According to chapter eight, a way forward to successfully develop skill mix of occupational groups in healthcare has already been developed elsewhere in healthcare. Closer observation of this successful approach demonstrates why the current approach being taken to the development of skill mix in community pharmacy by the Governments’ Rebalancing Committee is fundamentally flawed and why it fails to secure the confidence of the profession.
The Department of Health’s New Ways of Working (NWW) programme was focussed upon the improvement of skill mix involved in the provision of the mental health service. It introduced new and extended roles for a range of staff grades. It was led by the National Institute for Mental Health and it considerably developed the overall quality of the mental health service.
“This successful NHS skill mix programme was built on solid foundations because it was planned and led by personnel who are experienced in the field and whose authority is earned by their ability to command the respect of those who will be affected by the changes. This is a role for experienced coal face practitioners and not for civil servants,” says PDA Chairman, Mark Koziol.
From the success of this NWW programme, a number of principles were established which could be transferred to community pharmacy to improve skill mix and develop new roles:
- Benefits for both users and their carers must first be identified
- A needs assessment would be required to determine whether the NWW programme would be needed to deliver the benefits identified in point 1
- Any new roles need clearly defined competency requirements
- Clear communication and buy-in must be secured with the relevant key stakeholders
- Complete clarity around professional accountability and responsibility must be established.
This NWW skill mix programme relied upon the following working principles:
- Horizon scanning must take place to identify strategic objectives and anticipate likely long-term changes in the landscape that may require future changes to roles
- Not only would stakeholders need to sign up to the programme, they must become active partners in its implementation
- Securing evidence of what works well and then disseminating that evidence are necessary conditions of success
- Funding must be secured for the staff involved in any expanding roles (via a skills and salary escalator). Staff are unlikely to take on more responsibilities unless they are paid more.
- The process of change could be expected to take up to five years to complete
- The overall programme must be planned and led by personnel who are experienced in the field and whose authority is earned by their ability to command the respect of those who will be affected by the changes.
The NWW programme aimed to enhance the capability of the whole team and took a whole-system integrated approach. It did not seek to simply create new standalone roles for specific singular groups. Therefore, new roles in mental health were considered together with the needs of the whole team. Practitioners would only relinquish their existing roles and allow them to be taken up by other staff groups with newly-acquired skills if they could take on new roles themselves. In turn, others were simultaneously prepared to relinquish the roles to which the practitioners aspired.
The PDA has consistently argued that if the role of the pharmacist in the community pharmacy setting is to develop and flourish, then an extended role for pharmacy technicians is not only necessary, but it is vital.
The learning points observed in the Departments’ New Ways of Working project are highly relevant to community pharmacy if skill mix is to be developed in a way that enhances the roles of the pharmacist and the pharmacy technician.
Contained within the eight chapters of the PDA’s Pharmacy Technicians Report are a large number of recommendations which outline how skill mix in community pharmacy should be approached and the reasons why.
READ THE CHAPTER 8 EXECUTIVE SUMMARY HERE
READ CHAPTER 8 IN FULL HERE