Advancing clinical pharmacy practice

This Context Statement contains critical descriptions of my academic and professional outputs as a hospital clinical pharmacist and senior pharmacy leader, over the period 2007 to 2017, with some antecedents prior to 2007. Clinical Pharmacy has a main aim of optimising safe, appropriate and effective medicines use, for individual patients and organisations as well as system-wide. The Public Works presented here centre around four interrelated themes regarding clinical pharmacy – measuring and improving standards and quality of care; prescribing, prescribing practices and prescribing safety; innovative practice within legal and ethical frameworks; the impact and outcomes of clinical pharmacy. A unifying premise is my aim of advancing clinical pharmacy practice. The concept of measuring to improve standards and quality of clinical care has progressed considerably over the past 15 years. I present my contributions to this - developing, implementing, measuring and disseminating clinical pharmacy quality and performance indicators, as well as benchmarking and quality improvement initiatives. The chapter on prescribing encompasses the impact of electronic prescribing on pharmacy practice; the formal and informal roles of hospital pharmacists as prescribers; and a practice model I developed for pharmacists to practice as both specialist and generalist prescribers. I also discuss my research into inappropriate prescribing. The innovative practices in Chapter Four include the introduction of different models of practice to improve patient care and medicines use, with significant focus on a specific initiative - redesigning the discharge medication prescription pathway. Chapter Five highlights other work which I undertook to demonstrate the potential of hospital clinical pharmacy to improve outcomes. Throughout my professional career I have promoted the development of research capability within hospital pharmacy, to better improve patient care. In the concluding chapter, I draw from other professions to conceptualise a model of integrating professional practice, theory and research. Pharmacy Praxis is a philosophy which bears further development, in order to continue the progress of clinical pharmacy

Evidence for the outcomes and impact of clinical pharmacy: context of UK hospital pharmacy practice

Objectives: The role of clinical pharmacists in hospitals has evolved and continues to expand. In the UK, outside of a few national policy drivers, there are no agreed priorities, measures or defined outcomes for hospital clinical pharmacy (CP). This paper aims to (1) highlight the need to identify and prioritise specific CP roles, responsibilities and practices that will bring the greatest benefit to patients and health systems and (2) describe systematic weaknesses in current research methodologies for evaluating CP services and propose a different approach. Method: Published reviews of CP services are discussed using the Economic, Clinical and Humanistic Outcomes framework. Recurring themes regarding study methodologies, measurements and outcomes are used to highlight current weaknesses in studies evaluating CP. Results: Published studies aiming to demonstrate the economic, clinical or humanistic outcomes of CP often suffer from poor research design and inconsistencies in interventions, measurements and outcomes. This has caused difficulties in drawing meaningful conclusions regarding CP’s definitive contribution to patient outcomes. Conclusion: There is a need for more research work in National Health Service (NHS) hospitals, employing a different paradigm to address some of the weaknesses of existing research on CP practice. We propose a mixed-methods approach, including qualitative research designs, and with emphasis on cost-consequence analyses for economic evaluations. This approach will provide more meaningful data to inform policy and demonstrate the contribution of hospital CP activities to patient care and the NHS

Expert Panel: evaluation of the Government’s commitments in the area of pharmacy in England (Tenth Special Report of Session 2022–23)

Governments often make well-publicised policy commitments with good intentions to improve services for the public. While such policy commitments can be made frequently, it is often difficult to evaluate or monitor the extent to which these commitments have been, or are on track to be, met. For this reason, formal processes of evaluation and review are essential, not only to hold the Government to account, but to allow those responsible for policy implementation to critically appraise their own progress; identify areas for future focus; and to foster a culture of learning and improvement. Such a process can also promote improvements in the quality of the commitments made. Improvement and review are iterative processes during which the impact and success of innovations are identified, modified, and reviewed and this discipline is already in good use within the NHS. The concept has also been used successfully including in health and social care, by the Care Quality Commission (CQC). To apply this approach to health policy, the House of Commons Health and Social Care Select Committee established a panel of experts to support its constitutional role in scrutinising the work of the Government. The Panel is chaired by Professor Dame Jane Dacre DBE and is responsible for conducting politically impartial evaluations of Government commitments in different areas of healthcare policy. The Panel’s evaluations are independent from the work of the Committee. The Expert Panel produces a report after each evaluation which is sent to the Committee to review. The Panel’s report is independent. The final report includes a rating of the progress the Government have made against achieving their own commitments. This is based on the “Anchor Statements” (see Annex A) set out by the Committee. The intention is to identify instances of successful implementation of Government pledges in health and social care as well as areas where improvement is necessary, and to provide explanation and further context. The overall aim is to use this evidence-based scrutiny to feed back to those making promises so that they can assess whether their commitments are on track to be met and to ensure support for resourcing and implementation was, or will be, provided to match the Government’s aspirations. It is hoped that this process will promote learning about what makes an effective commitment, identify how commitments are most usefully monitored, and ultimately improve health and care. Where appropriate, the Panel will revisit and review policy commitments to encourage sustained progress. The Expert Panel’s remit is to assess progress against the Government’s key commitments for the health and care system rather than to make policy recommendations. This is the sixth report of the Expert Panel and evaluates the Government commitments made in the area of pharmacy services in England