
Two Trusts within Hampshire and IOW failed to recruit during this year.
Two students resigned in their second year without completing the course.
3.2.1.1 Retention / First Destination Employment for Qualified Pharmacy Technicians
Of the 29 technicians qualifying in 2009:
Within SC, five qualified technicians remained in the Trust which trained them. One
technician is currently doing a locum.
Within SEC, seventeen qualified technicians remained in the Trust which trained
them; one has a post in an NHS Trust elsewhere in the region, three have secured
posts in an NHS Trusts outside of region. One technician has moved to community
pharmacy and one is unemployed.
3.2.2 Training Provision
Underpinning Knowledge
The majority of preregistration pharmacy technicians undertake a BTEC in Pharmaceutical
Sciences as their underpinning knowledge for the NVQ 3. This is completed through day
release at Highbury FE College Portsmouth, Bromley FE College, Kent or Westminster
Kingsway FE College, London. An increasing number of employers are substituting FE study
with a distance learning training package from Buttercups which provides NVQ 3 Pharmacy
Services underpinning knowledge. The following Trusts use this model of study:
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Worthing & Southlands NHS Trust
Southampton University Hospitals NHS Trust
Portsmouth University Hospitals NHS Trust
SEMMED supports the delivery of two study days in the year for 2nd year pharmacy
technicians. These optional days provide underpinning knowledge about technical services and
medicines information enquiries and are designed and delivered by the Regional Quality
Assurance and Medicines Information Teams respectively.
NVQ Awards
SEMMED has a Service Level Agreement with three NVQ Centres which sets out the service
specification and reporting arrangements. These centres provide induction days, NVQ
registration and training manuals, portfolio support and certification for NVQ 2 and three
students and A1 & V1 awards.
Surrey & Sussex Trusts have accessed their NVQ services from Bradford College since July
2007. Bradford is registered with Edexcel as its awarding body and has direct certification
status.
Kent Trusts continue to access their NVQ services from Guy’s & St Thomas’ NVQ centre which
continues to have direct certification status.
Trusts in H&IOW continue to access their NVQ services from Wessex NVQ centre based at
Southampton NHS Trust which continues to have direct certification status.
One Trust within SEC is currently suspended from enrolling further trainees on NVQ’s. This is
due to the current number of trainees (L2’s & L3’s) registered compared with the number of
available Assessors/Verifiers including a number of trainee assessors. An action plan is in place
with clear progress and deadlines which need to be met, SEMMED are working closely with the
NVQ Centre to review progress and will confirm when the suspension can be lifted.
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3.2.2.1 Feedback on Preregistration Pharmacy Technician Year 2007 – 2009
Exit questionnaires were returned by 16 of the 26 (62%) pharmacy technicians. It is felt that
the reports received gave an honest view of the preregistration pharmacy technician’s view of
their training over the two years.
The questionnaire covered the following areas:
Underpinning Knowledge Provision for Pharmacy Services (BTEC)
Feedback from students attending college is very positive, particularly the interaction they gain
though networking with other students. The most useful aspect of the training is Actions &
Uses of drugs. This year students disagreed that they had repeated any work done at college
back at base (compared with last exit years data which confirmed the opposite was true)
Students were uncertain as to whether the information gained at college was easily
transferable to the NVQ 3 at base and there is variation across the patch with regards to
guidance supplied by Trusts to map competences gained at college to the NVQ 3.
Underpinning Knowledge Provision for Pharmacy Services (Buttercups Distance Learning)
Three Trusts use Buttercups distance learning course to provide underpinning knowledge
within the base hospital. The majority of students felt this provision worked well alongside the
NVQ 3 however the majority were uncertain that the teaching/support and guidance received
was adequate.
NVQ 3 in Pharmacy Services
Students complete the NVQ 3 along with the underpinning knowledge provision over the two
year period. All students are provided with a workbook. The majority of students found the
paperwork to be clear and concise, particularly useful is the information before each unit which
links to other units for the qualification. Assessments were considered fair and regular updates
regarding assessment plans were made.
Students felt it would be useful to include a medicines management unit. This is currently
being addressed within the national changes to the NVQ qualifications. More workbooks would
be useful and electronic version of paperwork.
Training at base Hospital and Future Career Development
All students rated assessors at base hospital as excellent and had opportunities to meet with
them on a regular basis. The majority of students agreed that they would undertake the
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training in the same hospital again; however four were uncertain whether they would like to be
based within the SEMMED region. (One confirmed they were not aware they were in the
SEMMED region)
Five of the sixteen responses confirmed they had more than one assessor during their training,
this ranged from between 2-5. Benefits of this approach include:
Easier to concentrate on each unit and work on more than one unit at a time
Good to have a second opinion and different areas of expertise
Good experience for trainee assessors
There were however concerns regarding consistency, particularly around assessors having
different ideas of how to collect evidence. This will be addressed as part of the quality
management currently in development for Preregistration trainee pharmacy technicians.
Fifteen of the sixteen trainees have secured posts upon qualification within the hospitals which
trained them. The reasons are stated in the table 3.9 below.
Table 3.9 Salary 1 Training on offer 2 Suitable hours 1 Suitable location 8 Challenge 2 Interest in this area of work 6 Other (please state)
90% of qualified technicians are still working in the NHS; this is an increase of 6% from last
year.
Table 3.10
Year of qualification Retention into NHS posts upon
qualification (% of total students qualifying)
2009 90%
2008 84%
2007 71%
2006 93%
2005 84%
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3.2.3 Preregistration Pharmacy Technicians 2008 – 2010
Table 3.11 shows the number of preregistration pharmacy technicians who were commissioned
in the financial year 2008/9. The majority of students commence training in September 2008
and are due to complete by July 2010. One student based at East Sussex Hospitals NHS Trust
and one student at East Kent Hospitals NHS Trust commenced in January 2009 and are due to
complete in December 2010.
Table 3.11 NHS South Central
NHS South East
Coast Hampshire & Isle of Wight
No. of 1st year commissions 2008/9 28 11
No of places filled 27 12
Attrition rate (%) in the 1st year 0 1
Portsmouth NHS Trust is funding one student independently. East Sussex did not fill one of
their places due to infrastructure issues. One student based at Basingstoke has moved to
Oxford Radcliffe NHS Trust.
3.2.4 Preregistration Pharmacy Technicians 2009 – 2011
Table 3.12 shows the number of preregistration pharmacy technicians who were commissioned
in the financial year 2009/10. The majority of students commence training in September 2009
and are due to complete by July 2011. One student based at East Sussex Hospitals NHS Trust
and one student based at Basingstoke Hospitals NHS Trust commenced in January 2010 and
are due to complete in December 2011.
Due to a lack of assessors at Maidstone & Tunbridge Wells, two students will be completing the
Buttercups NVQ 3 model.
Table 3.12
NHS South Central
NHS South East
Coast Hampshire & Isle of Wight
No. of 1st year commissions 2009/10 30 13
No of places filled 30 13
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3.3 Trainee Pharmacy Assistants
Pharmacy assistants are required to undertake the NVQ L2 either completing the full award or
units appropriate to their area of work. This knowledge is gained in the workplace using a
training manual to guide their study. For smaller Trusts and Prisons who do not have a robust
infrastructure system, SEMMED offers a distance learning package delivered by Buttercups
where assessing and verification is conducted remotely.
Table 3.13 shows numbers registered, completed and total number of units certificated for each NVQ centre
Wessex NVQ centre 2006 2007 2008 2009
Number of L2’s registered 5 31 19 16
Number completed full award 9 5 5 11
Number unit certificated 34 41 13 5
Guy’s & St Thomas’ NVQ centre 2006/2007 2007/2008 2008 2009
Number of L2’s registered 8 5 8 9
Number completed full award 4 14 5 3
Number unit certificated 20 21 4 8
Bradford NVQ centre 2007/8 2008 2009
Number of L2’s registered 42 39 53
Number completed full award 3 10 36
Number unit certificated 1 8 14
Buttercups Ltd 2008 2009
Number of L2’s registered 13 10
Number completed full award 0 3
Number unit certificated 0 16
Number of modules completed 144 (74%) 130 (87%)
Buttercups distance learning course students complete the knowledge modules before
completing the units. There are 15 modules in total and this figure has also been included
within the above table.
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The figures in the above tables of L2’s registered include all those registered with a centre at
any given time and therefore include trainees from 2008 who have not yet completed their
award.
The number of L2’s completing their award has increased over the last 2 years; this is largely
due to an increase in assessor infrastructure and trainees completing the award in a shorter
time period. This also includes assistants who were already employed and required to complete
the L2 (or units of) due to registration requirements, this has now levelled out across the
whole patch and only newly appointed assistants are now registering and enrolling onto an
NVQ following the 6 month induction period requirement.
Attrition
Wessex Over the last 2 years, 1 has left and 1 moved
to L3
Guy’s & St Thomas’ 3 left during 2009
Bradford 6 withdrawn during 2007/09 for reasons such
as health or leaving Trust
Buttercups 1 withdrawn
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4. Developing the existing workforce – Supporting Qualified Staff
4.1 Prescribers 4.1.1. Non-Medical Prescribing (South East Coast only)
The number of new non medical prescribers trained between April 2009 and 2010 is broken
down by University and shown in Table 4.1
Table 4.1
Cohort 1 Cohort 2 Total
Univ of Surrey 17 cancelled 17
Univ of Brighton 11 8 19
Canterbury Christchurch 35 35
Medway School of Pharmacy 10 13 23
The breakdown by profession is shown in table 4.2
Table 4.2 Number of Non-Medical Prescribers
Profession Number trained in 2009/10
Nurse 80 Pharmacist 12 Podiatrist - Radiographer - Optometrist - Physiotherapist 2 Physicians Assistant -
Two “Safe to Prescribe” conferences were held in 2009 for all non medical prescribers across
the South East Coast. The events provided the opportunity for staff to network and share best
practice, learn about new developments in non medical prescribing and consider how they can
contribute to the provision of modern accessible health care in line with the SEC regional
vision, “Healthier People, Excellent Care”. The same event was held twice, repeated in Kent
(115 delegates) & Sussex (140 delegates).
Feedback from the day was excellent particularly the session on the Medical Legal Aspects of
Non Medical Prescribing. As a result a more lengthy focussed event on this subject, “The Jury’s
Out” was commissioned and held in March 2010. There were approximately 85 delegates.
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4.1.2 Prescribing for Junior Doctors
“Safe Prescribing” is part of a suite of e learning materials available to Foundation doctors to
support them during their training. South Thames Foundation School doctors received
passwords to access Safe Prescribing in September 2009 but we are aware that only
approximately 50% have used these. In addition hospital pharmacy staff frequently provide
prescribing training at a local level for their junior doctors but often it does not refer to or build
upon the Safe Prescribing programme.
To improve this, SEMMED liaised with Electronic Learning for Health (ELFH) and in January
2010, a named lead pharmacist in each hospital in SEC received their own password for Safe
Prescribing. This will enable them to become familiar with the Safe Prescribing materials and
encourage their use through integration or reference in their teaching.
In 2010 it is hoped to develop this further through working in partnership with the Foundation
School to promote the programme as well as support lead prescribing pharmacists to network
and share teaching and assessment resources.
4.2 Community Pharmacy Project (South East Coast only)
During the second year of the post, the community pharmacy development lead post has built
on the work previously achieved.
This specifically includes:
PCT community pharmacy leads network with regular quarterly meetings
New community pharmacy commissioning network supported by Primary Care
Commissioning
The expansion of North East England’s harmonisation of accreditation (HAG) scheme
for community pharmacy enhanced services which was rolled out across the SHA
area in 2008/9
Continuing support for PCTs to develop pharmacists as pharmacists with a special
interest (see section 5.1.3)
Continuing support for the Health Informatics Service (HIS) team with their work to
roll out the electronic prescription service
Advice and support to the SHA and PCTs regarding pharmaceutical issues during the
National Flu Pandemic alert
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Harmonisation of Accreditation (HAG) Work is now being carried out by Primary Care Commissioning to try to meet one of the
Pharmacy White Paper objectives to roll out the North West England scheme for harmonisation
of accreditation of pharmacists for enhanced services across England. This has already has
been successfully implemented in SEC ahead of the national adoption of the scheme All the
PCTs have agreed to recognise HAG accredited pharmacists and are working towards providing
enhanced service training to the HAG standard.
To build on this plans are being progressed to commission local enhanced service training
across the region. This will mean that a pharmacist working in community pharmacy in any of
the PCTs in SE Coast can access any training event and become HAG accredited to provide the
enhanced service in any of the PCTs. Subject to PCT agreement; a pilot will start in September
and run throughout this academic year.
Electronic Prescription Service (EPS) The HIS team has received support with its work developing and implementing the EPS in
South East Coast. There is a regular agenda item at the community pharmacy leads network
meetings and the SE Coast EPS forum has been re-established.
Pan SHA pharmacy event – June 2009 SEMMED and NHS London organised a community pharmacy event for representatives from
the PCTs in SE Coast, London, South Central and East of England. The event focussed on
World Class Commissioning of Pharmacy Services and Pharmaceutical Needs Assessments
(PNA). There was a mixture of plenary and workshops and the participants found that the
practical exercises and ‘real’ scenarios in the workshop were very useful. Although the PNA
toolkit had not, at that time, been published, the groups identified up to three actions that
they could take away and put into practice. The full workshop report can be found on the
SEMMED website.
Community Pharmacy Commissioning Network The first meeting of a region wide community pharmacy commissioning network took place on
19th November 2009. At the meeting there were representatives from PCTs, LPCs and the
primary care support services. It was a very successful and useful networking day and the
agenda included:
An overview of the changes to the NHS (Pharmaceutical Services) Regulations 2005
that took effect from 17 September 2009
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An opportunity to input to the consultation on the fees for pharmacy applications
and new arrangements for the provision of appliances
An update on pharmaceutical needs assessments and progress so far
An opportunity to share best practice and issues to do with pharmacy contract
applications and contract monitoring and fitness to practice.
The full workshop report can be found on the SEMMED website. The next meeting of this
network will take place in the summer.
National Flu Pandemic SEMMED was able to support the SHA and PCTs emergency planning teams by providing
pharmaceutical advice and cascading information from the Department of Health and other
SHA colleagues during the flu pandemic.
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4.3 Accreditation of pharmacy staff to take on new roles
4.3.1. Training for pharmacy staff leading to Accreditation
SEMMED has developed, organised and delivered courses, some of which lead to accreditation,
which contribute to service development and enhanced roles performed by pharmacy staff.
These courses are:-
Final Check of Dispensed Items (Accredited Checking Pharmacy Technicians)
Medication Management Intermediate Level
Medication Management Advanced Consultation Skills
Train the Trainers
In and Pre-Process Checking in Technical Services
Medication Management Introduction
All courses are mapped onto the Knowledge and Skills Framework to support candidates with
evidence requirements towards their dimensions.
See table 4.5 for the number of candidates who have attended SEMMED’s training for
accreditation during September 2008 – March 2010.
4.3.1.1 Final Check of Dispensed Items (Accredited Checking Pharmacy Technicians)
The Accredited Checking Pharmacy Technician (ACPT) course was developed in the South East
in 1997 and was pivotal in the development of the 2001 National Framework for the Final
Check of Dispensed Items. The technician checking role is embedded in pharmacy dispensaries
and contributes to effective skill mix. It has been a mechanism to enable the extension of
clinical pharmacy services.
The ACPT accreditation is now a fundamental requirement within all hospital pharmacy
dispensaries and is seen as essential for most pharmacy technicians to progress in dispensary
management roles. Training for the accreditation was delivered locally in cluster groups
throughout 2008 – 09. SEMMED remaining responsible for the assessment and final
accreditation of staff and quality assurance of the scheme. There are five cluster groups
Kent and Medway
East Sussex
West Sussex
Surrey
Hampshire & Isle of Wight
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Cluster training delivery of ACPT is now well established and all NHS ACPT trainees in the
region are now trained and managed within the cluster structure. During 08/09 the only ACPT
trainees which SEMMED trained directly were 8 BMI employees. The current numbers of ACPT
trainees are:
Table 4.4 – Numbers of ACPT Trainees
Trained during 08/09
Kent and Medway 11
East Sussex 6
West Sussex 13
Surrey 7
Hampshire & Isle of Wight 6
Others (8 BMI, 4 Community) 12
Total 55
Training was undertaken by the Clusters using local trainers with support from SEMMED on
quality / resources.
The figures in the updated table below are taken from Cluster spreadsheet reports of training
activity.
4.3.1.2 Medication Management Introduction The Medication Management programme was developed to support and enhance the delivery
of a patient focused pharmacy service and in particular the evolving roles of Assistant
Technical Officers and Pharmacy Technicians. The Introduction level provided underpinning
knowledge to support the Intermediate and Advanced levels, which lead to accreditation, or
could be used as a stand alone course to support individuals who were new to Medication
Management.
4.3.1.3 Medication Management Accreditations – Intermediate & Advanced
The Intermediate level course provided training on assessing patients own drugs and
medication history taking. In response to feedback from stakeholders on the roles of
intermediate medicines management technicians, device counselling was added to the syllabus
in August 2007.
Candidates were assessed via a portfolio and an Objective Structured Clinical Examination.
This course was pitched at Agenda for Change Band 4 & 5 Pharmacy Technicians. Candidates
have to be re-accredited every two years using CPD records as evidence of competence.
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The Advanced Level course was introduced in 2005 to give candidates the opportunity to
demonstrate the impact their role has on patient care by considering clinical governance and
risk assessment issues. The course was pitched at experienced Medicines Management
Technicians at Agenda for change Band 5 & 6. However, during the Course Board review in
August 2007, it was suggested that the course no longer met service needs as advanced
technician roles were becoming more specialised, particularly in Primary Care Trusts. As a
result, the decision was made to suspend the Advanced Medicines Management accreditation
and develop new courses that would have relevance to specific roles. These courses were:-
Advanced Consultation Skills
Use of medicines reconciliation package
Advanced Consultation Skills
This course for candidates already accredited at the Intermediate level was developed in early
2008 after being identified as a need in August 2007. Stakeholders contributed to the design of
a course that reflected the then current / future roles of pharmacy technicians including
domiciliary visits to undertake medication review in patients’ homes, pharmacy technician led
clinics in the acute sector and medicines management support for Patient Education groups.
The course included training in consultation skills, assessing and supporting concordance /
adherence, admission and discharge planning.
The second cohort started in May 2009. Initially there were 7 technicians enrolled on the
course – three failed to complete due to ill-health; 3 passed and were accredited and 1 has
been granted an extension on their portfolio submission. Result of the final candidate will be
reported next year.
This course has now been withdrawn from the SEMMED programme. Previous accredited
technicians were canvassed and asked if they had been able to apply the practices gained into
their everyday work. Of the 10 accredited across the region, only 1 technician working in a
private hospital had been able to take consulting to the next level.
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4.3.1.4 In & Pre Process Checking Technical Services (IPPC)
The In and Pre Process Accuracy Checking accreditation was originally developed by the South
West region as a means of standardising the training and assessment of pharmacy staff to
undertake this activity. The SEMMED programme has been adopted from the South West and
modified to include an examination process.
Within the course, the pre and in process checking has been further divided into product type
and staff can be accredited to check parenteral nutrition, cytotoxics and control intravenous
additives (CIVAs) or all three.
The scheme does not accredit staff to undertake the “final release check” (although this is
being developed nationally) which remains the responsibility of the Authorised Pharmacist.
However, it does provide a valuable mechanism for assuring standards of training across the
region and enabling the transfer of accreditations across organisations in the south of England.
Candidates can take up to 18 months to complete the programme and SEMMED have been
liaising with departments for feedback on candidate progress for discussion at the Course
Board. In total 13 participants have achieved accreditations since the programme commenced.
One candidate has achieved all three In and Pre Process Checking Accreditations and another
has achieved two Accreditations (for Cytotoxics and Aseptics).
Following the first Course Board meeting in April 2008, the course is now open to NVQ 2
qualified Senior Assistant Technical Officers permanently based in aseptic units if
supported/nominated by the Unit Manager and Chief Pharmacist.
4.3.1.5 Train the Trainer (TTT)
The Train the Trainers accreditation is viewed as an important tool in supporting education and
training capacity and capability within Trusts. It is a competency based programme in which
participants are required to demonstrate their skills in facilitating learning and submit a
portfolio of their teaching experience.
During 2009/10 three cohorts have been held.
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Table 4.5 Number of participants on training for accreditations period September
2008 – March 2010
Training for Accreditation Schemes Kent,
Surrey & Sussex
H&IOW Other Total
Introduction to Medicines Management 16 3 3 22
Intermediate Medication Management (IMM) (3 courses) 40 4 3 47
Medication Management Advanced Consultation Skills 10 0 1 11
In & Pre-process Checking (IPPC) 7 8 0 15
Train the Trainers (TTT) (4 courses) 27 10 0 37
Medicines Reconciliation (1 cohort) 10 6 1 17
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4.3.2 Assessment of Competence & Accreditation
The numbers of students undertaking the assessment and their success rates are shown in
table 4.6 The figures are shown for the Period Sept 2008 to March 2010. The number of
students coming forward for assessment is not in line with the numbers enrolling on courses as
students complete practice activities at their own speed and may come forward for assessment
at any time in the 18 months following enrolment.
Table 4.6 Number of candidates taking assessment and pass rates
Accreditation Assessments
Kent, Surrey & Sussex H&IOW Other Pass rate
ACPT 30 24 9 97%
IMM OSCEs x 3 exams 34 17 2 72%
TTT 24 5 2 62%
IPPC 2 2 0 100%
Advanced Consultation Skills 3 0 0 75%
PIPC (new cohort March 10)
6 5 0 82%
The ‘other’ column is for those from private organisations, Ministry of Defence or NHS Trusts
outside of the SEMMED region.
The pass rate for both ACPT and IMM is higher than in the previous year. TTT is lower due to
re-submission of portfolios which are still to be marked and not included within the overall
pass rate.
Pre and In Process Checking (PICP) formerly IPPC assessments have been included separately
in the above table, please see section 4.3.3.3 for further information on the changes to this
course.
1 Advanced Consultation Skills candidate has been granted an extension.
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Table 4.7 Number of practising accredited staff within the SEMMED region to end of February 2010.
Accredited Scheme Reaccreditations Accrediting for
first time Total practising accredited staff
Accredited Checking
Technicians
2009/10 = 121 2009/10 = 47 304
In & Pre-Process Checking
Accreditation (Aseptics) 2009/10 N/A 2000/10 = 7
14
Medication Management
Accredited Scheme
2009/10 = 21 N/A 35
Intermediate Medication
Management
2009/10 = 24 2009/10 = 22 99
Advanced Medication
Management 2009/10 = 10 2009/10 = 2
28
MM Advanced Consultation
Skills
2009/10 N/A 2009/10 = 4 10
Patient Consultation
Skills Accredited scheme
2009/10 = 11 N/A 15
Train the Trainer
2009/10 = 2 2009/10 = 20 47
Quality, Risk & Audit
2009/10 N/A 2009/10 = 8 16
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4.4 Review of Training and Assessment
4.4.1 Medicines Reconciliation Accreditation
Once the decision was made to suspend the Advanced Medicines Management accreditation
extensive work was carried out during 2008/2009 to develop an accreditation tailored to
support medicines reconciliation as defined in the NICE/ NPSA guidance
(http://www.npsa.nhs.uk/corporate/news/guidance-to-improve-medicines-reconciliation/ )
As a result of this project, the new SEMMED Medicines Reconciliation Accreditation was
launched in March 2009. Medicines Reconciliation is a process designed to ensure that all
medication a patient is currently taking is correctly documented on admission and at each
transfer of care. It encompasses: collection of the medication history from a variety of sources
(usually a minimum of two); checking that medicines prescribed on admission for the patient
are correct and communicating any changes in medicines so that they are readily available for
the next person caring for the patient.
This programme has been developed to support and enhance the delivery of a patient focused
medicines reconciliation service and in particular the evolving roles of pharmacy technicians.
The course work is predominantly work based and the training develops practical Medicines
Reconciliation skills split into three main elements: Patient’s Own Drugs; Medicines
Reconciliation and Device Counselling. It is recommended for Pharmacy Technicians with at
least one year’s experience. SEMMED will accept applications from any NVQ2 (or above)
qualified healthcare professional, depending on the relevance to their job role and if supported
or nominated by their Trust. Candidates will be assessed via a portfolio and an Objective
Structured Clinical Examination.
This programme will replace both the Medication Management Introduction and Intermediate
Medication Management courses as this new course enables Trusts to deliver the NPSA/NICE
Safety Solution Number One on Medicines Reconciliation.
4.4.2 Changes to delivery of training.
During the academic year 2008/2009, the Intermediate Medication Management training
programme was supplied to one Trust via compact disc and hard copy, for in-house delivery of
the training. Under this arrangement SEMMED continued to remain responsible for the
assessment and final accreditation of staff and quality assurance of the scheme. It was hoped
this model would provide much more flexibility to this Trust regarding the timing and delivery
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of the programme and, at the same time, would again enable SEMMED to progress on the
design and delivery of the new Medicines Reconciliation accreditation in response to continued
service redesign and skill mix changes.
4.4.3 Pre and In Process Checking (PIPC) formerly IPPC SEMMED have delivered the Pre and In Process Checking accreditation for pharmacy
technicians working in technical services since 2007. A review of the accreditation began in
2009. This was to ensure that the accreditation was in line with the National Framework for
PIPC.
SEMMED have worked closely with South West Medicines Information and Training (SWMIT)
since development of the scheme but have taken the decision to look at standardising delivery
and assessment methods. Collaborating has ensured that the South of England will be
delivering to the same criteria and standard, supporting confidence and transferability in the
accreditation.
This has meant some changes to the content of training days- the accreditation has now
become a 2 day residential instead of 2 study days held a week apart. An assessment of
candidates checking process has been introduced to day 2 of the residential. Quality assurance
of the assessment has been built in by SEMMED and SWMIT who will act as external examiners
for each other.
To achieve the full accreditation candidates must successfully complete the assessment on day
2 and 1000 checks per module.
8 candidates attended the training in March 2010 with an extra 3 undertaking the assessment,
9 out of 11 candidates were successful.
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4.4.4 Pharmacy Foundation Training Nearly all Band 6 NHS employed pharmacists will undertake a postgraduate diploma in
pharmacy practice to prepare them to take on more senior specialised roles. Most Band 6
Pharmacists are enrolled on the Joint Programme Board (JPB) diploma which is a standardised
diploma syllabus agreed by 9 Universities across London and the South East. The design,
review and management of this programme has been co-ordinated by a central team based in
London for a number of years. However in 2009 it was agreed that as the programme was now
well established and there was a drive to improve employer engagement at a local level,
responsibility for managing the programme should be devolved to Regional boards mirroring
SHA geographies. Responsibility for the design of curriculum and assessment would remain
with a central co-ordinating committee but this model would enable employers to take a more
active role in inputting to this.
The SEC JPB held its first meeting in October 2009. It was agreed that this Board would be
more appropriately named the Pharmacy Foundation Board so that it would be more
meaningful to stakeholders outside of pharmacy. The Board has identified a number of work
streams to focus on, namely:-
Central commissioning of the diploma programme
Working closely with the SHA Education Commissioning Team a proposal has been prepared
making the case for central commissioning of the programme. The primary benefits would be
improved yet reduced quality management processes for Trusts, employer and education
commissioner input into quality management of commissioned programmes and co-ordination
of specialist placements in the latter part of the programme. The proposal will be considered
by the SHA Education Commissioning Board in April 2010.
Mapping specialist placements to defined areas of practice
Working with workforce planners to identify specialties in growth and decline and planning
placements to reflect this. Reviewing the suitability of existing placements
Student feedback
Reviewing how and when this is collected and ensuring feedback is provided to employers
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4.4.5 Training in Specialist Areas
In response to the ongoing strategic review of SEMMED, the number of specialist training days
delivered by SEMMED has gradually reduced over recent years. Instead, SEMMED works
closely with Regional Pharmacy Specialists (covering London, Eastern England and the South
East) to either administer specialist training days or signpost to networks and training days.
This has been most noticeable in Clinical Pharmacy Services, where network days now focus on
areas which would have been previously addressed by SEMMED e.g. NPSA alerts and
medicines reconciliation.
A small number of events are held jointly with London Pharmacy Education & Training (LPET)
to improve economies of scale and reduce cost.
Between April 2009 and March 2010, the following events were included in the annual
programme:-
Basic critical appraisal skills and information governance (shared with London
Pharmacy Education & Training)
Advanced critical appraisal skills (shared with London Pharmacy Education &
Training)
Fundamentals of aseptics (four repeated days shared with London Pharmacy
Education & Training)
The breakdown of attendance for these days by region is shown in Table 4.8
Table 4.8
Course/Event Kent, Surrey & Sussex H&IOW Other Total
Basic critical appraisal skills and information governance 5 1 1 7
Advanced critical appraisal skills 5 2 0 7
Fundamentals of Aseptics
(figures affected by cancellation of course on 3rd February 2009 due to heavy snowfall)
20 18 0 48
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5. Enabling and supporting the workforce
5.1 Succession Planning and Developing Leaders
5.1.1 Pharmacists with a Special Interest (PhwSI)
Pump priming funding has been made available by the SHA to PCTs to develop PhwSIs. Five
PCTs successfully bid for these monies and are now developing pharmacists who wish to
become PhwSIs.
NHS Surrey has recruited six community pharmacists who are now on the short
course at Medway School of Pharmacy to develop their skills to become PhwSIs
providing alcohol services in community pharmacy. The PCT has been successful in
bidding for dome funding from GOSE for a brief interventions project on alcohol
services which the community pharmacists will be using to help them develop their
portfolios
NHS West Sussex has three community pharmacists signed up on the GP Substance
Misuse part 2 training and have agreement from Addaction locally to include these
community pharmacists within their service development. The pharmacists will be
encouraged to go on to become independent prescribers.
NHS Brighton and Hove is developing a PhwSI in sexual health services. This
community pharmacist will help support other local community pharmacists to
develop their skills in order to provide a wider range of sexual health services. The
PCT is also hoping to identify further funding to train another PhwSI in order to have
some succession planning.
NHS Medway has one of its PCT pharmacists training to be a PhwSI in dementia in
order to support other pharmacists to support care homes with their medicine safety
issues.
NHS Eastern and Coastal Kent have received expressions of interest form ten
community pharmacists who are now developing business cases around epilepsy
services through community pharmacy. The successful pharmacists will start the
Medway course in September.
5.1.2 Management Skills for Senior Pharmacists
In recent years, Chief Hospital Pharmacists in South East England have become increasingly
concerned about the challenges in recruiting future leaders of Pharmacy Services in the acute
sector. As a result, research into the role of chief hospital pharmacists and perceptions of their
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deputies was commissioned. The study resulted in the creation of a management course within
the South East, targeted at senior pharmacists.
A course to address this training need was developed and has run since 2007/08. It covers a
range of management skills in the context of the role of Chief Pharmacist and exposes
participants to a range of different role models and practices.
The third cohort of this course started in September 2009. There are 13 participants from
South East Coast and Hampshire including senior pharmacists from the acute, mental health
and primary care sectors.
Participants are encouraged and supported to develop a portfolio of their
management competences - this is linked to the Chief Pharmacist Competency
Framework developed through CoDEG.
Participants are required to undertake a project in the workplace to apply their
management skills
Feedback from participants is positive and the course will be run again in 2010/11. Learning
sets to allow participants to continue their professional development in senior management
have met for participants in the 2007/08 and 2008/09 cohorts.
5.1.3 Chief Pharmacist Network (SEC)
SEMMED actively supports this network through facilitation of the agenda and organisation of
meetings. Meetings are held quarterly and provide an opportunity to discuss common issues
and share best practice. Focus over the past 12 months has been on linking into SHA
initiatives and sharing approaches to common problems e.g. Responsible Pharmacist
regulations. Specific outputs from the meetings have included a bid for regional innovation
funding (which was unsuccessful); an innovations event to prepare a future innovation bid in
line with SHA priorities, the creation of a dispensary leads network and the identification of a
named Chief Pharmacist to work with each SHA Clinical Pathway.
5.1.4 Dispensary Service Lead Network (SEC)
In 2010 a new network was set up in response to the request of the Chief Pharmacist Network
(SEC) and to the needs of all Trusts within the SEC region. Trusts have completed and
returned a questionnaire to SEMMED regarding the issues that affect them and their practice.
SEMMED will actively support this network through organisation of meetings and facilitation of
agendas. Meetings will be held 6 monthly and provide an opportunity to discuss common
issues and share best practice.
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5.2 Developing the Education Infrastructure 5.2.1 Preregistration Pharmacist Tutors
Tutors Network
In the current 2009/10 cohort, there are 51 preregistration tutors supporting 54
preregistration trainee pharmacists. SEMMED organises and facilitates quarterly meetings for
tutors and a representative from each Trust is expected to attend. The meetings are designed
to share information, update the tutors on new guidance which has been issued from the
RPSGB and to discuss changes and developments for the regional pre-registration trainee
programme. The meetings provide a very useful forum for preregistration tutor networking and
developments for future study day programmes. During the last twelve months, there has
been wide representation from all Trusts which included both new and experienced tutors and
the meetings have provided an opportunity for tutors to share experiences and knowledge.
Tutor meetings have also included outlining the Centre Review process for Trusts with input
from the Exit Questionnaires and other relevant topics such as Modernising Pharmacy Careers,
Inter Professional Learning and Patient Involvement. In September a Continuing Professional
Development session was run by CPPE pharmacists to promote CPD both for the tutors and
their preregistration pharmacists. The preregistration Pharmacist tutor meetings enabled the
group to review the SEMMED Regional Training Guide to ensure that the learning outcomes
and suggested practice activities were in line with those directed by the RPSGB and to reflect
service requirements.
The meetings also resulted in the PCT rotations becoming mandatory within the region for a
minimum of two weeks and work is in progress to develop clear learning outcomes for the core
two week rotation.
5.2.1.1 Training for Tutors
During 2009, 2 educational workshops were held for Preregistration Pharmacist Tutors. These
workshops were aimed to equip tutors with the most up-to-date standards in education. The
sessions were seen to be intellectually stimulating but it was not always easy to see how to
translate them into practice. It was felt that pre-course reading would have been helpful. As a
result a further 2 day workshop is scheduled for June 2010 focusing on the uses and the
teaching of clinical reflective writing. The workshops aim to equip tutors with new
understanding about elements of their professional judgement that drive their practice. The
course will explore and provide evidence of the quality of their clinical thinking and decision-
making to enable them to enhance the teaching of professionalism to Pre-Registration
Pharmacists.
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5.2.2 Training for new Preregistration Tutors At present, SEMMED delivers Train The Trainers, which includes principles of teaching, learning
and assessment and also a single study day for new preregistration tutors, which provides an
introduction to the role and responsibilities of a preregistration tutor, appraisal skills and audit.
In June 2009, eight participants attended the new tutor day; of those, six became new
preregistration tutors.
5.2.3 Quality Management SEMMED’s integration into KSS Deanery has provided many opportunities for shared learning
between professions and improved economies of scale. As part of this united approach, in
2009, pharmacy was included for the first time in the KSS Quality Management of NHS Trust
training placements of doctors, dentists and now preregistration trainee pharmacists. This KSS
process is called “Centre Review”.
Centre Review Visits Each centre was visited twice. The first visit was carried out by a pair of trained verifiers, to
verify and sign-off that the Centre’s Quality Manual is complete. Pharmacy departments
completed their own portfolio of evidence which was then submitted to the Trusts Medical
Education Manager in readiness for verification. The second visit, a fortnight later, was a
formal meeting between the NHS Trust Chief Executive, Director of Medical Education, MEM, a
Dean, Deanery Pharmacy Lead and a Deanery Education Adviser (plus any other NHS Trust
staff the Chief Executive wishes to invite, such as the Medical Director, Chief Pharmacist or
Finance Director). That meeting focused on the results of the Quality Manual verification visit
and the Education Strategy for Postgraduate medical, dental and preregistration trainees’
pharmacist education which has been prepared by the NHS Trust. At the end of each meeting,
a draft Action Plan was agreed for the forthcoming year.
Feedback from pharmacy staff was that the process was less time consuming than they had
originally anticipated but that communication with the Medical Education Manager in their trust
could have been improved in some cases.
In many organisations, Centre Review provided an opportunity for pharmacy to shine and share
examples of good practice with other professionals and managers. There were some common
weaknesses identified, namely inconsistent and undocumented meetings between tutors and
trainees, lack of recognition of the tutor role and pharmacy not being integrated into corporate
educational governance systems.
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5.2.3 Developing Educational and Practice Supervisors (DEPS) in pharmacy
Identification of the growing need for competency frameworks that agree and standardise the
knowledge, skills and behaviours/attributes/qualities of pharmacy tutors in the workplace was
identified from a number of various sources:
SEMMED – from the Centre Review process
Joint Programmes Board – feedback from their postgraduate hospital and community
diploma students
Trusts – highlighting the duplication of training that staff were undertaking
SEMMED also recognised gaps in training that were applicable to preregistration pharmacy
tutors.
In August 2009 the DEPS project group was created to explore and identify the attributes of
pharmacy educational supervisors in the workplace, in order to develop an accreditation/QA
process that will ensure competence and fitness to supervise.
To begin this ambitious task, a broad spectrum of professionals were asked to join the project.
Membership of this group includes an education specialist from the Kent Surrey Sussex
Deanery, the director of SEMMED, Educational and Training leads in a range of supervisory
roles, a Chief Pharmacist and teacher practitioners.
The concept of the group has been positively received by members of the Professional
Leadership Body when the project was presented at am RPSGB meeting in January 2010.
The main output to date has been a comprehensive terminology document that rationalises all
of the identified terms within pharmacy education. The draft accreditation framework is
expected in May 2010.
Phase 1 of the project is due to be completed by the end of July 2010.
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6. Providing advice to the Strategic Health Authority Both the Head of SEMMED and Community Pharmacy Development Lead provide
pharmaceutical advice to NHS South East Coast.
With the exception of workforce advice covered elsewhere in this document, other examples of
activities include:-
SHA representation at local Controlled Drugs Local Intelligence Networks (LINs).
This was shared with the Clinical Governance Team but from 2010 will be the
responsibility of the Community Pharmacy Development Lead.
Review of Operating and Workforce Plans with regards to pharmacy services and
medicines management
Responding to pharmaceutical enquiries
Working with other Directorates e.g. recent Pharmacy/ Public Health event
More recently the team has been involved in the production of the SHA QIPP workstream on
medicines management. It is anticipated that this area of activity will increase.
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7. Delivering the service
7.1 Staff
The service is delivered by SEMMED, a small team comprising 7.8wte registered pharmacists,
pharmacy technicians and business and administration staff. Over the past 12 months the
team has been restructured in line with changing business priorities. As a result the full time
highly specialist pharmacist post has been split into 2 part time posts – one specialising in
curriculum and the pharmacist preregistration programme and the second focusing on
education infrastructure and quality. In addition the part time programme support post for
preregistration pharmacist training has been split into 3 x 0.2wte secondments from other
organisations. Two of these posts are with local Universities thereby improving our links and
relationships in preparation for the future integration of the undergraduate and preregistration
programmes. The third secondment is with a PCT to support the development of PCT
placements.
7.1.1 Staff development
A number of SEMMED team members have taken part in a 360 degree survey. An external
company was commissioned to provide support with the set up and implementation.
Stakeholders and team members were involved and asked to complete the survey
electronically. Questions were categorised into 4 sections; personal qualities, vision and
strategy, service delivery and stakeholder relationships. Feedback following the results has
been included within individuals’ personal development plans.
Pharmacy Workforce Lead/ Head of SEMMED
0.8wte
Community Pharmacy
Development Lead 0.5wte
Business and Operations Manager
1wte
Highly Specialist Pharmacist, Education
Infrastructure & Quality 0 6wte
Highly Specialist Pharmacist, Curriculum
Development 0.5wte
Principal Pharmacy Technicians 2 x 0.6wte (job share)
Programme Support Pharmacists 3 x 0.2wte
E-Learning Project Officer
1wte
Administrator 0.6wte
Administrative assistant
1wte
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Investment has also been made in developing the competencies of the team through Masters
in Clinical Education, Postgraduate Medical Education Certificate and MBA. The impact on
practice includes the following:
MBA – inform the implementation of the pharmacy workforce strategy
Masters in Clinical Education – understanding theory behind teaching and delivery of
courses thus providing confidence to review programmes and take on new
challenges that embrace the future direction of pharmacy.
PG Medical Education Cert – apply the principles of curriculum development,
teaching and learning; and assessment in medical education in the delivery and
future direction of the preregistration pharmacist programme
7.1.2 Networks
Given the small size of the team, SEMMED effect most change through engagement and
facilitation of networks. Examples of some of these networks and projects are shown below
Group Description SEMMED Role Example of output
National NHS Pharmacy Education
& Development Committee (and
subcommittees for preregistration
and support staff training)
National network Represent pharmacy
workforce development in
SEC
Annual vacancy survey to OME
and NHS Pay Review Body
Modernising Pharmacy Careers
Phase 2 Working group
National project Represent NHS pharmacy
education and
development
Work in progress to make
recommendations on integration
of undergrad and prereg
pharmacy programmes
Dept of Health/ SHA Non Medical
Prescribing Leads Network
National network Represent NHS SEC Info cascaded to trusts from DH
Dept of Health/ SHA Pharmacy
Leads
National network Represent NHS SEC Information sharing eg response
to pandemic flu
National Medicines management
accreditation project
National project Chair of project, report to
NHS Pharmacy Education
& Development Committee
Work in progress
National Allied Health Professions
prescribing project group
National project Represent SHA Non
medical prescribing leads
Work in progress to develop
physio and podiatrist prescribing
Preregistration tutors network Regional network Chair and organise Regional interview process
SEC Pharmacy Foundation Board Regional
Education Board
Facilitation and
organisation
Central co-ordination of
postgraduate diploma training
SEC Chief Pharmacists Network Regional Network Facilitate and organise Development of innovation bids
and QIPP projects
Regional Local Pharmaceutical
Committee Forum
Regional Network Represent NHS SEC Discussion on development of
HAG accreditation
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Group Description SEMMED Role Example of output
Developing pharmacy education
supervisors in practice
Regional project Facilitate and organise Standardised education
terminology document
Community Pharmacy Leads Regional network Chair Work in progress to co-ordinate
training for local enhanced
services across the region
improving access and economies
of scale
Non Medical Prescribing Leads Regional network Chair Screening calculations paper for
potential NMP applicants
Further education college liaison Regional network Represent NHS SEC Dialogue about quality of
programmes
GP specialty school Regional network Represent SEC
pharmacists
New initiative
London and South East Specialist
Pharmacy Services
Virtual network Represent NHS SEC,
cascade information to
NHS Trusts as appropriate
Annual meeting of all chief
pharmacists across London and
SE of England
SEC Dispensary Managers
Network
Regional network Facilitate Developing common patient
questionnaire- in progress
7.2 Information Management – www.semmed.nhs.uk
The SEMMED websites continues to provide stakeholders up to date information on many
aspects of our service. An E-Newsletter is now available to anyone who signs up through the
website.
7.3 Finance
The budget is expected to break even for 2009/10. Total budget including pay, non pay and
delivery of programmes was £575,000 .
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