Community

Pharmacy

Handbook

Community

Pharmacy

Handbook

Jon Waterﬁeld

BPharm, MSc, MRPharmS, PGCE

Senior Lecturer in Pharmacy Practice and Clinical Pharmacy

Leicester School of Pharmacy, De Montfort University

Leicester, UK

London • Chicago

Published by the Pharmaceutical Press

An imprint of RPS Publishing

1 Lambeth High Street, London SE1 7JN, UK

100 South Atkinson Road, Suite 200, Grayslake, IL 60030-7820, USA

is a trade mark of RPS Publishing

RPS Publishing is the publishing organisation

of the Royal Pharmaceutical Society of Great Britain

First published 2008

Typeset by Photoprint, Torquay, Devon

Printed in Great Britain by TJ International, Padstow, Cornwall

ISBN 978 0 85369 716 9

stored in a retrieval system, or transmitted in any form or by any means,

without the prior written permission of the copyright holder.

The publisher makes no representation, express or implied, with

regard to the accuracy of the information contained in this book and

cannot accept any legal responsibility or liability for any errors or

omissions that may be made.

The right of Jon Waterﬁeld to be identiﬁed as the author

of this work has been asserted by him in accordance with the

A catalogue record for this book is available from the British Library

Contents

Preface vii

How to use this book ix

Acknowledgements xi

About the author xii

Abbreviations xiii

1 Continuing professional development 1

The CPD concept 2

CPD and clinical governance 4

CPD – getting started 5

Personal development planning 18

2 Management skills in the pharmacy 29

Time management 31

Motivating your team 39

Management of meetings 42

Performance management 44

Teamwork and communication 45

Information management 48

Management style 51

3 Training and development of the pharmacy team 59

Pharmacy support team 59

Training needs analysis 63

Training methods in the pharmacy 66

Coaching skills 75

Evaluation of training 78

4 Contractual framework for community pharmacy 87

Contract overview 88

Essential services 90

Standard operating procedures 104

Monitoring the contract 108

Support for people with disabilities 109

Community pharmacy contract for Scotland 112

5 Medicines use review 121

Accreditation 122

Planning the MUR service 125

Conducting a MUR 129

Practical solutions to patient problems 133

Summary 135

6 Offering enhanced services 144

Commissioning of services 144

Practical guidance on delivering enhanced services 147

7 Supplying medication 181

Dispensary design and workﬂow 181

Patient medication records 189

Accredited checking technician 190

Dispensing errors 192

Electronic transmission of prescriptions 197

Managing customer complaints about NHS services 198

Patient group directions 200

Pharmacists as prescribers 202

8 Responding to symptoms 210

Presentation of symptoms 212

Making a differential diagnosis 214

Communication skills in the pharmacy 218

Effective use of support staff 221

Speciﬁc product requests 224

Evidence-based recommendation 224

Monitoring of symptoms 227

Audit – responding to symptoms 228

9 Multidisciplinary working 235

Relationships with general practice 237

Medicines management 237

Making a business case for a new service 242

Negotiation skills 244

Working with hospital pharmacists – discharge schemes 246

Working with speciﬁc patient groups 247

The way forward 251

Answers 259

Appendix 1 Example of a medicines use review form 273

Index 278

vi Community Pharmacy Handbook

Preface

With the introduction of the new contractual framework for community

pharmacy there are many opportunities for pharmacists to engage in new

ways of working. For the community pharmacist this new challenge is

both exciting and daunting: exciting in that the pharmacist has many

more opportunities to apply their skills as a primary healthcare profes-

sional; daunting, as for many pharmacists this is completely new ter-

ritory. A theme that runs throughout this book is continuing professional

development (CPD) and how this essential process can be applied to

develop conﬁdence and expertise in new areas of practice. The aim of this

book is to provide a spectrum of relevant and accessible information on

contemporary community pharmacy practice.

Chapters 1 to 3 are on CPD, applying management skills to com-

munity pharmacy and the training and development of the pharmacy

team. These introductory chapters recognise that in order to successfully

participate in new opportunities, the pharmacist needs to be conﬁdent

about managing their own development and in turn the training and

development of their support team. It is clear that the successful intro-

duction of new services is dependent on the effective management of the

whole pharmacy team.

Chapters 4 to 6 include information on the new contractual frame-

work, offering advanced services and the practical issues associated with

the delivery of the most popular enhanced services. While much of the

content of these chapters relates speciﬁcally to the contractual framework

in England, many of the practical issues discussed also relate to other

national contracts.

Chapters 7 to 9 are on supplying medication, responding to symp-

toms and multidisciplinary working. These chapters aim to provide an

insight into some of the newer ways of working both within the phar-

macy and with other healthcare professionals.

The book is designed to answer practical questions such as:

■ how do I manage my own professional development?

■ what is the best way of motivating and supporting my pharmacy support

team?

■ what are the practical issues involved in setting up new services?

■ how do I work effectively with the primary care team?

■ how do I promote the value of pharmacy services?

Clearly this is a challenging and deﬁning time for community pharmacy.

Community pharmacists are highly accessible healthcare professionals

with many conﬂicting demands on their time. The overall aim of the

Community Pharmacy Handbook is to provide a stimulus to encourage new

ways of working that will result in increased pharmaceutical care in the

community. If this aim is even partially achieved, the effort has been well

worth while.

Jon Waterﬁeld

December 2007

viii Community Pharmacy Handbook

How to use this book

In addition to offering support for the community pharmacist, this hand-

book will also address some of the learning needs of pharmacy under-

graduates and preregistration graduates.

Key features of each chapter

Checkpoint

At the beginning of each chapter there is a short ‘Checkpoint’ section

with some questions to encourage personal reﬂection on the subject. It is

a useful exercise to think about each question before starting to read the

chapter.

Implications for practice

At the end of each chapter there are two suggested activities to apply

what has been discussed in practice. The activities are only intended as

suggested starting points and may lead to other continuing professional

development activity.

References and further information

At the end of each chapter a reference and further information section is

provided to supplement the text. Many of the references to original doc-

umentation have a URL reference. All of the sites have been checked for

accuracy and relevance.

Multiple choice questions

There is a set of ten multiple choice questions that relate to each chapter.

These questions are designed to mainly test factual recall and provide the

opportunity for self-assessment of different subject areas. The questions

are written in the style of the Royal Pharmaceutical Society of Great

Britain registration examination.

Case studies

An integral part of this handbook is the inclusion of case studies to con-

solidate the issues and apply the knowledge explored in each chapter. The

exercises are aimed at three different levels:

■ level 1: pharmacy undergraduate student

■ level 2: preregistration graduate

■ level 3: community pharmacist.

A set of brief suggested answers for all case studies is provided at the end

of the book. The answers are not intended to provide a deﬁnitive model

answer, but to support the reader in the reﬂection and learning process.

x Community Pharmacy Handbook

Acknowledgements

I would like to express my sincere thanks to Sandra Hall, Head of

Pharmacy Practice, Leicester School of Pharmacy, for reading the

manuscript and offering helpful comments and suggestions.

The book would not have been written without the support of my

family. Many thanks especially to Alison who encouraged me to embark

on this project. Daniel, Anna and Mark ensured that the book was on

schedule by regularly asking how many words had been written!

About the author

Jon Waterﬁeld registered as a pharmacist in 1984, having completed

his degree at the University of Bradford. Jon qualiﬁed as a science teacher

and completed his Postgraduate Certiﬁcate in Education at the University

of Leicester. The early part of his career included teaching science in

secondary and further education, both abroad and in the UK. Jon

also developed a career within community pharmacy and held various

positions as a community pharmacist-manager. In 1993 he completed a

pharmaceutical industry research project that resulted in an MSc degree

in pharmacology. For several years Jon was national Pharmacy Training

Manager for Gehe UK. In 2005 he was appointed Senior Lecturer in

Pharmacy Practice and Clinical Pharmacy at Leicester School of

Pharmacy, De Montfort University.

Abbreviations

ACE angiotensin-converting enzyme

ACT accredited checking technician

AMS acute medication service

BMI body mass index

BNF British National Formulary

CD controlled drug

CE continuing education

CHD coronary heart disease

CMP clinical management plan

CMS chronic medication service

CPD continuing professional development

CPMMP Community Pharmacy Medicines Management Project

CPPE Centre for Pharmacy Postgraduate Education

CRC child-resistant container

CSCI Commission for Social Care Inspection

DDA Disability Discrimination Act 1995

DOTS directly observed therapy scheme

DQ direct questioning

EEA European Economic Area

ETP electronic transmission of prescriptions

FH family history

GMS general medical services

GP general practitioner

GSL general sales list

HbA

haemoglobin A

HEI higher education institution

HPC history of presenting complaint

ICAS Independent Complaints Advocacy Service

IT information technology

LPC local pharmaceutical committee

MAR medicines administration record

MAS minor ailment service

MCA medicine counter assistant

MEP RPSGB Medicines, Ethics and Practice guide

MUR medicines use review

NatPaCT National Primary and Care Trust Development Programme

NICE National Institute for Health and Clinical Excellence

NPA National Pharmacy Association

NPSA National Patient Safety Agency

NRT nicotine-replacement therapy

NSAID non-steroidal anti-inﬂammatory drug

NSF National Service Framework

NVQ National Vocational Qualiﬁcation

OTC over-the-counter

P pharmacy medicine

PC presenting complaint

PCC primary care contracting

PCO primary care organisation

PCT primary care trust

PDP personal development plan

PGD patient group direction

PHS public health service

PI prescription intervention

PIL patient information leaﬂet

PMH past medical history

PMR patient medication record

PNA pharmaceutical needs assessment

POM prescription only medicine

PPD Prescription Pricing Division

PSNC Pharmaceutical Services Negotiating Committee

QOF Quality and Outcomes Framework

RCA root cause analysis

RPSGB Royal Pharmaceutical Society of Great Britain

SH social histor y

SLA service level agreement

SMART speciﬁc, measurable, achievable, relevant and timed

SOP standard operating procedure

SSRI selective serotonin reuptake inhibitor

SVQ Scottish Vocational Qualiﬁcation

SWOT strengths, weaknesses, opportunities, threats

TNA training needs analysis

WCPPE Welsh Centre for Pharmacy Postgraduate Education

WML Waste Management Licensing (Regulations)

xiv Community Pharmacy Handbook

Continuing professional development

Twenty years from now you will be more disappointed by the things you

didn’t do than by the ones you did do. So throw off the bowlines. Sail

away from the safe harbour. Catch the trade winds in your sails. Explore.

Dream. Discover.

(Mark Twain)

Continuing professional development (CPD) for the healthcare pro-

fessional is a theme that runs throughout this book. There are many

deﬁnitions of CPD and often much confusion about what CPD means in

practice. One very simple deﬁnition of CPD is: ‘everything that you learn

that makes you better able to do your job’. The primar y aim of the CPD

process is to improve the quality of the services we provide as a com-

munity pharmacist. The quality of pharmaceutical service provision is

increasingly measured by both the public and our paymasters. CPD

offers the pharmacist the opportunity to stand back and look at ways

of improving their level of professional competence. The fact that you

are reading this Community Pharmacy Handbook is evidence that you are

interested in CPD and developing the way that you practise in the

community.

This introductory chapter looks at:

■ the origins and drivers for CPD

■ the issue of continuously improving quality and clinical governance

Checkpoint

Before reading on, think about the following questions to identify

your own knowledge gaps in this area:

■ What are some of the issues that resulted in the introduction of a

formalised approach to continuing professional development (CPD)

for healthcare professionals?

■ How do you deﬁne CPD?

■ What is the difference between CPD and continuing education

(CE)?

■ What is a personal development plan (PDP)?

■ practical issues surrounding CPD and overall personal development

planning.

The CPD concept

It is useful at the outset to look at how CPD has come to the forefront of

our thinking as a profession and why it is so important. Pharmacy is a

respected profession and the community pharmacist is placed in a posi-

tion of trust, especially in the way that they relate directly to patients and

are readily accessible to provide advice and information. CPD involves

establishing a framework to ensure that professional competence is main-

tained and the public is reassured about the high quality of pharmacy

services offered.

The high-proﬁle tragic events at the Bristol Royal Inﬁrmary moved

the spotlight on to the competence of healthcare professions. One of the

many recommendations from the Bristol Royal Inﬁrmary Inquiry (the

Kennedy report) was that it must be part of all healthcare professionals’

contracts that they undergo appraisal, CPD and revalidation to ensure

that all healthcare professionals remain competent to do their job.

The

government made it clear that health professions should set up systems

of mandatory CPD. CPD for health professionals was also emphasised in

The NHS Plan,

and speciﬁcally for pharmacists in Pharmacy in the Future

– Implementing the NHS Plan.

3,4

CPD is not only driven by government documentation, it has also

become a practical reality due to the rapid increase in knowledge relevant

to the practice of pharmacy. The extended role of the community phar-

macist that has incorporated a much more clinical emphasis has pre-

sented the profession with a challenge. The challenge is to ensure that

pharmacists are not only up to date with their pharmaceutical knowl-

edge, but are also ﬁt to practise in terms of skill and application of their

knowledge. In the past the emphasis has been on continuing education

(CE) and this has taken the form of evening meetings, study days and

distance learning. This is not an uncommon approach and CE activities

were found in other professions such as medicine, nursing, engineering

and law. CPD now replaces the earlier requirement of the Royal

Pharmaceutical Society (RPSGB), for all pharmacists to complete 30 hours

of CE every year. One of the principles of the Code of Ethics for Pharmacists

and Pharmacy Techniciansis to develop professional knowledge and com-

petence.

This will require the pharmacist to undertake and maintain up-

to-date evidence of CPD relevant to their ﬁeld of practice (Principle 5.4).

Some pharmacists have difﬁculty with the CPD concept as they feel more

2 Community Pharmacy Handbook

comfortable with a knowledge-based CE approach where they attend a

learning event or read a chapter in a text book. The acquisition and

updating of knowledge in this way is an important activity and one that

is a part of the CPD process. However, it is important that a distinction is

made between CE and CPD. After many years of using the CE approach

it has become clear that this approach has several disadvantages in terms

of ensuring ‘ﬁtness for practice’. Some of the problems encountered with

CE are:

■ CE events do not include the many day-to-day practice-related activities

where signiﬁcant learning takes place, for example interaction with a

colleague or tutorial involvement with a pregistration trainee

■ CE events tend to be passive in their approach and to bypass other ways

of learning such as job shadowing another healthcare professional or

discussing a case with a general practitioner (GP)

■ CE is not speciﬁc for individual pharmacists and their development

needs at the time. For example a training evening on a speciﬁc topic may

not be relevant to the development needs and practice priorities of an

individual. The aims and objectives of CE courses and training packages

are generally set by the course provider

■ the CE assessment process tends to assess only the knowledge gained as

opposed to the impact of that knowledge on the pharmacist’s practice.

CE certainly has an important place in our ongoing development, but

needs to be incorporated into the wider CPD framework. There are many

deﬁnitions of CPD as it applies to different professions. One example

from the Institution of Civil Engineers is:

The systematic maintenance, improvement and broadening of knowledge and

skills and the development of personal qualities necessary for the execution of

professional and technical duties throughout your working life.

There are many similar deﬁnitions, and all have common keywords that

emphasise the continual ongoing nature of the CPD process, the refer-

ence to knowledge, skills and behaviour, and the linking of these to

professional practice.

The CPD concept is all about the individual driving their own

professional development. To engage fully as a community pharmacist

within a changing environment, a positive approach towards CPD is

essential. An open approach is needed that allows the pharmacist to stand

back and ask questions such as:

■ what service do I want to deliver?

■ what are my development needs in this area?

■ how do I meet these needs?

■ how will I reﬂect on my development in this area and ensure that the

service I offer is of the highest quality?

Continuing professional development 3

4 Community Pharmacy Handbook

CPD and clinical governance

Clinical governance has been deﬁned as:

A framework through which NHS organisations are accountable for continuously

improving quality of their services and safeguarding high standards of care by

creating an environment in which excellence in clinical care can ﬂourish.

At ﬁrst sight this formal deﬁnition can appear quite complex. Clinical

governance is all about how to improve quality. The quality-improve-

ment agenda within the NHS includes setting standards from the

National Institute for Health and Clinical Excellence (NICE) and national

service frameworks (NSFs) and the monitoring of standards by the

Healthcare Commission and others. It is important to recognise that the

clinical governance umbrella covers a wide range of activities and pro-

cesses for improving quality and ensuring professional accountability.

These processes include the following areas:

■ evidence-based practice

■ CPD

■ audit

■ risk management

■ remedying poor performance

■ monitoring clinical care

■ patient and public involvement

■ staff management

■ being accountable.

CPD is seen as a fundamental component of the quality-improvement

agenda and good professional practice. CPD needs to be directed at areas of

practice where enhancement of capability is required.

Capability in this

case can be deﬁned as the extent to which individuals can adapt to change,

generate new knowledge and continue to improve their performance.

The pharmacist is required to recognise the limits of their profes-

sional competence, practise only in those areas in which they are com-

petent to do so and refer to others where necessary. This principle of the

Code of Ethics is of particular relevance to the community pharmacist

who is faced with adapting to new expectations, in terms of services

offered and new ways of working.

There is currently wide-ranging discussion about the revalidation of

pharmacists and how this may operate in the future. CPD is seen to be an

essential component of a much wider revalidation process. For example,

a revalidation system may involve some form of practice requirement

such as a performance appraisal or a practice audit.

Many community pharmacists, while recognising the importance of

CPD, can feel uncertain about where to start in terms of their own pro-

fessional practice.

CPD – getting started

It is important to get started with the CPD process. Many pharmacists are

not engaging fully in CPD and need further support to enable them to do

so.

The aim of this section is to provide the information and guidance

necessary to start the process and incorporate CPD as part of everyday

working practice.

Some of the major barriers to CPD that could possibly prevent phar-

macists from participating fully in the CPD process are:

■ a perception that CPD is time consuming

■ a misunderstanding of the CPD process and what is involved for the

pharmacist

■ difﬁculties in identifying learning needs and evaluating CPD activities.

With the introduction of mandator y CPD it is imperative that these

barriers are broken down to enable practising pharmacists to move

towards a more focused approach in their own development. CPD need

not necessarily be time consuming. For example, a brief question from a

patient regarding their medication may lead the pharmacist to reﬂect on

their current knowledge of a particular drug. This may result in only a

small amount of research such as looking at reference sources and later

applying this knowledge to the next similar patient quer y. The ﬁrst part

of this process may only take a matter of minutes. Conversely, if as part

of a personal and business development plan a pharmacist decides to

become involved in the provision of a smoking-cessation clinic, this will

clearly involve a much more detailed approach to the planning and

development of knowledge and skills before being able to apply this to

practice. Both examples of CPD will take vastly different amounts of

time and input. Many pharmacists are already involved in CPD on a

daily basis but are failing to plan and record their activity. It is only

through the disciplined planning and recording of CPD activities that

the pharmacist can obtain a more accurate picture of the amount of time

it is taking. It is unfair to say that CPD is time consuming, as much of

what constitutes CPD activity is integrated into everyday practice. The

practicalities of the planning and recording procedures will be discussed

later in this section.

The second barrier is a misunderstanding of the CPD process and

what this involves. For example, not all pharmacists understand the

difference between CE and CPD, and there are deﬁnite differences in

pharmacists’ attitudes and perceptions of the CPD process.

This is not an

easy barrier to overcome as it often involves a change in behaviour and

working patterns. For example, the community pharmacist who has

recently attended a training evening on asthma may ﬁle the course

Continuing professional development 5

material and do nothing further with the information they have gained.

Alternatively the pharmacist may return from the same CE event and con-

tact the local asthma nurse to informally discuss one of the case studies on

the use of corticosteroids in acute asthma. During the conversation the

details of the case become reinforced and the pharmacist arranges a more

formal meeting with the asthma nurse to look at ways of working

together more closely. It is this latter approach that allows the pharmacist

to gather momentum in terms of both individual development and deliv-

ering improved patient outcomes.

The third barrier of ﬁnding difﬁculty in identifying learning needs

and evaluating CPD activities can only be overcome with increased

experience. The identiﬁcation and driving of our personal learning

agenda and development plan is a concept that is relatively new for the

community pharmacist. The subsequent evaluation of our CPD is a skill

that can only be developed over a period of time. The pharmacist should

continually make CPD records and examine what they do with a positive

but critical eye. This is one of the reasons why it is so important to get

started!

CPD is an ongoing cyclical process of reﬂection on practice, plan-

ning, action and evaluation or reﬂection on learning (Figure 1.1). It is

useful to look at each of these stages in turn.

Reﬂection on practice

Reﬂection on practice is the process that is used to ‘self-diagnose’ our

learning needs. This process involves standing back and looking at

what has been achieved in our practice and where we see our career

progressing in the future. On a broader scale this is what takes place when

6 Community Pharmacy Handbook

Figure 1.1 The continuing professional development cycle.

Reflection on practic

Action

Evaluation

(reflection on learning)

Planning

we start to write a personal development plan (PDP). It is important to

recognise that there are different ways of identifying learning needs

through reﬂection (Figure 1.2). A practical example is included under

each heading to illustrate different methods of identifying and highlight-

ing professional development needs.

Continuing professional development 7

Figure 1.2 Continuing professional development: methods of identifying

learning needs through reﬂection on practice.

Reflecting on

RPSGB areas

of competence

Identification

of learning

needs through

reflection on

practice

Being

prompted by

local and national

policies

Being

prompted by

organisational

priorities

Reading and

continuing

education

events

Professional

audit

Appraisal and

peer review

Critical

incident

analysis

Examples

All of the examples in this section involve the community pharmacist

James Brown, who works for a small multiple in a town centre phar-

macy. He has been registered as a pharmacist for 11 years and has

worked mainly as a community pharmacist-manager throughout this

time.

Critical incident analysis

Critical incident analysis is about learning from meaningful events, and

involves taking a thoughtful approach to a particular event and looking

at the outcome. It is not important if the outcome to the event was

positive or negative. The important issue is that the event is analysed and

the question asked: ‘What did I do to bring about this positive/negative

outcome?’

If the outcome was positive then we are looking at ways of applying

our success to other similar situations. If the outcome was negative then

we are looking at ways of avoiding a similar situation in the future.

Appraisal and peer review

Appraisal and peer review are an excellent way of assessing learning

needs. Typically the way we view our own work is often different from the

8 Community Pharmacy Handbook

Example 1.1

A customer asks James for his professional opinion on the beneﬁts of tak-

ing glucosamine tablets for pain in his knee joint, as he has been recom-

mended to take this by his GP. The customer notes that the product is

quite expensive and would like some more information and advice

before making the purchase. Glucosamine is not James’s specialist sub-

ject and he has not read round the subject even though he has been

aware of recently published articles on this product. He decides to

actively recommend the product as it has been suggested by the GP but

ﬁnds himself unable to provide an adequate answer to the customer.

On analysis of this incident James feels that he has been put on the

spot and not really addressed the query in a professional manner.

He starts to think about what his learning needs are in this area and he

comes up with two suggestions:

■ the need to become more familiar with the use of this product and

look critically at the evidence base for its use

■ the need to adopt a standard procedure when asked about areas

where he has little or no knowledge, for example recording the query

and customer details and researching thoroughly before answering the

question.

These broad suggestions have stemmed from a critical incident that

probably took less than ﬁve minutes of James’s working day.

way that our line manager or colleagues see us. For example we may be

over-critical of what we do or may have blind spots and areas of devel-

opment that we tend to ignore. Appraisal tends to be a formal process

compared to peer review, which could include an informal conversation.

In some cases it is useful to ask a colleague to discuss a critical incident

that you are considering, as they may be able to look at the incident from

a completely different angle.

Professional audit

A professional audit involves systematic evaluation of professional work

against set standards. The process of audit will be discussed in more detail

in Chapter 4. Professional audit is a useful tool when reﬂecting on our

learning needs.

Continuing professional development 9

Example 1.2

James Brown was talking to his pharmacist friend Ruth Owen about the

glucosamine query incident and admitted that he felt that the quality

of professional service that he had offered had been less than satisfac-

tory. Ruth mentioned that recently she had experienced a similar inci-

dent and this prompted her to contact the medical information

department of the glucosamine manufacturer. Ruth obtained some use-

ful reference sources and made some brief notes. Ruth showed James

her notes and he was impressed with the way that the papers had been

neatly summarised and ﬁled. Ruth suggested that a more organised

approach to customer queries and the creation of an accessible ﬁle

would be useful. Ruth offered to share and explain her system of note

taking and ﬁling. This conversation added a new dimension to James’s

critical incident analysis and identiﬁed a further learning need.

Example 1.3

James has noticed recently that a lot of customers have complained

about the length of time they need to wait for a prescription. He is

determined to ﬁnd the reason for this increase in customer dissatisfac-

tion and decides to carry out an audit. James is aware that there are

continued overleaf

Critical reﬂection on the information provided by an audit can act as a

stimulus to help identify individual learning needs.

Reading and continuing education events

Active reading of journal articles and the participation in CE activities

such as workshops can often encourage the wider exploration of an area

of personal development. The consideration of questions such as those

found in the ‘Checkpoint’ sections at the start of the chapters in this book

can be a useful tool. The questions can act as a prompt to ask: ‘Is this sub-

ject relevant to my practice and how can I apply this knowledge?’

10 Community Pharmacy Handbook

many factors that could affect the time taken for prescriptions to be

completed. One factor that he is particularly interested in is the level of

stafﬁng at different times of the working day. He plans to construct an

audit to determine the number of staff available for the dispensing pro-

cess at different times of the day and some indication of their skill level.

The information he gains from this audit helps him to identify certain

problem areas that relate to staff management and training. Some of

these problem areas could be improved by more proactive manage-

ment of staff, and he identiﬁes this as an area for CPD.

Example 1.4

James attends a local Centre for Pharmacy Postgraduate Education

(CPPE) evening on hypertension, and in the pre-course reading and

during the presentation there is reference to the taking of accurate

blood pressure readings. He already supplies digital blood pressure

meters and would like to offer a blood pressure monitoring service.

However, the practical use of blood pressure meters and obtaining an

accurate reading is not covered in the workshop. It is some time since

he was involved in taking blood pressure readings and he feels that his

knowledge and level of skill in this area must be improved if he were to

introduce a blood pressure monitoring service.

Being prompted by organisational priorities

In some cases the reﬂection may be imposed from above, through an

employer or by the implementation of national priorities by a local

primary care organisation (PCO).

Being prompted by local and national policies

National priorities and speciﬁc local initiatives can sometimes prompt the

individual pharmacist to think more clearly about their CPD needs.

Continuing professional development 11

Example 1.5

The pharmacy multiple that employs James decides that his pharmacy

is to start offering a cholesterol testing service within the next 6

months. James starts to reﬂect on the knowledge and skills needed to

be able to deliver this service. The company training department has

produced a training manual designed to prepare all staff for the launch

of this new ser vice. James quickly skims through the training material

and aims to focus on areas that he feels less conﬁdent in. For example

he has recently read some articles on hypercholesterolaemia and feels

conﬁdent to be able to discuss total cholesterol readings and associated

risk factors. However, he is much less conﬁdent about the practical

aspects of taking blood samples and interacting with the client in a

more clinical setting. On reﬂection he decides that this is the area that

he needs to develop and gain conﬁdence in.

Example 1.6

The NSF for Older People highlights the issue of falls in the elderly.

James’s local PCO will be shortly introducing a project to reduce the

incidence of falls in older people. This programme involves a domicili-

ary visit by the local pharmacist to assess the medication of patients

identiﬁed by other healthcare professionals as at risk of falls. James

would like to become involved in this project and starts to reﬂect on

the knowledge and skills needed to carr y out the medication assess-

ment. As part of his reﬂection he starts to list the types of medication

continued overleaf

Reﬂecting on RPSGB areas of competence

Another approach is to regularly take stock of our competence by match-

ing our own self-assessed competence against published criteria.

Having looked at different opportunities to reﬂect on practice we now

12 Community Pharmacy Handbook

associated with falls in older patients, and draws out a ﬂow diagram

of some of the issues involved. He ﬁnds this exercise relatively straight-

forward and feels that he has the necessary clinical knowledge in this

area. However, he does not feel as conﬁdent in conducting a patient

interview and has not been involved in a domiciliary visit of this type

before. James makes a telephone enquiry about the project to express

his interest and voice his reservations. The local project lead assures

him that a full induction process is available, which includes interview

observation and work shadowing. He decides that involvement in this

project would provide the opportunity to develop his patient interview

skills.

Example 1.7

James logs on to the RPSGB Plan and Record website,

and browses

through the key areas of competence (Appendix 7). He looks at the

areas of competence speciﬁc to community pharmacy. This list acts as

a prompt for reﬂecting on his own CPD. He decides by looking at the

list that he would like to prioritise a key area of competence that would

beneﬁt his practice as a pharmacist. Recently he has had some queries

from a local nursing home about waste disposal, which he has been

unable to answer. Looking at the list of areas of competence he notices

that ‘Disposing of medication and participating in medicine disposal

schemes’ (competence C6g) comes under the broader heading of:

‘Supplying medicines, dressings and appliances; and managing stock’.

James decides that his working knowledge of waste disposal legis-

lation is not up to date and is inadequate. By looking at this list of areas

of competence it has prompted him to reﬂect on his own CPD in this

area. He decides he will return to this list of competences to reﬂect on

his practice in other areas.

need to set speciﬁc learning objectives. The SMART acronym is a useful

tool when setting objectives.

■ S – speciﬁc: the objective should state clearly what it is that you want to

be able to do.

■ M – measurable: will it be possible to determine if you have met your

learning objective?

■ A – achievable: will it be possible to achieve your objective when you take

into account resources such as time, cost and support?

■ R – relevant: is the learning objective relevant to your practice? The more

speciﬁc your objective, the more useful it is likely to be. Avoid using

woolly or broad statements.

■ T – timed: your speciﬁc objective needs a speciﬁc deadline for your goal

to become real.

Using the speciﬁc examples, James Brown could now set learning objec-

tives to be achieved within a set time period:

■ Example 1.1: to be aware of the current evidence base for glucosamine

products and be able to summarise this for interested customers

■ Example 1.2: to introduce a user-friendly hard copy ﬁling system that will

assist him in his response to customer queries

■ Example 1.3: to introduce a new staff hours management system that

takes into account skill mix and the needs of the business at different

times of the day

■ Example 1.4: to demonstrate the ability to take an accurate blood pressure

reading and to conﬁdently discuss all the different types of digital blood

pressure meters

■ Example 1.5: to be able to competently perform a test for total cholesterol

within speciﬁed guidelines

■ Example 1.6: to be able to conﬁdently conduct a structured patient

interview

■ Example 1.7: to be able to brief the pharmacy team on the correct

procedures for the collection and disposal of pharmacy waste.

We are now in a position to move to the next stage of the cycle, which is

the planning of our CPD.

Planning

In the examples of the previous section, speciﬁc learning needs have been

identiﬁed. The next stage is to prioritise these learning needs and make a

decision on how these needs will be met. Many of the skills needed in

planning CPD such as time management and prioritising needs will be

covered in Chapter 2.

The ﬁrst part of the planning stage is to decide on the urgency of the

identiﬁed objectives. There may be an urgent and immediate need to

meet an identiﬁed objective or the objective may relate to an ongoing

Continuing professional development 13

14 Community Pharmacy Handbook

Table 1.1 CPD planning: assessment of different learning methods

Learning objective: to improve my management skills by the introduction of a new staff hours management system that

takes into account skill mix and the needs of the business

Proposed activity Advantage Disadvantage

Experiment by introducing a new Quick to implement Not obtaining any external input and

timetable of staff working hours and there could possibly be serious

see how this works in practice consequences and human resource

issues if the proposal does not work in

practice

Speak to a colleague in another Gaining the insight and experience of a Finding time for a meeting to discuss

pharmacy who has a good system of colleague that appears to be well the system at length and decide if it

tracking staff hours using IT, and ask organised and has introduced a system would be appropriate for the situation

them for advice that works well in practice

Select assessed modules of a management Obtaining expert opinion on this speciﬁc May eventually have the knowledge to

skills course that involves assertiveness dilemma and addressing the key issue, carry out the change successfully but

training and how to successfully i.e. the introduction of change into the the process of studying modules and

introduce change culture of a well-established pharmacy being assessed will be onerous and

working pattern take a long time to complete

development need that will only become apparent over a period of

months or years. For example the provision of a cholesterol-testing

service (Example 1.5) is to take place within the next 6 months and so

there is not an immediate need to meet this learning objective. The objec-

tive relating to glucosamine (Example 1.1) is much more urgent as local

GPs are now starting to prescribe or recommend this product.

The second stage of the planning process is to consider the im-

portance of the learning objective in terms of how the learning will

impact on yourself, your colleagues, your organisation and your service

users.

In one of the previous examples, the development of management

skills and the introduction of a new staff hours management system

(Example 1.3) is important as this is already impacting on levels of service

and ultimately patient care. When assessing the importance of a learning

objective the pharmacist needs to stand back and ask the question: ‘How

often will I use the new skill or knowledge in my practice?’ The manage-

ment skills required in this example will have high importance as this

skill is used every day in the management of staff. The other examples all

involve skills or knowledge that are likely to be used less frequently. It is

only by looking at the urgency and importance attached to a learning

objective that each one can be prioritised and a date set to achieve the

objective. It is always necessary to set a speciﬁc date when writing a

SMART objective.

Having identiﬁed the urgency and importance of the task it is now

necessary to identify appropriate activities to meet the learning needs.

There are many different ways of meeting objectives. Ideally a wide vari-

ety of options are considered that take into account the individual pre-

ferred learning style and the resources available. In the initial stages it is

useful to note the activities that are considered to be the most appropri-

ate and then systematically look at the advantages and disadvantages of

each method. This process may seem quite time consuming but ensures

that the time and effort is invested in the most appropriate learning activ-

ities. An example of assessing different learning methods for meeting an

objective is summarised in Table 1.1

By looking at the advantages and disadvantages we are in the posi-

tion to make a professional judgement about the best course of action.

Action is the next stage of the CPD cycle.

Action

This part of the CPD process is about implementing plans that have been

selected during the planning stage.

Continuing professional development 15

The speciﬁc plans are carried out within the deﬁned time limit and a sum-

mary is made of what has been achieved. Once the planned activity has

taken place, it is time to move on to the evaluation stage.

Evaluation

At this stage of the CPD cycle, questions are being asked such as:

■ has my learning objective been met?

■ have I tested if what I have learnt can be applied to practice?

■ am I now able to work differently?

■ were there any problems with the reﬂection, planning or action parts of

the CPD cycle? (For example was the learning need identiﬁed correctly

and the objective speciﬁc enough?)

16 Community Pharmacy Handbook

Example 1.8 Extract from James Brown‘s CPD record

After speaking to my colleague about his system of managing staff

working hours I can now use a piece of software to construct a work-

ing hours matrix that relates to skill level, volume of business and staff

availability. My colleague has offered to look at the initial draft of my

revised schedule of stafﬁng before I implement it, which I hope to do

in the next week.

Example 1.9 Extract from James Brown‘s CPD record

My colleague thought my initial draft needed amending to take into

account the need for more dispensary staff on a Saturday morning. I

followed this suggestion and have introduced the new programme of

working hours. Generally the new system has worked well and this has

encouraged me to look more closely at staff working hours. However, I

have found it difﬁcult to introduce these changes as staff members

seem very unwilling to change their hours and this has caused some ill

feeling. Increased Saturday working has been particularly unpopular

and I feel that I need further development of my management skills to

be able to carry through this change successfully.

This is an example where the CPD cycle would be re-entered at reﬂection

to pinpoint what particular management skills are needed to address this

ongoing problem.

Unscheduled learning

Not all CPD falls into the neat cycle of reﬂection, planning, action and

evaluation. In some cases the pharmacist may have a conversation with a

colleague or attend a training event and learn something that could be

applied speciﬁcally to their practice. The learning is unscheduled or

opportunistic as it was not a planned piece of CPD.

This type of learning starts with action and moves on to the evalu-

ation of what was learnt. In some cases this may be developed further by

reﬂecting in more depth and moving on to the reﬂection stage of a new

CPD cycle.

Plan and record

The pharmacist CPD record should comply with the good practice criteria

published by the RPSGB. Good practice criteria and useful advice to sup-

port the pharmacist in recording their CPD are available on the RPSGB

Plan and Record section of the CPD website.

Referring to these criteria

can help to ensure that the CPD portfolio is balanced. It is important that

a CPD record includes examples of learning that starts at action, and

learning that starts at reﬂection.

Continuing professional development 17

Example 1.10

James Brown reads an article in the Pharmaceutical Journal on the treat-

ment of fungal nail infections and studies the additional advice that

should be given to patients with a fungal nail infection to prevent recur-

rence. James notes the importance of this advice in achieving a success-

ful long-term outcome for the patient. This prompts him to think about

his knowledge and practice when giving additional advice for other

fungal infections such as athlete’s foot and vaginal candidiasis. James

starts to develop a series of additional advice protocols for use within

the pharmacy team when speaking to patients with fungal infections.

The CPD portfolio can be documented either on paper and retained

in a ﬁle, or recorded electronically by making a website entry. The format

is the same in either case and copies of exemplar record sheets can be seen

on the Plan and Record website. Electronic recording of CPD is the pre-

ferred option as there is easy access to additional information at the time

of entering the online record. The web-based record is also more secure

than a paper version which could be mislaid or destroyed.

Current guidance is that it should take approximately 30 minutes to

record one CPD entry and approximately one entry should be made each

month. The pharmacist may choose to engage in much more CPD than

this, depending on their personal circumstances and development needs.

The aim of CPD recording is to produce a portfolio of good-quality

entries. The portfolio should reﬂect good practice criteria, using different

learning activities, rather than a large collection of similar entries.

Once the initial hurdle of the ﬁrst entry has been made and the user

becomes familiar with the recording procedure, the process becomes

more integrated into working practice. Ultimately the individual CPD

programme is driven by and linked closely to individual personal devel-

opment planning.

Personal development planning

CPD that is unplanned and spontaneous is unlikely to bring about the

maximum return in terms of your investment of time and effort. A PDP

is essentially a plan of action. The PDP provides the pharmacist with the

opportunity to set personal targets and ﬁnd the best way to achieve these

targets. A well constructed PDP takes a more global view of where the

pharmacist is heading and what they would like to achieve along the way.

Different formats can be used for a PDP. The RPSGB has a pro forma that

can be used and asks a series of questions to help establish CPD priorities.

Alternatively, the pharmacist may prefer to use a different format or con-

struct their own PDP. The following stages are required to produce a PDP.

A PDP is based on three questions:

■ where am I now?

■ where do I want to be?

■ how can I get there?

Where am I now?

Asking this general question will lead to additional questions such as:

18 Community Pharmacy Handbook

■ what am I good at?

■ what do I need to work on?

■ what could help me overcome my weak areas?

■ what could be a barrier to the change I need to make?

At this stage the lower edge of the development gap is being deﬁned.

Where do I want to be?

This is a very personal question and there will be many variables to con-

sider in formulating your answer. The questions listed below may help to

answer the question. It will be necessary to ask many other questions to

formulate an answer to this question. For example:

■ what do I like doing?

■ what is my motive for personal development?

■ what is my ultimate personal/professional goal?

■ how will I measure my success?

It may be easier to answer this question in stages by setting a series of

goals to reach the ﬁnal endpoint rather than one massive goal that seems

unrealistic.

By answering this question the upper limit of the development gap

is being deﬁned.

How can I get there?

Having identiﬁed the development gap the next stage is to determine

how your objective can be achieved. An effective PDP will consist of a

number of manageable portions in order to achieve the overall aim. The

plan for achieving a development goal will ideally consist of short-,

medium- and long-term objectives. PDPs are not set in stone and need to

be reviewed regularly. For example a PDP may include short-term goals to

be reviewed in 3 months’ time, medium-term goals to be reviewed in 6

months and a long-term goal to be reviewed after 2 years. Different time-

frames need to be selected that will be suitable for both the individual

and the organisation that the individual is associated with. When asking

the question ‘how can I get there?’ it is important to be realistic about

factors that will affect progress. Remember to factor social, domestic,

monetary and organisational constraints into the objectives. Keep your

objectives SMART.

Figure 1.3 provides a summary diagram of the basic structure of a

PDP.

The PDP should not be set in stone but is a ﬂuid and evolving docu-

ment as individual circumstances and aspirations change.

Continuing professional development 19

20 Community Pharmacy Handbook

Figure 1.3 Constructing a personal development plan.

2 Where do I want to be?

1 Where am I now?

‘The development gap’

3 How can I get there?

PDP objectives

Timeframe

Example 1.11 Personal development plan

Anita Taylor qualiﬁed as a pharmacist 3 years ago. The ﬁrst two years of

practice she worked for a large multiple as a relief pharmacist. Anita

then spent 6 months self-employed as a locum pharmacist before

moving to her current position as the pharmacist-manager of a busy

pharmacy that is part of a small multiple group.

Extracts from Anita Taylor’s PDP planning notes

Where am I now?

Some recent workplace incidents that have added to my sense of job

satisfaction:

■ performed ﬁrst MUR [medicines use review] on a patient and felt that

it went well and felt comfortable in this role

■ Recently tutored an enthusiastic summer vacation student and found

that I really enjoyed discussing responding to symptoms and different

over-the-counter (OTC) medicines that have recently been deregulated

from POM [prescription only medicine] to P [pharmacy medicine]. I

found it beneﬁcial being able to discuss this in more detail and found

that by having to explain this area it improved my own knowledge.

Learning needs that have arisen from these experiences

Although I found these experiences increased my sense of job satisfac-

tion I wish my clinical knowledge was more up to date. The MUR

patient asked some searching questions about their angina and I feel

→

Continuing professional development 21

that it would be useful to update my clinical knowledge in this area.

The informal tutoring of a vacation student was useful as I have not

been involved in this type of work before. I feel that my tutoring and

coaching skills could be improved as I would like to act as a preregis-

tration tutor next year.

Workplace issues that will impact on my PDP

■ There is a large amount of pressure to increase the amount of business

with residential homes and there is the strong possibility that my store

will be a centralised point for this business.

■ The company is aiming to introduce a new PMR [patient medication

record] system next year. The system will facilitate the recording of

much more information and will enhance my clinical role further.

■ I have seen a peripatetic pharmacist training position advertised that

will involve delivering off the job training sessions for all levels of

pharmacy staff. I would be very interested in this type of work.

Local issues that will impact on my PDP

The local PCO is trying to engage pharmacists in a new domiciliary

visiting scheme and medicines management service with the elderly.

Where do I want to be? Career plans for the next 3–5 years

I would like to achieve the following:

■ a clinical diploma qualiﬁcation with an emphasis on community

pharmacy and offering enhanced services

■ be able to offer a medicines management service to care homes and

develop expertise in this area

■ tutor a preregistration graduate

■ develop my tutoring and clinical skills

■ be in a strong position to apply for a future pharmacist training role

when this is advertised.

How do I get there? Personal development plan outline

Objectives – Year 1

(Review every 3 months. A PDP should have speciﬁc review dates so

that the pharmacist can work towards achieving each speciﬁc goal.)

■ Research suitable clinical diploma courses that have a community

pharmacy bias. Look at ﬂexibility of modules and types of assessment

and possibility of funding from employer. Select a course that fulﬁls

criteria and start the course at the next available opportunity.

continued overleaf

The pharmacist with a PDP has a powerful tool to develop professional

and personal expertise in a systematic way. Producing a PDP is a vital step

in your professional life – a blueprint for the future that may change the

course of your life journey.

Implications for practice

Activity 1

Carry out a review of your CPD entries over the past 6 months using the

RPSGB pro forma (Personal Review of CPD Record, RPSGB website,

Appendix 5).

22 Community Pharmacy Handbook

■ Arrange meeting with manager to discuss personal development and

express interest in training and future development opportunities.

Offer willingness to work as a preregistration tutor for the next year.

■ Arrange meeting with primary care pharmacist to discuss opportunities

locally and offer to become involved in domiciliary visiting scheme.

■ Undertake the necessary training to become accredited to offer

medication management service to care homes. Undergo CPD

activities to ensure that I am competent in this area.

Provisional objectives could be written for year 2 at this stage, or the

objectives could be written later in the ﬁrst year in line with how the

PDP is evolving.

Top tips for producing a PDP

■ Think positive: the production of a PDP should be an exciting prospect

as it is all about what could be possible and achievable.

■ Think about the future: the challenge is to stay current in our own

ﬁeld of expertise. To achieve this requires forward planning.

■ Find a mentor: this person needs to be non-judgemental and willing

to offer help by providing feedback, suggestions and a support

framework. For the pharmacist that works alone a mentor is

particularly important as it is often difﬁcult to assess in isolation

how your PDP is progressing.

■ Make full use of all resources available: resources include the internet,

increasing quantities of literature and training materials and the

expertise of colleagues. All of these resources can input into a PDP.

■ Take a broad pragmatic approach when developing a PDP.

■ Do you see any patterns emerging in the way that you write your CPD

entries?

■ Is it clear what you have both learnt and applied over the past 6 months?

■ Will this exercise make your next CPD entries different in any way?

Activity 2

Using a blank sheet of paper write a ﬁrst draft of your own PDP for the

next year using the questions: ‘Where am I now?’ ‘Where do I want to

be?’ ‘How do I get there?’

Multiple choice questions

Directions for questions 1 and 2: each of the questions or incomplete

statements in this section is followed by ﬁve suggested answers. Select the

best answer in each case.

Q1 Which one of the following most closely matches the function of the

Healthcare Commission?

A Setting National Service Frameworks

B Setting clinical standards

C Monitoring standards in the NHS

D Monitoring participation in CPD for healthcare professionals

E Improving patient and public involvement in healthcare

Q2 Which of the following most clearly represents the CPD cycle?

A Evaluation, action, reﬂection, planning

B Planning, reﬂection, evaluation, action

C Action, planning, evaluation, reﬂection

D Reﬂection, planning, action, evaluation

E Reﬂection, action, evaluation, planning

Directions for questions 3 to 6: for each numbered question select the

one lettered option above it which is most closely related to it. Within

each group of questions each lettered option may be used once, more

than once, or not at all.

Questions 3 and 4 refer to different stages of the CPD cycle.

A All stages of the CPD cycle

B Evaluation

C Action

D Planning

E Reﬂection

Continuing professional development 23

A pharmacist observes that there is a clinical article on the treatment of

hypertension in the Pharmaceutical Journal. Select from A to E which one

of the above ﬁts the following statements.

Q3 After reading the article and the suggested additional reading the

pharmacist asks the question: ‘Am I now able to work differently?’

Q4 A pharmacist decides not to read the article as he already has the

theoretical knowledge in this subject area but is looking for training to

improve his practical skills in this area.

Questions 5 and 6 are about the following documentation:

A Bristol Royal Inﬁrmary Inquiry (Kennedy report)

B The NHS Plan

C Pharmacy in the Future

D RPSGB Code of Ethics

E RPSGB ‘Plan and Record’

Which of the following statements most closely matches the document?

Q5 A requirement for all practising pharmacists to adopt CPD.

Q6 A recommendation that all healthcare professionals should undergo

appraisal, CPD and revalidation as part of their contract.

Directions for questions 7 and 8: each of the questions or incomplete

statements in this section is followed by three responses. For each ques-

tion ONE or MORE of the responses is (are) correct. Decide which of the

responses is (are) correct. Then choose:

A if 1, 2 and 3 are correct

B if 1 and 2 only are correct

C if 2 and 3 only are correct

D if 1 only is correct

E if 3 only is correct

Directions summarised:

A: 1, 2, 3 B: 1, 2 only C: 2, 3 only D: 1 only E: 3 only

Q7 This question is about continuing education (CE)

1 CE is often speciﬁc for individual pharmacists and their development

needs.

2 CE often has a passive approach to learning.

3 CE assessment is often knowledge based.

Q8 Which of the following are ways of reﬂecting on practice as a community

pharmacist?

1 Critical incident analysis

24 Community Pharmacy Handbook

2 Professional audit

3 Peer review

Directions for questions 9 and 10: The following questions consist of a

statement in the left-hand column followed by a second statement in the

right-hand column.

Decide whether the ﬁrst statement is true or false.

Decide whether the second statement is true or false.

Then choose:

A if both statements are true and the second statement is a correct

explanation of the ﬁrst statement

B if both statements are true but the second statement is NOT a correct

explanation of the ﬁrst statement

C if the ﬁrst statement is true but the second statement is false

D if the ﬁrst statement is false but the second statement is true

E if both statements are false

Directions summarised:

A: True True second statement is a correct explanationof the ﬁrst

B: True True second statement is NOT a correct explanation of the

ﬁrst

C: True False

D: False True

E: False False

Q9 As part of their CPD a newly registered pharmacist sets the following

objective: ‘To become accredited to offer a medicines use review service in

the pharmacy using the CPPE online assessment within the next two

months’.

■ Statement 1: The objective is not speciﬁc and needs to be rewritten.

■ Statement 2: The SMART acronym is a useful tool when setting

objectives.

Q10

■ Statement 1: When planning CPD it is necessary to list as many

options as possible to fulﬁl a speciﬁc learning need and look at the

advantages and disadvantages of each option.

■ Statement 2: When planning CPD it is important that a wide variety of

options are considered that take into account the individual learning

style of the pharmacist and ensure that time is invested in the most

appropriate learning.

Continuing professional development 25

Case studies

Level 1

John is a pharmacy undergraduate in year 2 of the MPharm degree course.

He is fairly quiet and can sometimes appear aloof and reserved. He has

enjoyed the pharmaceutical science modules but has found the pharmacy

practice part of the course more challenging. John feels especially uncom-

fortable when working as part of a group or being asked to make a formal

presentation to his colleagues. He has no previous experience of working

in a pharmacy and tends to spend his holidays travelling and working

part-time in an accounts ofﬁce. He is very unsure about where to apply

for his preregistration training but was quite interested in a presentation

on hospital pharmacy recently held at the university. At a recent meeting

with his tutor he was asked to write a brief statement for his personal

development portfolio, including some personal objectives for the next

year.

■ Write four objectives for John to include in his portfolio that could be

achievable over the next year.

Level 2

John is now a preregistation graduate working in a hospital pharmacy

department. The preregistration year has been challenging and there have

been times when he has found it difﬁcult to work with some other mem-

bers of staff, especially pharmacy technicians. The registration exam is

now only 4 months away and he is working hard to ensure he has

covered all the necessary parts of the exam syllabus. In his last appraisal

meeting his tutor expressed the view that she had some concerns relating

to his communication skills. He has decided that once registered he

would like to work in community pharmacy. He does not wish to pursue

a career in hospital pharmacy at this stage. He has recently seen a vacancy

for a pharmacist-manager in his home town that would be ideal for his

personal circumstances.

He has obtained the following information about the vacancy:

■ town centre pharmacy, part of a small multiple and dispenses

approximately 600 items per week. Pharmacy located on a busy road

with inadequate space for parking

■ main competition is a well-managed health centre pharmacy that is

about 100 m away

26 Community Pharmacy Handbook

■ business has been managed by a series of locum pharmacists for over 9

months

■ would consider newly qualiﬁed pharmacist and there is some induction

training available

■ staff team well established and reasonably motivated and includes a

qualiﬁed pharmacy technician

■ the owner is keen to develop the business further and to participate in

the provision of new pharmacy services.

John decides to apply for the position. As part of the application process

he is required to produce a short statement outlining his personal and

professional development needs.

■ Using SMART objectives outline a personal development plan for John

before he starts work as a community pharmacist in his ﬁrst pharmacy.

Level 3

John was offered the position and has been in post for 6 months. He has

an informal meeting with his employer to discuss his work. His employer

is pleased with how John has settled into the business and has noted the

positive increase in prescription volume and turnover. He is keen for John

to expand the business and to be able to offer a supply and advisory ser-

vice to residential homes. John agrees to this in principle but needs to

undertake some CPD in this area. Later that week John reﬂects on this

area and starts to complete the RPSGB documentation for a new CPD

cycle.

■ Outline the reﬂection and planning sections of John’s CPD entry.

References

1 The Bristol Royal Inﬁrmary Inquiry – Final Repor t (2001). www.bristol-

inquiry.org.uk/ (accessed 24 August 2007).

2 Department of Health. The NHS Plan: a plan for investment a plan for

reform. London: Department of Health, 2000. www.dh.gov.uk/en/

Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/

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3 Hunt P. Pharmacy in the Future – Implementing the NHS Plan. London: The

Stationery Ofﬁce, 2000.

4 Royal Pharmaceutical Society of Great Britain (RPSGB). Pharmacy in a

New Age. London: RPSGB, 1995.

5 Royal Pharmaceutical Society of Great Britain. Code of Ethics for

Continuing professional development 27

Pharmacists and Pharmacy Technicians. London: Royal Pharmaceutical

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8 Fraser S, Greenhalgh T. Coping with complexity: educating for capabil-

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2002; 269: 618–622.

11 Department of Health. National Service Framework for Older People.

London: Department of Health, 2001. www.dh.gov.uk/en/Publications

andstatistics/Publications/PublicationsPolicyAndGuidance/DH_400306

6 (accessed 7 September 2007).

12 Royal Pharmaceutical Society of Great Britain. CPD for Phar macists and

Pharmacy Technicians in Great Britain. www.uptodate.org.uk/home/

PlanRecord.shtml (accessed 24 August 2007).

13 Department of Health. Pharmacy in the Future: implementing the NHS

Plan. A programme for pharmacy in the National Health Service. London:

Department of Health, 2000. www.dh.gov.uk/en/Publicationsand

statistics/Publications/PublicationsPolicyAndGuidance/DH_4005917

(accessed 7 September 2007).

28 Community Pharmacy Handbook

Management skills in the pharmacy

Failing organisations are usually over-managed and under-led.

(Warren G Bennis)

Many advertisements for pharmacist positions in community pharmacy

are for the job title of pharmacist-manager. Even within the more clinically

orientated positions, the community pharmacist will be expected to man-

age clearly deﬁned projects that will call on their management skills. This

dual role of both pharmacist and manager can sometimes cause conﬂict as

the pharmacist may struggle to effectively balance the two roles. In many

cases, the pharmacist will focus on their professional role and neglect their

management responsibilities. This unbalanced approach can often lead to

reduced job satisfaction. Increasingly the speciﬁc management skills

required by the community pharmacist are necessary in order to participate

more fully in their professional role. This chapter focuses on the manage-

ment skills required in the community pharmacy in order to be effective in

offering new services. The implementation of new ser vices makes new

demands on our resources and the way that the pharmacy team operates.

Before new services can be launched it is necessary to look at how estab-

lished management techniques can help to achieve our objectives.

In many cases the community pharmacist has unusual working con-

ditions compared to other managers. This is often a consequence of the

high level of public accessibility and the pharmacist being actively

engaged in the supply process.

The Health Act 2006 addresses many of the difﬁculties relating to the

Checkpoint

Before reading on, think about the following questions to identify

your own knowledge gaps in this area:

■ What are the principles of effective meetings management?

■ How does a successful team differ from a group of workers?

■ Give one example of a simple time-management tool.

■ Describe one theory of motivation in the workplace. How could I

apply this theory to the pharmacy team?

requirements about supervision and responsibility in a community phar-

macy. The Health Act replaces the more rigid requirement for ‘personal

control’ with the provision of a ‘responsible pharmacist’. The ‘responsible

pharmacist’ will have professional accountability for all processes in the

pharmacy. This would allow the pharmacist to be temporarily absent from

the pharmacy to engage in such activities as meetings with general prac-

titioners (GPs) or offering services to patients in their own home. This

legislation also permits the appropriate delegation of the supervision of

the sale and supply of medicines to trained registered pharmacy tech-

nicians, without the direct supervision of a pharmacist. This is designed to

enable the pharmacist to use their skills more effectively and offer a wider

range of services.

The speciﬁc practical details of these changes are not set out in the

legislation but are to be formulated into regulations. At the time of writ-

ing, work was in progress on the new regulations to be made under the

Act that relate to the ‘responsible pharmacist’ and ‘supervision’.

It is anticipated that the regulations should clearly deﬁne those

activities that can only be undertaken when the responsible pharmacist is

present. The detail of any delegation should include clear lines of

accountability and a robust system of being able to contact the respons-

ible pharmacist when they are absent from the pharmacy. As patient

safety is a major concern, there would need to be a clear justiﬁcation for

the pharmacist being absent from the pharmacy and speciﬁc guidance on

how remote supervision would operate in practice. It is clear that the new

regulations will affect the framework in which the community pharma-

cist operates and will allow a much greater degree of ﬂexibility.

This chapter aims to guide the community pharmacist through

practical management methods speciﬁcally applied to a pharmacy envi-

ronment. As an effective manager, the pharmacist is in a strong position

to inﬂuence the quality of the services that they offer.

The Management Standards Centre, in response to studies showing

that poor management is hindering the UK economy, has developed a set

of standards for managers.

These standards were developed after exten-

sive consultation with employers and individual managers. These man-

agement standards are used widely by many organisations within the UK

and cover the main areas of:

■ managing self and personal skills

■ providing direction

■ facilitating change

■ working with people

■ using resources

■ achieving results.

30 Community Pharmacy Handbook

Each area is divided into clear sections that can be used to self-assess indi-

vidual skills and identify areas for continuing professional development.

An overview of some of the management issues in a community phar-

macy is outlined in Figure 2.1.

Managing self and effective personal skills determine how success-

ful the manager is in all other areas of management. The effective man-

agement of our time underpins all that we hope to achieve as a manager,

particularly in the busy environment of a community pharmacy.

Time management

One of the frequent complaints of managers is that they have insufﬁcient

time to accomplish the tasks they have set out to achieve. Working in the

community pharmacy setting can have speciﬁc frustrations compared to

an ofﬁce-based workplace. These differences need to be recognised at the

outset, as many management theories can ignore the individual work

setting and tend to apply the theory that one size ﬁts all.

Management skills in the pharmacy 31

Figure 2.1 Overview of management issues in a community pharmacy.

Achieving results

Management style

Community pharmacy management

Information management Team motivation

Meetings management Performance management

Teamwork and communication

Management of time/personal

effectiveness

The community pharmacy manager has to overcome two speciﬁc

problems in order to manage their time effectively:

■ the pharmacist is available to patients at all times. The community

pharmacist is probably the most accessible healthcare professional and

can be accessed by a member of the public by telephone or by walking

into a pharmacy and asking to speak to a pharmacist. Indeed this is one

of the unique strengths of community pharmacy

■ the pharmacist has traditionally been fully involved in the supervision

of supplying medicines. This important legal and professional

responsibility has taken priority and consumed a large proportion of

working time.

These issues of availability and supervision are ones that are being actively

debated and need to be addressed if the community pharmacist is to man-

age their time effectively. However, there are certain general principles

that can be applied to ensure that your limited time is protected and used

for maximum beneﬁt.

General principles of time management

Commit to change

Time management starts with a commitment to change. It is about look-

ing objectively about how time is used, making informed plans and

carrying out our plans.

Time management is a skill that needs to be developed on an on-

going basis. It will involve making changes to our working practices and

the relationships that we have with those we work with. The ﬁrst step is

to recognise that time management cannot be conquered in a day and

will involve change.

Put ﬁrst things ﬁrst

One of the seven habits of highly effective people is to put ﬁrst things

ﬁrst.

It is very easy to ﬁll the day with routine tasks that are of secondary

importance. Individuals and organisations need to focus on what matters

most. Time management is about asking the question ‘What is the most

important issue?’ The issue in question may be personal development,

it may be providing a new service, it may be tackling an ongoing staff

problem, or it may be dealing with a potentially difﬁcult customer com-

plaint. There are many areas that will call on our time, so our ﬁrst task

is to prioritise in terms of importance. This is not the same as asking

if something is urgent or responding to the person who is shouting

the loudest.

32 Community Pharmacy Handbook

Use time-management tools

A useful time-management tool is to develop a matrix that determines if

activities are urgent or important. An example of using this approach is

outlined in Table 2.1.

The effective time manager always asks the questions:

■ is the task important?

■ is the task urgent?

By assigning the task to a simple time-management matrix the manager

is starting to plan their time and think about speciﬁc priorities.

Box A is for signiﬁcant activities that have a real impact. It could in-

clude for example responding to the needs of a customer, a pre-arranged

meeting, a serious staff issue or an imminent deadline for submitting a

project proposal to the local primary care organisation. All of these could

Management skills in the pharmacy 33

Table 2.1 A time-management tool applied to a community pharmacy

Importance/

urgency Urgent Not urgent

Important A – do now B – plan to do

A dispensing error has Meet with practice

been made and the manager of the local

patient is waiting to see medical centre to discuss

you for an explanation. the new repeat dispensing

This would take full service you are offering

priority Plan space for important

non-urgent tasks

Not important C – reject D – resist

A survey that will only Read a journal article that

take ‘ten minutes of your does not relate to speciﬁc

time’ and has to be ongoing continuing

completed in person now professional development

Reject impromptu activities (CPD)

such as these that demand Plan to avoid altogether

your immediate attention any non-productive tasks

but are not important. It is that are neither important

important to explain why nor urgent

you are rejecting this type

of interruption

be classed as both important and urgent. It is possible that items that

have been placed in Box B may now have A priority. For example the

repeat dispensing service may have already been launched but you

have not discussed this sufﬁciently with the practice staff and this will

now potentially cause problems and so becomes an urgent and im-

portant task.

Box B is for planning and preparation. This is the area of the time-

management matrix that is used to forward plan important meetings,

develop new procedures or respond to staff or personal development

needs. It is important to constantly review this area to check that the task

is still important and that it has not moved to Box C.

Box C is for all the trivial and off-loaded requests from others. It

covers a whole range of issues such as making duplicated effort or

responding to unreasonable demands for information from staff or

employers. These are activities that need to be rejected diplomatically and

a careful explanation given as to why the task is being rejected. The expla-

nation is important as this helps to generate a more open culture of how

time is used and what is important in the management of the pharmacy.

This is an area where the pharmacist aims to prevent re-occurrence of

trivial demands. It may involve speaking to customers, suppliers, staff

members and employers to look for a long-term solution to common

urgent problem. For example if there is frequent questioning from staff

on the medicine counter about a speciﬁc product, it may be useful to

assign the issue to Box B and develop training material or a protocol that

is going to ease the burden of future queries in this area.

Box D includes the activities that should be rejected completely.

These include the endless possible interruptions to valuable time such as

idle web browsing or allowing a customer to turn a professional con-

sultation into an opportunity to chat. Pleasant as these activities are,

they do not contribute to the proactive and effective completion of a

daily work schedule. It is useful to ask for the reason behind Box D activ-

ities as sometimes they may be stress related and be seen as a release from

the working day. The best antidote to such activities is to have a clear

structure and schedule of tasks to the working day, which have been

created in Box B. To do this will depend on the cultivation of good work

habits.

Cultivate good work habits

Many of the tried and tested techniques for managing time are about cul-

tivating good work habits. The following suggestions can be applied to

the community pharmacy setting.

34 Community Pharmacy Handbook

Keep a proper diary

The pharmacy diary needs to be a useful working tool and not become a

task in its own right. This means that a clear and consistent system of

diary keeping is in place that can be managed effectively. The use of a

joint staff diary in a pharmacy is a useful time-planning tool. The type of

diary will depend on individual preferences, and the merits of a tradi-

tional hard copy diary compared to an electronic diary need to be con-

sidered. One of the dangers of diary keeping is to use more than one

document. This can be a real hindrance to time management and frag-

ment the information that is needed to be able to make management

decisions effectively. Ideally, the diary should be large enough to contain

all the relevant information that will impact on the running of the phar-

macy. Examples of this type of information include:

■ all staff holidays

■ times when local surgeries will be closed for staff development meetings

■ potential busy times – for example by looking at the days before public

holidays or local events.

By having this information accessible the manager is able to make both

long-term plans (Box B-type activities) and short-term plans (Box A-type

activities).

The diary can be clearly coded to ensure that if appointments are

being made they are scheduled into the most appropriate time slot. For

example if the pharmacy is offering a cholesterol-testing service by

appointment it would seem practical to avoid booking any tests on the

Friday before a bank holiday. The well-disciplined use of a diary by the

entire pharmacy team ensures that there is a transparent working docu-

ment that empowers the manager to make informed decisions.

Keep a ‘to do’ list

There is always the danger with ‘to do’ lists that the making of the list

becomes an onerous task. The list should ideally be in electronic format

that can be adjusted easily and quickly and tasks moved around as their

priority changes. It is useful to keep a weekly overview of tasks that need

to be completed and a daily ‘to do’ list with more detailed information. A

useful format for a ‘to do’ list is provided in Table 2.2.

The daily ‘to do’ list is drawn from the weekly list and can only

be written by taking into account the diary entries for that day. It is

important that the list is ﬂuid enough to take into account the needs of

the business. The weekly list needs to be seen to be diminishing as the

week progresses.

Management skills in the pharmacy 35

36 Community Pharmacy Handbook

Table 2.2 Example format for a weekly/daily ‘to do’ list

To do – Week commencing ……………………..

■ Prepare for 39 week appraisal of prereg

■ Complete pre-course reading for CPPE evening

■ Finish off writing home visit reports – 8 to write

■ Discuss new standard operating procedure for prescription reception

with dispensing team

■ Prepare for the contract visit from the PCT at the end of the month

■ Ensure locum cover in place for trial extended opening hours next

month

■ Prepare presentation for local GPs to explain MUR service

Day Diary entry ‘To do’

Monday Technician off on ACT Prepare for 39 week appraisal of

training day, prereg on prereg

study leave (p.m.) Brainstorm ideas for presentation

to GPs

Tuesday Locum – all day a.m.: ﬁnalise preparation for area

a.m. – visit of area manager visit

manager p.m.: write 4 home visit reports

Wednesday Local surgeries closed p.m.: write 4 home visit reports

half-day training day Complete pre-course reading for

CPPE evening

Thursday a.m.: meeting with p.m.: prepare meeting with staff to

prereg to discuss discuss new SOP for prescription

calculations reception – arrange suitable time

for meeting (to take place before

end of month)

Start to prepare for the contract

visit from the PCT at the end of the

month – discuss audit form with

senior technician – highlight areas

that need to be acted on and

agree action plan

Friday Trainee disp (X) – To do: discuss extended opening

annual leave hours trial with staff and payments

involved – set up voluntary rota

system. Book pharmacist locum

cover

ACT, accredited checking technician; CPPE, Centre for Pharmacy Postgraduate

Education; PCT, primary care trust; SOP, standard operating procedure.

Do the most unpleasant job ﬁrst

It is always tempting to tackle an easy task ﬁrst. The theory behind this is

that it will be achieved quickly and encourage the manager to go on and

achieve more difﬁcult tasks. First, if the task is very small and simple

should a pharmacist-manager be doing it at all? Second, it is often the

larger and more difﬁcult task that is labelled as important that has clear

business beneﬁts.

As a pharmacist-manager you may be faced with a choice of two

phone calls:

■ phone a potentially difﬁcult customer to discuss the options regarding

the supply of a generic product that you are having difﬁculty sourcing

■ phone a friendly regular customer to let them know some further

information they requested about their new treatment.

The more difﬁcult phone call is the starting point for the day. The difﬁ-

cult conversation cannot be postponed or the issue may escalate into a

customer complaint and generate more work and involvement. Always

start with more difﬁcult tasks and use easier tasks as ‘ﬁllers’ that can be

done quickly at any time.

Eliminate distractions

A community pharmacy is a distracting place to work. There is a constant

ﬂow of people and conversation, ringing telephones and ad hoc queries.

All of these distractions can deplete the positive energy required for tack-

ling the major items on the ‘to do’ list. It is a useful exercise to devise

ways of avoiding distraction. For example, consider the questions:

■ what is a reasonable length of time for a telephone conversation?

■ do some customers or members of staff make unreasonable demands on

your time?

■ is there any way that noise levels could be reduced?

■ is it possible to make the pharmacy a less distracting place to work?

Remove clutter

Some pharmacy work areas are unnecessarily cluttered with a variety of

papers, messages and ‘post it’ notes. In a dispensary working area this can

be particularly hazardous where a clear ﬂow of work is needed to provide

an efﬁcient service. Dispensary workﬂow is discussed further in Chapter

7. One effective work habit that will help to maximise time is to handle

paper only once. Every day the post will include a variety of material

ranging from circular junk mail to important communication giving

Management skills in the pharmacy 37

details of product recalls. Ensure that a suitable ﬁling system is in place so

that the paper is not allowed to accumulate. Post opening should be done

at a time when any item requiring action can be dealt with immediately.

If any item of post requires a more detailed response the item should be

annotated with a quick note and the task assigned to the weekly ‘to do’

list. The document should then be placed in a pending tray so that it can

be located easily when the task is due. An accessible ﬁling system should

be used for all product information, letters and invoices, and items ﬁled

immediately where possible.

If there is an option to receive information electronically, always

select this option to reduce the amount of paper that needs to be pro-

cessed.

Analyse your time and work processes

Periodically it is worth while assessing the way that time is used for differ-

ent tasks and the systems that operate in the pharmacy. This does not

need to be an elaborate time and motion study but simply an indication

of how the days are spent and how this correlates to your workload and

stafﬁng levels. Looking at systems and procedures with a critical eye is

time well spent as it provides vital information on the efﬁciency of the

pharmacy. This may involve looking at a practical area such as the most

appropriate location for a dispensary stock item or a complex procedure

for supplying a medicine under patient group directions.

Share your work

Where possible, work should be shared, especially if the task is large or

tedious. For example making an inventory of controlled drugs for a stock

audit is both quicker and easier if other members of the team are

involved.

Seize the moment

Take every opportunity to use moments that are not actively engaged in

work. (See Examples 2.1 below.)

Seek advice

If a pharmacist is planning a speciﬁc project there are often opportunities

to seek advice from colleagues who have worked successfully on similar

projects. Always ask for advice and cultivate sharing of ideas. Useful ques-

tions include:

38 Community Pharmacy Handbook

■ are there any short cuts that could be taken?

■ are you on the right lines?

■ have any important issues been overlooked?

By committing to change the way you work, putting ﬁrst things ﬁrst,

using time-management tools and cultivating good work habits you are

well on your way to conquering a skill that is in great demand – the

effective use of time.

Motivating your team

A community pharmacist cannot achieve their work objectives in isola-

tion. The pharmacist-manager depends on a co-operative, willing and

able team in order to be able to meet deadlines and deal with difﬁcult

situations. In reality the manager may have to face employees who are

tired, disgruntled and generally at odds with their working life. This is a

difﬁcult problem to overcome, particularly for the new manager who is

enthusiastic about their role and ﬁnds it hard to accept the negativity of

their pharmacy team. This section is about how to exert positive inﬂu-

ence and motivate the pharmacy team.

A useful starting point is to consider your own behaviour and the

impact it may have on your colleagues. Ask a few simple self-assessment

questions:

■ do I habitually moan about the work situation and the volume of work?

■ do I complain about company procedures?

■ do I act as a positive role model in offering a professional and positive

experience for the customer?

■ do I take time to explain what I am trying to achieve in my approach to

work and in the ongoing development of the pharmacy?

Management skills in the pharmacy 39

Examples 2.1

■ A pharmacist makes a telephone enquiry to a medical information

department and is put on hold for several minutes. Many of the small

tasks that have been allocated to the pending tray can be tackled in

these short time slots.

■ A staff member starts to talk informally to the pharmacist about an

operational procedure that concerns them and this is part of a much

wider issue that needs to be discussed as a team. The pharmacist uses

the time to take proper notes of their concerns and ﬁles the record so

that the time taken for the conversation is used to its full advantage.

■ do I ensure that my team are frequently acknowledged for their

contribution, and make reference to their successes?

It is by looking closely at our own behaviour that we start to realise the

possible impact that we can have on the wider pharmacy team. The man-

ager has to be motivated in order to be able to motivate a team. The ﬁrst

step to being a motivational manager is to be a positive role model.

The next step is to look at motivation as a long-term project rather

than a quick easy ﬁx. The pharmacy manager will need to develop an

approach that is sustainable and maintains enthusiasm and commitment

from their team. There are many different motivational theories that can

be applied to the workplace. For this section we will conﬁne the dis-

cussion to the ‘Motivation–Hygiene’ theory identiﬁed by Herzberg.

This

theory is still widely accepted as an important piece of workplace

psychology and can be applied to the pharmacy environment. Herzberg

identiﬁed several factors such as salary levels, general working conditions

and company policies which he called ‘hygiene factors’. These factors can

be demotivating if they are poor but do not tend to be motivating if they

are good. For example if your pharmacy team works in a pharmacy that

is in desperate need of a reﬁt and staff are paid at the lower end of the

salary scale and have to tolerate archaic company policies and procedures

they will naturally feel demotivated. However, if all of these areas are

addressed: the pharmacy is reﬁtted to a high standard, their salary is

improved to above the nearest competitor and the policies and proce-

dures are streamlined, the pharmacy team will be more motivated. The

theory suggests that once these factors have reached a certain standard,

then further improvement will not motivate the workforce. The hygiene

analogy is that once a workplace washroom is clean, no one cares if it is

scrubbed up to an even higher standard of cleanliness.

The second part of Herzberg’s theory involves looking at what

people actually do in the workplace. The main motivators appear to be: a

sense of achievement, recognition for work done, growth and advance-

ment in their role and an interest in the job. In summar y, additional

monetary reward is pleasant but not as motivational as being valued and

trusted.

To motivate a team, the manager needs to apply both hygiene and

motivational factors simultaneously. The aim is to treat the team in the

best way possible within the constraints of the organisation. This involves

ensuring that the level of remuneration is competitive, the workplace

environment is pleasant, the level of supervision and interpersonal rela-

tionships are satisfactory and there are seen to be sensible policies and

procedures in place. Failure in these areas will lead to dissatisfaction. The

challenge is to ensure that hygiene factors are in place and people are

40 Community Pharmacy Handbook

employed in such a way that they are able to achieve results, are recog-

nised for what they do and are able to take responsibility for their work.

The pharmacist-manager who is keen to introduce the development

of new services is in a strong position to be able to offer these motiva-

tional factors to the team.

For example, the introduction of an accredited checking technician

(ACT) into the team provides the motivational opportunity for a suitable

member of staff to be recognised, developed, valued and trusted.

When thinking about how to motivate a pharmacy team to achieve

more, it is useful to ask the question: why do certain members of staff

remain loyal and enthusiastic about their work? Many loyal members of

pharmacy staff who remain in their work for many years feel stimulated

by the healthcare environment in which they operate and their oppor-

tunity to contribute to the local community. Once the hygiene factors are

in place, the manager’s aim is to work on the motivational factors that are

unique to the pharmacy environment.

Summary of pharmacy motivators

■ Achievement: a motivational pharmacy manager takes the trouble to

ensure that members of the team can achieve something tangible during

their work. This will often lead to developing new skills and enhanced

job satisfaction. For example, during a working week a new part of the

patient medication record (PMR) programme is mastered or a team

member is signed off as competent for a new standard operating

procedure.

■ Recognition for achievement: ensure that the efforts and achievements of

the team are recognised; for example, the professional way a difﬁcult

customer is handled is acknowledged or success in a dispensing exam is

celebrated.

■ Interest in the task: this will mean taking the time on a regular basis to

ensure that the type of work being done by team members is varied and,

where possible, the task is put into context of the overall work. For

example the member of staff recording the initial patient screening

information for the supply of medication by patient group directions will

have a much more positive approach to their work if they can see the

importance of the questions they are asking. If they are unable to see the

signiﬁcance of the questions they will treat the task as a repetitive

administrative exercise.

■ Give responsibility for the enlarged task: by allocating responsibility for a

discrete area of work, the tasks that make up that area can be seen as

more palatable. For example, capping empty bottles to ensure that no

dust collects in them is not the most exciting of tasks when faced with it

in isolation every week. However, if this task is part of a much wider task

of taking responsibility for all the packaging materials in the pharmacy

including how and when they are ordered, stored and used, the

motivation towards this task can change.

Management skills in the pharmacy 41

■ Growth and advancement to higher level tasks: the manager will need an

ongoing awareness of different levels of achievement of the pharmacy

workforce, potential for increasing responsibility and succession

planning. Individual team members will need encouragement so that

they are working towards an appropriate level of achievement and are

encouraged to engage in higher-level activities.

Management of meetings

Mismanaged meetings can be a time-wasting activity and costly in terms

of resources and decreased staff morale. Conversely, a well-managed meet-

ing that has been well thought out can be both productive and motiva-

tional. The holding of any signiﬁcant meeting in a pharmacy can be

difﬁcult to achieve in normal working hours. This means that many

meetings with the pharmacy team are informal and interrupted by the

ongoing business of the pharmacy. Clearly this type of meeting is not

ideal to discuss important business. If the meeting is held after a full

working day it becomes especially important that the meeting is well

planned to justify the time and cost involved for those attending. The

pharmacist-manager will also need to attend meetings with other health-

care professionals, and in some cases will need to call their own meeting,

for example when planning a new service. This section is designed to help

the pharmacist manage meetings more effectively. The characteristics of

a good meeting can be summarised under the headings listed below:

■ good preparation

■ agreed procedures

■ someone to lead, chair or support the meeting

■ a focused discussion

■ a clear purpose or agenda

■ discussion of relevant matters

■ effort to reach conclusions by consensus

■ a forum for everyone to contribute

■ each person is actively invited to contribute

■ high-quality listening by everyone

■ time managed

■ rapid publication of results and further action.

The success of any meeting will depend on:

■ careful input and preparation before the meeting

■ appropriate actions and demeanour during and after a meeting

■ continued evaluation after the meeting is over.

The stages involved in effective meetings management are summarised in

Figure 2.2.

42 Community Pharmacy Handbook

Before any meeting always ask the question: is this meeting necessary? If

the main purpose of the meeting is to provide information then it may

be that a meeting is not needed. If, however, the information being

discussed is of a sensitive or controversial nature then a meeting may pro-

vide the opportunity for questions, comments and clariﬁcation. It would

be unwise to circulate such information in a written memo or by email.

Having established that a meeting is necessary, the next task is to under-

take the important pre-meeting planning. The following summary is a

useful checklist before the meeting:

■ clarify the purpose of the meeting and deﬁne objectives. These should be

incorporated into the meeting documentation

■ book the room, any audiovisual equipment and refreshments well in

advance of the date of the meeting. Think about the most appropriate

venue, as this should be neutral ground

■ decide who should attend the meeting, based on who is most likely to

contribute. It is important that the meeting is balanced and does not

contain a majority of either over-dominating vociferous people or a

signiﬁcant group of introverted non-participants

■ try to keep attendance at the meeting to a minimum

■ organise and distribute a clear agenda and any supporting materials well

in advance of the meeting

■ schedule the meeting with clear start and end times and determine how

long should be taken on each item of the agenda

■ identify a chairperson; this does not necessarily have to be yourself.

Before the meeting the chairperson will need to consider the content of

the meeting and the speciﬁc agenda items. By systematically working

through the agenda items in advance, the chairperson is well prepared for

the issues that may arise during the course of the meeting.

Management skills in the pharmacy 43

Figure 2.2 Stages involved in effective meetings management.

MANAGEMENT

OF THE

MEETING

Purpose defined

Objectives

Agenda/timing

Research

Supporting materials

INPUT AND

PREPARATION

OUTPUT AND

EVALUATION

Statement of purpose

High quality listening

Agreed procedures

Defined roles

Focused discussion

Publication of results

Monitoring action

points

During the meeting it is the role of the chairperson to control the

discussion and ensure that the meeting is conducted in an orderly way. It

involves using well-developed observational and listening skills to ensure

that all participants are involved. It is important to gain opinions from all

present rather than let the loudest personality monopolise the meeting.

The chairperson will also try and summarise and clarify the issues as the

meeting progresses. This is for the beneﬁt of the person taking minutes

and also helpful to ensure that all participants are following the matters

being discussed. In cases of confrontation where there are clear opposing

views and heated discussion, it is useful if the chairperson reminds par-

ticipants of pre-arranged ground rules for the conduct of the meeting.

Sometimes it may be necessary to call for a break in the proceedings to

diffuse a difﬁcult situation. Minute writing involves recording the salient

points regarding the discussion, and focuses on action to be taken by

whom and when.

After the meeting ensure that the minutes are circulated within two

weeks and monitor and evaluate the progress of the action points. This is

a vital process for effective meetings management and ensures that the

time spent on the meeting has been worth while.

Performance management

For many managers the term performance management can bring un-

satisfactory images to mind such as conducting difﬁcult appraisals and

setting unrealistic targets. Performance management is a much broader

activity that is all about getting the right things done successfully. The

pharmacy manager is clearly a performance manager working towards

achieving high standards of patient care through the performance of

others. Management experts have tried to characterise performance man-

agement as either of two approaches:

■ a process-based approach which is based on a systematic analysis of the

work done and the processes involved, in order to achieve the ideal

predetermined result. Examples of this type of approach include

operational research, job evaluation and management by setting

objectives

■ a people approach that works towards having the right people with the

right skills in the right jobs and their effective management and

motivation. Examples of this type of approach include training needs

analysis, succession planning and performance-related pay.

In a community pharmacy the manager will be concerned with achieving

the right skill mix and this is discussed further in Chapter 3. The manager

44 Community Pharmacy Handbook

will also be concerned with looking critically at systems of work and aim-

ing to improve performance through detailed project planning.

Self-check questions for the pharmacist-manager

■ Do I effectively communicate the vision of the pharmacy and the

organisation so that the pharmacy team is aware of the current driving

force behind what is trying to be achieved?

■ Have I established key results, objectives and measures for the pharmacy

business unit? These key results will not only be business based such as

prescription volume but also relate to the provision and expansion of

new services.

■ Are there clearly identiﬁable business process objectives and key

indicators of performance for those processes? For example a clearly

deﬁned procedure to identify patients suitable for a medicines use review

(MUR) will translate into a key performance indicator of numbers of

MURs completed each month.

■ Have I identiﬁed key areas of the pharmacy business that I will need to

monitor and evaluate?

■ Is the performance of the pharmacy benchmarked against examples of

good practice? Am I fully aware of quality indicators for a particular

service?

■ Do I keep myself informed of the performance of my competitors and,

where there is a substantial shortfall in my activity, aim for concentrated

improvement in performance?

Ultimately the performance of any pharmacy manager and the pharmacy

team is measured by customers and service users. This is reﬂected in the

use of customer satisfaction surveys within the pharmacy contractual

framework.

Teamwork and communication

The traditional community pharmacist has tended to be seen as a lone

worker with a strong directive management style. This independent

image is at odds with the effective use of support staff and the building of

a cohesive team. Making effective use of pharmacy support staff through

appropriate levels of skill mix is considered instrumental to developing

the pharmacist’s role in delivering the government’s medicines manage-

ment agenda.

There has been much attention on skill mix issues for

pharmacists and their support staff who work in the community and

primary care sectors.

These issues will be explored further in Chapter 3

on training and development of the pharmacy team. It is important to

note that even if the appropriate skill mix is in place and the number of

hours of stafﬁng is adequate, a pharmacy may under-perform through

Management skills in the pharmacy 45

lack of a teamwork culture. A clear distinction can be made between a

group and a team. Groups can be deﬁned as two or more people who

meet regularly over a period of time, perceive themselves as a distinct

entity distinguishable from others, share common values and strive for

common objectives.

The group of people working in a community phar-

macy could easily ﬁt into this deﬁnition. A team is also a group, but it

takes on a much more sophisticated form. Teams are groups with com-

plementary skills who are committed to a common purpose, clear per-

formance goals, and approach to their work for which they hold

themselves mutually accountable.

This collective way of working is

more than putting together pieces of work in a co-ordinated manner; it is

about team members being accountable for performance both as an indi-

vidual member and as a team. This high ideal is much more difﬁcult to

achieve but has greater long-term rewards. In a community pharmacy

culture that is rapidly changing, the isolated community pharmacist

working with a group of support staff is no longer sustainable. The main

characteristics of an effective team are outlined in Figure 2.3.

46 Community Pharmacy Handbook

Figure 2.3 Characteristics of an effective team.

Conflict

management

Shared

purpose

Understanding

of individual

role

Commitment

to the team by

the individual

Good

communicaton

Support for

other team

members

Trust

between

team members

Transparent

decision

making

Strong

leadership

EFFECTIVE

TEAM

A successful pharmacy team needs a clear and well-communicated

sense of purpose beyond surviving the everyday routine of inevitable

tasks. The shared development of a mission statement gives focus to the

priorities and activities of the team. The pharmacy team will need to

identify their key areas of priority. For example a pharmacy may set up

the following broad goals:

■ to improve staff morale and systems of working

■ to work more closely with other local healthcare professionals

■ to build up strong relationships with customers.

Once the wider aims have been identiﬁed and agreed on, the next stage

is to determine how team members will work towards the agreed ideal.

This can be done by translating the goals into SMART (speciﬁc, measur-

able, achievable, relevant and timed) objectives and periodically meas-

uring the success of the team. For example one speciﬁc team objective

may be to ensure that all members of the dispensary team can readily

identify all the GPs, practice nurses and receptionists at all the local

medical centres. How this could be achieved and measured could be

agreed by the team.

The Belbin team model is used by many organisations to analyse the

way that their team works. Belbin deﬁned a team role as being about how

people behave in a team, how they contribute to a team and how they

interrelate with other team members. He concluded that for a team to be

balanced it should demonstrate nine different roles that are linked to per-

sonality types. An outline of Belbin’s work and role descriptions can be

found on the Belbin team roles website.

An individual leaning towards

a particular role within a team can be determined by completing a Belbin

questionnaire. This information can then be used to reﬂect on how the

individual uses their role to contribute towards their team’s effectiveness.

One pitfall of using this type of approach is that the team member may

become overly concerned with their Belbin role within the team. The

team member may become unwilling to develop new ways of contribut-

ing to the team that they perceive to be outside their own area of

strength. The Belbin system can be useful if a manager is setting up a new

team as it provides the potential to include different types of team mem-

bers. In practice many teams are already well established and will need to

operate within the conﬁnes of the team members that they have.

However, it can be useful for the established team to look at the way that

it works together and the strengths of individual team members. The

pharmacist is often expected to perform the role of team leader which

equates to Belbin’s co-ordinator role, even though this may be outside

their own personality comfort zone.

Management skills in the pharmacy 47

Ideally a strong leader will:

■ enable team members to become involved and committed to an agreed

goal

■ be an honest and open communicator

■ celebrate success and achievement.

The issue of communication or lack of it is one that often causes prob-

lems in a team. In a community pharmacy where the team often works in

close proximity, communication within the team should be a particular

strength. Of all the many methods of communication including notice

boards, memos, bulletins and email it is face-to-face contact and regular

open dialogue that is the most effective. Regular praise and genuine

encouragement are essential if a team is to ﬂourish. Inevitably there will

be times of conﬂict in any team and it is important to be able to deal with

conﬂict issues speedily and effectively. Team problems should not be

ignored, especially if other team members perceive that a team member

is not contributing to an agreed team goal. For example, one method is

to introduce a ‘pharmacy problem log’ which provides the transparent

opportunity to report identiﬁed problems and look at how these can be

resolved by requesting suggested solutions from the team. The log can be

used to record all problem areas and assess work patterns that are emerg-

ing within the team.

It is well-recognised that successful teams enjoy their work and inter-

act at a social level. It can be useful to arrange regular social events to

ensure that the whole team has the opportunity to meet outside the work-

ing environment. Arranging a regular social event can have a positive

impact on how the team interacts and communicates. It can be useful

if the responsibility for organising the event is taken on by different

members of the team.

One of the challenges for a manager is to build up an effective work-

ing team. Working as part of a successful team that communicates effect-

ively can make the working environment a much more enjoyable place.

This is a goal worth aspiring to for any pharmacist-manager.

Information management

In common with any manager, the community pharmacist will need to

be able to manage information in order to make informed decisions.

Information can be categorised according to its market value. The three

main types of information can be classiﬁed as listed below:

■ information for sale: for example written material or software that is

48 Community Pharmacy Handbook

available at a market price. This often has a limited shelf life and its value

declines with time, for example an externally produced and marketed

information pack on how to set up a blood pressure monitoring service

in your pharmacy

■ information that is freely available: for example access to websites,

pricelists, pharmaceutical advertisements and promotional material. In

many cases, access to this type of material brings speciﬁc beneﬁt to the

owner of the information

■ information for internal use by an organisation which is not intended to be

sold and is of high value to the user. This includes business information,

sales ﬁgures, prescription items, minutes of meetings and projected

income from new services.

The pharmacist will use all the above types of information. However, it is

the internal information that is of most value to the pharmacist-manager.

As there is no external market for internal information, it is difﬁcult to

estimate the value of this type of information. The value of internal infor-

mation is totally dependent on a number of factors such as:

■ relevance

■ completeness

■ accuracy

■ clarity

■ timing.

Management skills in the pharmacy 49

Example 2.2

Moira Brown has managed a busy suburban pharmacy for over two

years and is keen to develop new services. The following scenarios high-

light the importance of information management in the pharmacy.

Scenario 1

Moira’s projected sales ﬁgures for a new food allergy-testing service are

very promising but are based on the ﬁgures from a pharmacy in a com-

pletely different demographic area to her own practice. She would

need to question how relevant the ﬁgures are and if they could be

applied to her own business.

Scenario 2

Moira wants to determine the best time to book MUR appointments so

that she can have the appropriate staff resources in place to carry out

this advanced service. She delegates a member of the dispensary team

to collate information about stafﬁng levels and prescription volumes.

When the information is produced she realises that it does not present

continued overleaf

Using internal information and managing this information effectively is

the lifeblood of any business. In common with many managers, the phar-

macist can suffer from information overload.

50 Community Pharmacy Handbook

Top tips for pharmacy information management

■ Access your email inbox only at speciﬁc times of the day so that

this does not interrupt your ﬂow of work.

■ Have a user-friendly hard copy ﬁling system that will incorporate

sections of information that can be easily accessed. Ideally, items

should be ﬁled immediately or placed in a designated ﬁling tray.

Examples of useful sections could include:

– product information A–Z

– patient information leaﬂets A–Z

– primary care organisation (PCO) information

a complete picture as she has no information on all local surgery open-

ing times and how many GPs are in surgery at any one time.

Scenario 3

Moira is pleased to notice a steady signiﬁcant increase in prescription

numbers over the past few weeks and starts to think how this will affect

her stafﬁng levels. On investigation she notices that there are some

errors on the daily prescription record sheet entered by a new member

of staff and realises that she is working with inaccurate information.

Scenario 4

The PMR system that Moira is using is adequate but does not always

provide information in a clear and accessible form. To offer a more pro-

fessional service and signpost patients to appropriate services she needs

to be able to access collated information quickly and easily. Moira can

foresee that she will need a more up-to-date system that will offer clear

information and a means of engaging more fully in the new contract.

Scenario 5

Moira wishes to put in a proposal to offer a full pharmaceutical service

to a 53-bed care home as she is aware that the home is about to change

ownership. Moira is aware of some of the priorities of the new care

home organisation and submits a detailed proposal to incorporate some

of these priorities. Due to time pressures her proposal is not submitted

until 3 months after the change of ownership, by which time the new

owner has decided to take up the services of another pharmacy.

→

Management style

The community pharmacist manager is usually responsible for a small

team of people involved in the delivery of a safe and effective pharma-

ceutical service. Increasingly this will involve the delivery of patient-

orientated pharmaceutical services. It is useful to reﬂect on your own

individual management style and how this is inﬂuenced by your person-

ality, and your working environment. Some management theories cat-

egorise managers into four basic types: directing, supporting, coaching

and delegating.

The directive management style can inspire conﬁdence in your team

and means that often you give clear and precise instructions. The dis-

advantage is that it can be seen as narrow and patronising and does not

allow enough input from the team.

The supportive style of manager is good at giving feedback and an

excellent listener. The disadvantage is that they can be seen to be swayed

by too many opinions, and lacking in direction. The coaching manager

uses a combination of directing and supporting and depends on building

solid relationships within the team. Coaching will be discussed in more

detail in Chapter 3. This vital skill can be applied to both the training and

Management skills in the pharmacy 51

– health-promotion and signposting information

– prescribing information

– business information

– personnel ﬁles

– business development

– training and development.

■ Decide how information technology will be used to develop the

pharmacy, and make a plan of how this will be achieved. Break

down each requirement into manageable stages, for example:

‘Tobecome competent in the use of an electronic system of

recording and referring MUR information’.

■ Look at ways of making appropriate business information clear,

relevant and available to all of the pharmacy team. Consider

regular short meetings to communicate information, and back this

up with electronic and hard copies.

The successful pharmacist-manager will need to gain mastery over

how they manage and use information. Knowledge and competence

in the management of information will increasingly become an

important characteristic of a successful community pharmacy

manager.

management of your staff. The delegating style of management will only

work if there is clear communication about the delegated task. Many

managers ﬁnd it hard to let go of certain tasks and will only supervise

rather than delegate. Other managers will be ineffective in their delega-

tion of tasks as they will fail to follow up the initial delegation and be

unclear about the outcome and the accountability for the task.

As a pharmacist you will need to employ all these different styles at

different times and with different members of your team. The directive

style may be more suitable to the medicine counter assistant that has just

started and needs clear pointers about what they should be doing. A

coaching style is appropriate to a trainee dispenser for example, who

may have some well-developed skills but is unable to progress and lacks

personal motivation. A combination of coaching and supervision can

help to develop and manage this member of your team. A supporting

style may be more appropriate when applied to a more mature member

of the team that is very able but lacks conﬁdence. By offering support

and encouragement to take more responsibility the aim is to move this

person on to a more independent state. The delegating style is most

appropriate for example to an experienced and conﬁdent pharmacy

technician. Provided the task, outcome and monitoring process are

agreed in advance there is no reason why this member of staff cannot be

delegated major objectives within the pharmacy, such as setting up a

weight-management clinic or introducing a new system of repeat pre-

scription collection.

Well-developed management skills are essential for the community

pharmacist to engage fully in the new opportunities available in com-

munity pharmacy. An ongoing process for any manager is to reﬂect on

some of the core management skills needed to make things happen

within a pharmacy and link this with their ongoing continuing profes-

sional development (CPD).

Implications for practice

After reading this chapter are there any management skills that could be

developed as part of your CPD?

Activity 1

Spend some time reﬂecting on how well the pharmacy team operates in

your pharmacy. Which of the characteristics of an effective team:

52 Community Pharmacy Handbook

■ are evident?

■ need more input and development?

Activity 2

Reﬂect on twodifferent examples from your own practice where you have

used different management styles. Was the management style used

appropriate to the situation?

Multiple choice questions

Directions for questions 1 and 2: each of the questions or incomplete

statements in this section is followed by ﬁve suggested answers. Select the

best answer in each case.

Q1 Time-management theory suggests all of the following except:

A Using time-management tools such as a matrix that determine if a

task is urgent or important

B Always start with easier tasks that can be done quickly and removed

from your ‘to do’ list

C Eliminate distractions where possible

D Spend time analysing your working day and work processes

E Seek advice from others on their systems of work

Q2 According to Herzberg’s theory the main motivators in a workplace are all

of the following except:

A Work that brings a sense of achievement

B Recognition for work that is done

C High level of remuneration

D Career advancement

E Genuine interest in the job

Directions for questions 3 to 5: for each numbered question select the

one lettered option above it which is most closely related to it. Within

each group of questions each lettered option may be used once, more

than once, or not at all.

A Co-ordinator

B Shaper

C Resource investigator

D Plant

E Team player

Select from A to E which one of the above ﬁts the following statements.

Management skills in the pharmacy 53

According to the Belbin team proﬁle:

Q3 A pharmacy technician who is very reﬂective and has excellent ideas but is

unable to progress their ideas into a workable project.

Q4 A medicine counter assistant who is very outgoing and has a lot of

contacts. They tend to quickly lose interest in a project once the initial

enthusiasm has passed.

Q5 A challenging dispensing assistant who thrives under pressure and enjoys

a challenge, particularly when there seem to be insurmountable obstacles.

However, they can sometimes provoke other members of the team and

may cause offence.

Directions for questions 6 to 8: each of the questions or incomplete

statements in this section is followed by three responses. For each ques-

tion ONE or MORE of the responses is (are) correct. Decide which of the

responses is (are) correct. Then choose:

A if 1, 2 and 3 are correct

B if 1 and 2 only are correct

C if 2 and 3 only are correct

D if 1 only is correct

E if 3 only is correct

Directions summarised:

A: 1, 2, 3 B: 1, 2 only C: 2, 3 only D: 1 only E: 3 only

Q6 The following statements are about information management:

1 There are three broad areas of information: information for sale,

information that is freely available and internal information used by

an organisation.

2 As a manager the most useful type of information is internal

information.

3 Saleable information often has a limited shelf-life, and its value

declines with time.

Q7 The following statements are about management styles:

1 A directive management style is often seen as positive and allows

input from the pharmacy team.

2 A delegating management style is appropriate to a newly appointed

medicine counter assistant.

3 A coaching management style uses a combination of directing and

supporting management styles.

Q8 The following statements are about general management skills and their

impact:

1 Managing self and the quality of a manager’s interpersonal skills often

determine how successful the manager is in all other areas of

management.

54 Community Pharmacy Handbook

2 The Management Standards Centre, after extensive consultation with

employers and individual managers, developed a set of standards for

managers that included such areas as: providing direction, using

resources and achieving results.

3 The management skills of a pharmacist-manager will have a high

impact on the quality of the services that they offer.

Directions for questions 9 and 10: The following questions consist of a

statement in the left-hand column followed by a second statement in the

right-hand column.

Decide whether the ﬁrst statement is true or false.

Decide whether the second statement is true or false.

Then choose:

A if both statements are true and the second statement is a correct

explanation of the ﬁrst statement

B if both statements are true but the second statement is NOT a correct

explanation of the ﬁrst statement

C if the ﬁrst statement is true but the second statement is false

D if the ﬁrst statement is false but the second statement is true

E if both statements are false

Directions summarised:

A: True True second statement is a correct explanation of the ﬁrst

B: True True second statement is NOT a correct explanation of the

ﬁrst

C: True False

D: False True

E: False False

■ Statement 1: A community pharmacy that offers remuneration above

the national average and is reﬁtted to provide excellent working

conditions will not necessarily improve the level of staff motivation.

■ Statement 2: The ‘hygiene factors’ identiﬁed by Herzberg can be

demotivating if they are poor, but do not tend to be motivating if

they are good.

Q10

■ Statement 1: A manager setting up a new community pharmacy team

would ideally try and recruit team members with different strengths.

■ Statement 2: Belbin demonstrated that for a team to be balanced it

should demonstrate a number of different roles linked to personality

type.

Management skills in the pharmacy 55

Case studies

Level 1

Sheetal is part of a group of four ﬁnal-year pharmacy undergraduates that

are required to make a formal presentation on a clinical case study. The

presentation forms part of their ﬁnal assessment for a module. The groups

have been allocated randomly and Sheetal is very concerned as she has

not worked with any of the students in her group before. The ﬁrst plan-

ning meeting did not go well as the group appears to be extremely

diverse. She makes a mental note of the behaviour of her colleagues:

■ Adil appears to be very loud and has many good ideas but is not very

willing to listen to other viewpoints

■ Angela is extremely quiet and does not contribute to the discussion but is

known to be very reliable and hard working

■ Liam is well known for achieving excellent academic results and has an

excellent grasp of the case study. Unfortunately he comes across as

arrogant and unwilling to co-operate with other members of the group

■ Sheetal is a conscientious student and feels concerned that the group will

not work well together and that this will have a negative impact on their

assessment.

The group is due to meet again next week for another planning meeting.

■ What advice would you give to Sheetal to ensure that the next meeting

runs more smoothly and is more productive?

Level 2

Michelle has been asked by her preregistration tutor to organise a health-

promotion activity in the pharmacy on National No Smoking Day. She is

pleased to have been trusted with this event and her tutor has suggested

that she should call a meeting of the dispensary team to discuss possible

activities and plan the day.

■ Produce a brief bullet-pointed list of constructive advice for Michelle on:

– how she should plan the meeting

– a suitable agenda for this meeting with proposed timing

– how she should follow up the meeting.

Level 3

John has now been registered for 3 years and is due to be relocated to

manage a pharmacy recently acquired by his employer.

56 Community Pharmacy Handbook

The pharmacy is situated on the edge of a large market town. The

business has been quite neglected and has been running on locums for

the past year. On John’s initial visit to the pharmacy he makes some notes

of the major points related to this pharmacy:

■ prescription items approximately 1000 per month

■ retail turnover very low

■ retail ﬂoor area large and ‘empty’ appearance. Good parking facilities

■ appearance of store very dirty and neglected. The dispensary in particular

looks very untidy and disorganised

■ dispensary grossly overstocked

■ there is no prescription-collection service

■ staff:

– one full-time supervisor, suffers from poor health and has had a lot of

sick leave, attitude is quite negative particularly towards the employing

organisation. The supervisor is not used to being managed or having a

permanent manager and is not at all involved in the pharmacy as she

sees this ‘as the work of the pharmacist’

– one part-time member of staff who works for three hours each morning,

and appears to be very slow in her work and also very reluctant to

become involved in the dispensary

– Saturday staff: two young students – inexperienced but seem to be well

motivated and keen to learn

■ some loyal customers, but mainly passing trade

■ the nearest pharmacy is on the same road and about 200 m away on a

busy part of the road

■ Carry out a SWOT (strengths, weaknesses, opportunities, threats) analysis

of this business.

■ What are John’s priorities as a new manager? Construct a time chart of

suggested actions for John during his ﬁrst 2 months as a manager.

References

1 The Management Standards Centre website. www.management-

standards.org.uk (accessed 4 September 2007).

2 Covey S. The Seven Habits of Highly Effective People. London: Simon and

Schuster, 1989.

3 Calder G. Motivating pharmacists. Pharm J 2000; 264: 729–731.

www.pjonline.com/editorial/20000513/articles/motivating.html

(accessed 7 September 2007).

4 Leigh A. 20 Ways to Manage Better, 3rd edn. London: Chartered Institute

of Personnel Development, 2001.

5 McGuire R. How to manage meetings effectively. Pharm J 2002; 268:

766–767.

6 Walters M, ed. The Performance Management Handbook. London: Institute

of Personnel and Development, 1995.

Management skills in the pharmacy 57

7 Department of Health. Pharmacy in the Future. London: The Stationery

Ofﬁce, 2000.

8 Department of Health. Pharmacy Workforce in the New NHS: making the

best use of staff to deliver the NHS pharmacy programme. London:

Department of Health, 2002.

9 Shaw ME. Group Dynamics: the psychology of small group behaviour, 3rd

edn. New York: McGraw-Hill, 1981.

10 Katzenback JR, Smith DK. The Wisdom of Teams; Creating the High

Performance Organisation. Boston: Harvard Business School Press, 1993.

11 Belbin Team Roles website. www.belbin.com/belbin-team-roles.htm

(accessed 4 September 2007).

12 Wilson DA. Managing information (Institute of Management

Foundation). Oxford: Butterworth Heinemann, in Association with the

Institute of Management, 1993.

13 Blanchard K. Leadership and the One Minute Manager. London: Harper

Collins, 1994.

Further information

Institute of Pharmacy Management website. www.ipmi.org.uk/ (accessed 4

September 2007).

McGuire R. How to build a successful team. Pharm J 2002; 269: 814–816.

58 Community Pharmacy Handbook

Training and development

of the pharmacy team

Excellence is an art won by training and habituation. We do not act

rightly because we have virtue or excellence, but we rather have those

because we have acted rightly. We are what we repeatedly do. Excellence,

then, is not an act but a habit.

(Aristotle)

At the outset it is important to differentiate between training and learn-

ing. Training is something that one person does to another. Learning is

something that we can only do for ourselves. The community pharmacist

is actively involved in the training of other members of the team. A

logical starting point when considering the training and development of

the pharmacy team is to consider who is being trained and for what

purpose.

Pharmacy support team

The subject of skill mix in the delivery of healthcare has been actively

debated in recent years. Optimising the mix of skills across the health

sector is considered to be a viable way of meeting patient needs,

Checkpoint

Before reading on, think about the following questions to identify

your own knowledge gaps in this area:

■ What formal qualiﬁcations are required for different types of

pharmacy support staff?

■ How would you carry out a training needs analysis in the

pharmacy?

■ Describe four different types of training method that could be used

in a community pharmacy and the advantages and disadvantages

of each method.

■ How can training be evaluated?

providing enhanced roles for staff and addressing recruitment and reten-

tion issues. Assessing and modifying skill mix in community pharmacy is

difﬁcult because of the diverse and complex nature of community phar-

macy.

A large study to explore and deﬁne the roles of dispensary support

staff looked at different community pharmacies and ways that support

staff operated.

The ﬁndings illustrate that the community pharmacy

environment is complex and diverse in terms of the roles played by

dispensary support staff. The study included the following different types

of pharmacy:

■ a pharmacy where all support staff have distinct roles that do not overlap

■ a pharmacy dominated by the owner-manager who is involved closely in

the day-to-day activities

■ a technician-led pharmacy that is highly efﬁcient but the technician is

unwilling to delegate tasks and decision making

■ a pharmacy with a pharmacy technician that provides a highly focused

dispensing service

■ a team of support staff that have effectively run the pharmacy with a

locum pharmacist in the absence of a permanent pharmacy manager

■ a pharmacy that demonstrated a strong team spirit among the support

staff to ensure that all tasks were completed.

The experienced community pharmacist may have experienced all of the

above different work scenarios and combinations of working patterns.

The variation across community pharmacies as well as the number, type

and activities of pharmacy staff must be considered in the development

of different models of skill mix.

It is important to be clear at the outset what types of support staff

exist in the pharmacy, how their role is deﬁned and what formal qualiﬁ-

cations are required.

The Medicines Ethics and Practice Guide deﬁnes three main types of

support staff:

■ pharmacy technicians

■ dispensing/pharmacy assistants

■ medicine counter assistants.

Medicine counter assistants

Medicine counter assistants (MCAs) are given delegated authority by the

pharmacist under a medicines protocol to sell medicines. Since 1996 it

has been a requirement that any MCA should have undertaken or be

undertaking an accredited course relevant to their role in the sale of

medicines and provision of healthcare advice. The Royal Pharmaceutical

Society of Great Britain (RPSGB) requirement is that the course should

cover the knowledge and understanding associated with speciﬁc units of

60 Community Pharmacy Handbook

the Scottish/National Vocational Qualification (S/NVQ) Level 2 in

Pharmacy Services. The speciﬁed units are 2.04 and 2.05 which include

the sale of over-the-counter medicines, prescription reception and issuing

completed prescriptions. Full details of accredited courses and the speciﬁc

knowledge and understanding required by the Pharmacy Services Level 2

units are available in the document Training Requirements for Medicine

Counter Assistants.

MCAs are required to be enrolled on a suitable train-

ing programme within 3 months of working on the medicine counter, or

as soon as is practical within local training arrangements. The training

programme should be completed within a 3-year time period.

Dispensing/pharmacy assistants

Up to January 2005 there were no formal training requirements for

members of staff working in the dispensary area either as a dispenser or

pharmacy assistant. There was quite a lot of confusion over these titles as

it covered a range of staff from the highly experienced and qualiﬁed phar-

macy technician to a school leaver who is working in a dispensary and

has limited experience. To try and clarify the situation for their own

employees, many companies had already introduced their own internal

training schemes at two levels: pharmacy assistant and dispenser. The

pharmacy assistant carried out routine dispensing tasks under the super-

vision of a dispenser. The situation was further confused by use of other

titles such as healthcare assistant and dispensing assistant.

Pharmacists have a professional obligation to ensure that dispensing

and pharmacy assistants are competent in the areas in which they are

working. This competency is deﬁned by a minimum standard equivalent

to the new Pharmacy Services S/NVQ Level 2 qualiﬁcation or undertaking

training towards this qualiﬁcation. This requirement applies to staff work-

ing in the following areas:

■ sale of over-the-counter medicines and the provision of information to

customers on symptoms and products

■ prescription receipt and collection

■ the assembly of prescribed items (including the generation of labels)

■ ordering, receiving and storing pharmaceutical stock

■ the supply of pharmaceutical stock

■ preparation for the manufacture of pharmaceutical products (including

aseptic products)

■ manufacture and assembly of medicinal products (including aseptic

products).

The dispensing or pharmacy assistant should be enrolled on a training

programme within 3 months of starting their new role or as soon as is

practical within local training arrangements. The training programme

Training and development of the pharmacy team 61

must be completed within a 3-year time period and the type of training

programme selected will depend on the speciﬁc job role of the member of

staff. There are four acceptable training programmes:

■ Pharmacy Services S/NVQ Level 2

■ relevant units of Pharmacy Services S/NVQ Level 2

■ a training programme accredited to be of an equivalent level to S/NVQ

Level 2 (for example an accredited company training scheme)

■ relevant units of a training programme accredited to be of an equivalent

level to S/NVQ Level 2.

During the introduction of this requirement there was a grandparenting

clause where existing staff were exempted by a statement of competence

from their supervising pharmacist submitted to the RPSGB.

Pharmacy technician

A pharmacy technician is a person who holds a S/NVQ Pharmacy Services

Level 3 qualiﬁcation, or a qualiﬁcation that has previously been recog-

nised by employers as a valid qualiﬁcation for pharmacy technicians. The

pharmacy technician has a wide variety of skills in the supply and use of

medicines, and this is often recognised by the formal management role

they have in a pharmacy. The RPSGB opened a voluntary register of phar-

macy technicians in January 2005 and issued guidelines for acceptable

qualiﬁcations.

This means that the title ‘pharmacy technician’ will

become protected in law and registration will be mandatory. There will be

an initial transitional period during which grandparenting arrangements

will apply to technicians who predate S/NVQ qualiﬁcations, who can

provide evidence of alternative qualiﬁcation and recent work experience

as a pharmacy technician. Transitional grandparenting arrangements will

only apply until 2 years after the introduction of statutory registration. A

full list of qualiﬁcations that apply during this period is available on the

RPSGB website.

In addition to training MCAs, dispensers and pharmacy technicians,

the pharmacist may also be involved in the training and development of:

■ pharmacy technicians undertaking extended roles such as an accredited

checking technician (ACT)

■ preregistration pharmacy graduates

■ undergraduate pharmacy students undertaking vacation employment.

Training and development in a community pharmacy can be a complex

area, given the wide-ranging skill mix issues and the external training

requirements for staff members undertaking different roles. The proﬁle of

the pharmacist as a training manager will be raised further, as new phar-

macy services are implemented, more accredited checking technicians are

62 Community Pharmacy Handbook

introduced, and the issue of pharmacist super vision becomes less pre-

scriptive. This chapter aims to provide an overview of important training

issues to support the pharmacist in this expanding role.

Training needs analysis

Careful analysis of training needs is the foundation of all good training

practice. Without a systematic training needs analysis, our training

methods and use of resources become questionable. The ﬁrst question to

ask is: ‘What is a training need?’

It is obvious that an experienced ACT may need, for example, to

develop speciﬁc IT management skills, whereas a newly appointed MCA

is more concerned with being able to operate a cash till. However the

difference in the content of training requirements for different personnel

is only a superﬁcial insight into training needs analysis (TNA).

TNA is concerned with the following areas:

■ types of learning need

■ organisational needs

■ individual needs

■ key task analysis

■ competency analysis.

There have been many attempts to classify types of learning. Bloom’s

Taxonomy of Learning proposes that there are four types of learning:

■ cognitive (thinking and analysing)

■ affective (feelings and attitudes)

■ psychomotor (physical)

■ interpersonal (relationships with people).

Theoretical classiﬁcations may seem artiﬁcial in practical workplace situ-

ations as there is a certain amount of overlap. The advantage of looking

at learning needs in more detail is that the training manager starts to plan

the training programme around a speciﬁc need rather than using the

approach that one size ﬁts all approach. (See Example 3.1 overleaf.)

The needs of the organisation also need to be entered into the TNA

equation to achieve a positive outcome. For the employee pharmacist this

may involve looking at the wider corporate picture. The self-employed

pharmacist will take time to reﬂect on personal business priorities.

To facilitate this process it is useful to ask questions such as:

■ what business objectives have the highest priority over the next 12

months?

■ how successful is the organisation engaging with the contractual

framework for community pharmacy?

Training and development of the pharmacy team 63

■ are there any new plans for offering new innovative services or offering

different product ranges?

■ is there any new legislation that may affect the way the team operates?

■ are there any plans for physical changes to premises or upgrading of

information technology systems?

Often when broader questions are considered there can be seen to be

some common ground and this will provide a different organisational

perspective to the overall training plan.

Another important component of TNA is the consideration of indi-

vidual learning needs. The goals and aspirations of pharmacy employees

are likely to differ from those of the organisation. For example the

competent dispensing assistant may have goals that include working for

a different employer and at a higher level. This excellent team member

may want to become a registered pharmacy technician and work for a

large multiple. The unspoken individual agenda may often be due to the

employer not being willing to invest in highly transferable skills, and sub-

sequently losing a highly valuable member of their team. When looking

at individual goals, open communication is vital to establish how the

employee feels about their own job role. For example the pharmacist

may perceive that their pharmacy technician could work more quickly

and process prescription items with greater efﬁciency. The pharmacy

technician may have the view that the patient medication record (PMR)

system is outdated and the number of support staff is not adequate for the

level of business. It is only by open and honest communication that you

can establish if there is a training need or if the deﬁciency is caused by

other factors that are unrelated to training. The consideration of indi-

vidual learning needs is vital if a realistic training programme is to be

implemented.

64 Community Pharmacy Handbook

Example 3.1

Mark is a pharmacy technician who has excellent theoretical knowl-

edge and performs well in operating an efﬁcient dispensing service.

However, his interpersonal skills and attitude towards customers and

colleagues is a constant source of concern. Should this member of the

team be required to complete more distance learning training packages

and theoretical learning, when his real learning needs have not been

addressed? Community pharmacy can provide many examples where

the type of learning need for individuals has not been considered fully.

The next stage of the TNA process is to analyse job roles and key

tasks in the pharmacy. There are different approaches to this task and a

better result is obtained if information is gathered from a variety of

sources. Questions that could be asked include:

■ what is the expectation of each job role from the pharmacy manager?

■ how does the job holder see their role and responsibilities?

■ is there any evidence from diary keeping or work shadowing? This

information would need to be used to assess the details of what a job

entails over a period of several weeks.

■ is there any information from team meetings or discussions with work

colleagues about how different members of the team perceive different

tasks?

■ what documentation is available on job descriptions and key outputs?

Having obtained a clearer view of what each role entails in your phar-

macy, the next stage is to break down each job into key tasks according

to what knowledge, skills and attitudes are required.

For example the MCA may have the following key tasks:

■ merchandising medicines

■ medicines stock control and management

■ sale of medicines

■ answering general customer queries and acting as a receptionist

■ prescription reception

■ store housekeeping duties.

By looking at the knowledge, skills and attitudes that are required by each

key task, a general picture should start to emerge. It may be for example

that the experienced counter assistant needs to develop more advanced

customer care skills and be able to act as a receptionist for the running of

a pharmacy-based weight-management clinic. The time and training

required to achieve this objective may mean that some non-customer-

based tasks will need to be relinquished to other members of the team. In

this scenario, the range of key skills required by this member of staff will

shift, and this needs to be acknowledged in the planning of training. A

community pharmacist interested in the training and development of

staff should aim to produce a matrix of all the job roles in the business

and the key skills required. Provided this information is regularly

updated, it will prove invaluable in ensuring that training is relevant to

the needs of the staff and ultimately the business.

A more recent approach to TNA is the concept of competence. The

competence-based approach looks more closely at the behaviour that

results from speciﬁc knowledge, skills and attitudes. Competency is

deﬁned as being able to perform ‘whole’ work roles to the standards

expected in employment and real working environments.

There are two

Training and development of the pharmacy team 65

main approaches when using competence as a means of identifying learn-

ing needs: input approaches and the outcomes model.

The input approach focuses on the blend of skills, personal

attributes and attitudes that enable people to perform effectively in the

workplace. This is all about patterns of behaviour that employees need to

bring with them to do a job effectively. The outcomes approach is the

model on which the NVQ system is based, where the employee is

matched against a set of performance standards. The use of performance

indicators is critical when using a competence-based approach. It will

involve asking questions such as:

■ what does good look like?

■ what is acceptable?

■ what is poor?

In pharmacy practice the competence-based approach is widely used and

forms the basis of the preregistration training programme. The use of a

speciﬁc template of competencies gives the pharmacy graduate a clear

idea of where they are heading, and is a valuable tool in determining their

own training needs.

Successful TNA involves adopting a reﬂective approach and looking

at the pharmacy with a critical eye. What is certain is that the time spent

on this vital process of assessing training needs is never wasted.

Training methods in the pharmacy

Having established speciﬁc training needs, the next stage is to determine

what training methods are most appropriate. Some of the factors to be

considered when selecting or designing the most appropriate training

method are summarised in Figure 3.1.

The pharmacy manager will need to consider such factors as:

■ time resources available and ensuring that adequate time for training is

built into the working week

■ cost as part of the overall training budget

■ organisational constraints such as how the training will complement the

existing company training plan

■ strengths and weaknesses of the pharmacist or staff member delivering

the training

■ the physical work environment, as this will also have some inﬂuence on

the training methods used. For example there is much more ﬂexibility if

there is a designated training room that is well equipped for both

individual and group training. This facility is only likely to exist in a

large pharmacy and the pharmacist working in a smaller pharmacy will

need to look carefully at how space and physical resources can be used to

66 Community Pharmacy Handbook

facilitate training. It is inappropriate to expect members of the pharmacy

team to study distance learning material while on the shop ﬂoor

■ preferred learning methods for individual members of staff, which will

also inﬂuence the type of training method selected. Some members of

staff will prefer a more active approach to learning and gain more from

being allowed to explore, test and learn by doing. Others prefer a more

passive approach and will gain more by observing, questioning,

interpreting and reviewing activities. Other members of the team will

prefer to learn in a group situation and reﬂect ideas off their colleagues.

There are three broad categories of training method:

■ trainer-centred training

■ learner-centred training

■ coaching.

Trainer-centred training includes any type of training where the trainer

controls the pace and content of learning. This will include formal pre-

sentations and demonstrations, either to an individual or a group. The

learner may slow the training down by asking a lot of questions but the

pace is ultimately set by the trainer. Role-plays and practical exercises are

also trainer centred as the trainer sets the training content and draws out

the key learning points.

Learner-centred training is at the opposite end of the spectrum and

is designed to give the learner complete control over their learning. The

established methods of learner-centred training include the use of printed

Training and development of the pharmacy team 67

Figure 3.1 Factors that inﬂuence the choice of training method in the

pharmacy.

Company

external

policy

Tutor

Trainer

TRAINING SUBJECT

Practical

workplace

issues

Resources

Individual

learning

preference

TRAINING

METHOD

training materials, books, journals and self-study materials. Learner-

centred training can be made more active by the use of self-development

questionnaires and personal learning logs. Increasingly learner-centred

learning uses information and learning technology such as DVD and

CD-ROM packages or internet based e-learning resources.

Coaching is a method of training that allows trainer and learner to

develop a learning partnership and to share control. This method of

training is particularly appropriate to community pharmacy and will be

discussed later in this chapter.

Many community pharmacies use a combination of distance learn-

ing programmes and on-the-job training to develop their support staff.

The main training methods used in the pharmacy are summarised

in Figure 3.2.

On-the-job training

Successful on-the-job training involves:

■ a clear identiﬁcation of the level of support that is needed

■ a clear identiﬁcation of the most suitable person to give this support.

68 Community Pharmacy Handbook

Figure 3.2 Types of training in the community pharmacy.

Coaching

Off-the-job

training

event

Distance

learning

Formal

presentation

Group

tutorial

One-to-one

tutorial

Role-play

Problem-based

learning

PHARMACY

TRAINING

The traditional approach to training a new member of staff is to ask a

more experienced member of staff to oversee their work and provide on-

the-job training on an informal basis. This traditional ‘sit next to Nelly’

approach clearly has disadvantages, in particular the duplication of any

poor working practices that an experienced employee may have devel-

oped over a number of years. On-the-job learning needs to be carefully

planned for it to be fully effective. It may involve a formal ‘buddy system’

with regular reviews and a clear competence-based framework that can be

assessed at regular intervals. Alternatively it may involve working

through the various elements of a task in a logical sequence with differ-

ent coaches for each stage of the task (Table 3.1).

In community pharmacy where there is often the question of

patient safety it can be inappropriate to let the new trainee work through

problems on their own and much of the early training will be working

through common standard operating procedures (SOPs). However, there

is a place for allowing the trainee to tackle certain tasks with little input

or supervision, provided this is followed up with a detailed discussion and

review of how they approached the task. Learning by doing is a powerful

training tool as long as it is followed up with supportive feedback. For

example the new MCA will sometimes have to interact with difﬁcult and

demanding customers. It is important that the new team member has

adequate opportunity to discuss their experience of dealing with cus-

tomers with a more experienced member of staff. When planning on-the-

job training there should be a clear distinction between tasks that have a

clear SOP and tasks where a certain amount of initiative and ﬂexibility are

required.

Training and development of the pharmacy team 69

Table 3.1 Examples of on-the-job training and identiﬁcation of a suitable coach

for a new dispensing assistant

Task Coach

Prescription reception procedure Experienced counter assistant

Handing out prescriptions Pharmacist or pharmacy technician

Dealing with the initial stages of a Pharmacist or pharmacy technician

customer complaint

Putting away stock in the dispensary Dispensing assistant

The two main beneﬁts of on-the-job learning in the pharmacy include:

■ training is immediately seen as relevant to the job as it is carried out in a

real workplace setting.

■ training is provided at a time that is relevant and ﬁts in with the

immediate needs of the trainee. This is in contrast to off-the-job training,

as the training may be appropriate when planned but sometimes loses its

relevance as the trainee becomes more experienced.

Off-the-job training

Off-the-job learning such as training days or regular day-release courses

can be a useful way of providing background information. Many employ-

ees are interested in completing a recognised course such as a BTEC/NVQ

course delivered by a further education institution.

A number of issues need to be considered before enrolling members

of staff on to externally delivered courses:

■ is the course relevant to the training needs of the employee?

■ will the course include work-based exercises? How relevant will the

exercises be to the pharmacy?

■ is there sufﬁcient time available to attend the course and complete all

required coursework and study?

70 Community Pharmacy Handbook

On-the-job training checklist

The following questions provide a useful checklist for on the job

pharmacy training:

■ is the training programme properly planned? (Check for natural

progression within the programme from simple to more complex

tasks)

■ is there the time and resources to ensure that the trainee is

adequately supported? (A weekly meeting needs to be scheduled to

discuss progress and offer the opportunity for communication)

■ is there a system of documentation that is transparent and allows

the trainee and the trainer to monitor progress? It is vital that all

training is clearly documented to prove that training has taken

place

■ is there an effective coach available to deliver the training? When

selecting a coach consider the level of skill required and choose a

member of the team who is able to offer full support through the

training process.

■ have any health and safety hazards been taken into account?

■ how will competence be measured?

■ how will the training be evaluated?

■ how will the absence of the employee from the workplace be covered?

■ what are the ﬁnancial implications for this type of training? Costs to be

considered should include course fees and associated costs (for example

travel costs and exam fees) and the cost of staff absence from the

pharmacy. The high cost of this type of training will also mean that the

retention of staff trained by this cost-intensive method will need to be

considered.

Distance learning

Distance learning by means of workbooks, training manuals and inter-

active e-learning are commonly used training methods to train pharmacy

support staff. The main advantages of distance learning are ﬂexibility and

cost-effectiveness. The disadvantage of this type of training method is

that a high level of individual motivation is required. Distance learning

courses that are well supported and supplemented by structured on-

the-job training are often the training method of choice in community

pharmacy.

Making a presentation

This traditional training method is often impractical during working

hours in a community pharmacy as it is not possible to release a number

of people at any one time. However, this method is increasingly used out

of normal working hours to communicate important information and

offer supplementary training on topical or important areas. For example

this training method may be chosen to train the team on a new POM

(prescription only medicine) to P (pharmacy medicine) switch or to

explain the service speciﬁcation and SOPs for the delivery of a new pro-

fessional service. If the presentation takes place outside working hours,

there is a cost implication in terms of overtime payments for staff. The

advantage of making a presentation is that a common message is deliv-

ered to all staff members at the same time.

Sufﬁcient thought needs to be given to the timing of a presentation.

This will depend on local circumstances, working patterns and individual

preferences. For example, some pharmacies have introduced successful

breakfast training meetings. In other situations a meeting in the evening

that includes a meal have proved popular. In view of the high cost of this

type of training it is particularly important to be aware of the key factors

that ensure a successful presentation. The old adage ‘Fail to prepare,

prepare to fail’ is especially pertinent when it comes to delivering a pre-

sentation. The presentation skills developed to train pharmacy staff will

also be invaluable when a pharmacist is required to present a new service

proposal to a local medical practice or primary care organisation.

Training and development of the pharmacy team 71

The traditional approach to a presentation can be very effective:

■ tell them what you are going to tell them

■ tell them

■ tell them what you have told them.

The structure of the presentation is made clear at the start. The content is

delivered in a way that is appropriate for the audience and engages their

interest and attention.

The key points are summarised at the end of the presentation to

ensure that the right message has been conveyed.

72 Community Pharmacy Handbook

Top tips for effective presentations

■ The material needs to be structured in a logical way. It is important

that there is a framework for the listener to relate to. During the

preparation of the presentation it may take several attempts to

obtain the best structure. This may be achieved by brainstorming

with a small group of other people who are not connected with the

presentation or some presenters prefer to use ‘post it’ notes that can

be moved around several times until the preferred ﬁnal format

emerges.

■ Be clear at the start of the presentation about your policy on

questions. When will you ask questions? Questions may be asked at

the beginning to check preliminary knowledge and understanding,

during the presentation to ensure attention, or at the end to

evaluate the understanding of the audience. When would you

prefer to take questions from the audience? There may be a

preference for a formal question and answer session at the end of

the presentation, or you may prefer to allow questions at any time

throughout the presentation.

■ The most effective presentations are clearly set out and the

audience has a clear idea of where the presentation is going and

what to expect. For example in the introduction you could explain

the structure of your presentation, what you hope to achieve in

each section and how long each section will take.

■ Signpost your presentation so that the audience is guided through

the structure. This may involve using regular summaries so that

learning is consolidated.

■ Rehearse the presentation to ensure that the timing is correct and

also ask a friend to point out any weak points such as areas where

there is a lack of pace or the content needs further clariﬁcation.

■ Be prepared for the unexpected. Think about the possibility of

questions taking longer than anticipated, a technical hitch with

your equipment or a confrontational audience member. A few

→

Many managers can be fearful of making a presentation. In reality, many

of the fears can be overcome by meticulous and careful planning. The

presentation remains a powerful training tool that allows a direct and

personal input into the development of a pharmacy team.

Using role-play

In any customer-focused business, role-play can be a useful training

method. In a community pharmacy the use of role-play in the training of

the pharmacy team can be applied to the following situations:

■ improving counselling skills and interaction with customers

■ developing teamwork, co-operation with colleagues and creative problem

solving

■ improving listening skills with both customers and colleagues.

The overall aim of role-playing is to ask someone to play a role other than

his or her own. This enables the team member to see the workplace

through different eyes.

Training and development of the pharmacy team 73

minutes spent thinking about the ‘What if?’ scenarios and possible

solutions will increase your conﬁdence.

■ Cultivate a clear and pleasant speaking voice that is neither over-

the-top enthusiastic or deadpan boring. From a listener’s

perspective it is easier to listen to a speaker who naturally

modulates and varies in pace and emphasis.

■ Ask a close friend about any distracting physical or verbal

mannerisms that you may have, as these may act as a barrier. Try to

develop ways of removing these possible distractions.

■ Think about the perspective of the audience and try to gain as

much rapport as possible by maintaining good eye contact, but not

with individuals for a prolonged period as this will cause

discomfort. Develop a scanning approach where you aim to engage

individuals, and systematically scan different areas of the room to

ensure that all listeners feel included.

■ Develop questioning skills that will provide you with information

on how the audience understands the content of the presentation.

It is useful to ask structured questions as the presentation

progresses.

■ Use a variety and combination of visual aids to add interest to the

presentation. The regular use of PowerPoint projection can become

stale and the use of different interactive methods such as ﬂip

charts, white boards and ‘post it’ notes may add interest to the

overall subject content.

Many people are apprehensive about this training method and can dis-

miss this type of training as simple play acting and of no relevance. To

gain maximum beneﬁt from this method the role-play exercises must

follow certain rules (see Top tips for role-playing exercises).

74 Community Pharmacy Handbook

Examples 3.2

■ It is valuable for a MCA to see the viewpoint of a customer who has a

complaint and has been treated in a dismissive way. Taking on the role

of the customer being shabbily treated helps to reinforce some of the

tension and anxiety that the customer may experience.

■ A pharmacy technician with new responsibility for managing different

members of staff may ﬁnd it beneﬁcial to take on the role of being

managed. A more experienced staff member plays the role of the

pharmacy technician and uses examples of aggressive, passive and

assertive management to provide the opportunity to explore methods

of communication. The role reversal of the pharmacy technician who is

put on the spot by their ‘manager’ offers the possibility of seeing

examples of good and less-desirable management traits.

Top tips for role-playing exercises

■ Be clear about exactly which competencies are trying to be developed.

(Example: a role-play to demonstrate the importance of dealing with

an aggressive customer in a calm manner.)

■ Make sure the scenario is real and relevant to the workplace. (Keep

a diary of real-life problems posed by customers or team members

and take steps to use these as a training exercise at a later date, with

some minor changes to preserve the anonymity of those involved.)

■ Keep the role-play simple. The role-play characters may not have all

the same information but the scenario should hang together as a

whole. Avoid complicated plots and make it simple for the

participants to carry out their role without being too worried about

the details of the scenario.

■ Prepare carefully for the role-play and allow sufﬁcient time for

constructive feedback and discussion.

■ The partners in a role-play situation should be carefully matched to

ensure that they will work well together and gain as much as

possible from the experience.

■ When providing feedback it is important to concentrate on the key

player and the skills that are being developed in that participant.

The key player should be asked to talk through their experience

→

If the initial barrier of awkward self-consciousness can be overcome, the

use of role-play can be a powerful training tool to improve communica-

tion skills in the pharmacy. The difﬁculties and objections encountered

in this type of training can seem trivial compared to the potentially

enormous cost of poor communication with ‘real’ customers.

Group work

Group work may be useful when several members of staff are using a dis-

tance learning course and need clariﬁcation and extra input to certain

areas of the course. For example, the pharmacist may decide to run a

small-group session on controlled drugs for their trainee dispensing assist-

ants. Many group training sessions revolve around a structured discussion

followed by feedback. This may be a quick informal sharing of ideas and/

or may be a formal presentation to the rest of the group. Successful small-

group training is dependent on certain key practical principles (see Top

tips for successful group training sessions below).

Coaching skills

In a busy community pharmacy, coaching is a practical training method

that avoids some of the disadvantages of other training methods.

Coaching involves the pharmacist asking questions and listening to the

replies in order to gauge what the level of their input should be. With

coaching the learner is totally involved in setting goals and answering

informal questions. This means that both coach and learner are encour-

aged by each other’s involvement in the process. Coaching can be applied

to both individuals and the whole team.

One useful approach to coaching is the GROW model. GROW is an

acronym for:

Training and development of the pharmacy team 75

and the good and bad points of the role-play. This should be done

before any of the other participants are invited to comment.

■ Concentrate any discussion on behaviours and not on the person

carrying out the role. In some cases it may be more appropriate to

prepare a structured report form for all involved in the role-play,

including any observers. This can act as a positive example on how

to focus on the observed behaviours rather than on the personality

of the team members involved.

■ goal

■ (current) reality

■ options

■ will.

Using these four stages, a coach can structure a useful coaching session. A

coaching session does not need to be formal and scheduled into the work-

ing week. Effective coaching is often spontaneous and designed to

respond to practical workplace training needs.

The model uses the following stages:

1 establish the goal

2 examine current reality

3 explore the options

4 establish the will.

Establish the goal

The pharmacist with their team member deﬁnes and agrees the goal to be

achieved using SMART (speciﬁc, measurable, achievable, relevant and

timed) objectives as discussed in Chapter 1. (See Examples 3.3 below.)

Successful coaching requires a clearly deﬁned outcome at the outset,

before moving on to the next stage.

76 Community Pharmacy Handbook

Top tips for successful group training sessions

■ Be clear about the learning objectives for the session and the format

of the available time for the session. Where possible involve group

members in the formulation of learning outcomes.

■ Encourage the group to take on different roles such as chairperson,

scribe, presenter or researcher. The group members will need to be

reminded to change roles during the next session.

■ Be clear about the practical details such as the length of the session,

the format of the feedback session and what materials are available.

■ If necessary the trainer may need to guide the discussion back on

track with a few questions, but avoiding the pitfall of joining in the

group discussion.

■ In a community pharmacy setting the group members will be used

to working with one another. If there is a new member of staff or a

visiting participant (for example from another pharmacy), the

trainer should take some time to ensure that all members are

introduced. If the group is new to this type of work then time

should also be spent establishing ground rules for group working.

Examine current reality

During this stage of the coaching process the pharmacy team member

should be asked in some detail about their current reality. This is an

important stage and involves an honest approach to the situation as it

stands. For example the pharmacy technician may have very limited

experience of working with residential homes and need a lot of direction

to set up the necessary records. Alternatively the pharmacy technician

may have wide experience of working with residential homes but not

have been involved in the initial setting-up stage before. The aim of this

part of the coaching session is to ask searching questions that enable both

the team member and the pharmacist coach to assess current reality.

Explore the options

Having made a realistic assessment of where the team member is in terms

of solving their problem, the next stage is to explore the options available

Training and development of the pharmacy team 77

Examples 3.3

■ Medicine counter assistant: to be able to recognise the symptoms of

conjunctivitis and know when the recommendation of

chloramphenicol eye drops is appropriate and also know when to refer

to the pharmacist.

■ Dispensing assistant: to be able to measure a patient for compression

hosiery correctly and order the appropriate product.

■ Pharmacy technician: to be able to set up a supply service to a newly

acquired residential home.

■ Preregistration graduate: to be able to conduct a patient interview as

part of a project to produce pharmaceutical care plans.

For all of these examples the pharmacist will need to ask questions at

the outset about how the team member will know when they have

achieved their goal, for example questions such as:

■ how will you know that you are competent to supply choramphenicol

eye drops?

■ how will you be able to determine that you can accurately measure for

compression hosiery and supply the correct product?

■ how will you prove that the residential home is fully set up and all

paperwork and patient medication record (PMR) systems are fully

operational for the ﬁrst month of supply?

■ What criteria will you use to determine how successful you are at

interviewing a patient?

to solve the problem and discuss the positive and negative aspects of each

option. It is important that the team member comes up with most of the

suggestions. For example the MCA may suggest:

■ completion of a distance learning package on conjunctivitis and

chloramphenicol eye drops

■ job shadowing a more experienced MCA when they make a sale of

chloramphenicol drops

■ a tutorial session with the pharmacist to ensure that the assistant has

sufﬁcient background knowledge.

It is useful for the pharmacist at this stage to ask leading questions to

ensure that the most appropriate options are selected. Typical questions

could include:

■ what else could you do?

■ are there any difﬁculties with job shadowing and how could these be

overcome?

Establish the will

This fourth and ﬁnal stage is all about asking the team member to commit

to a speciﬁc course of action. As the team member has already identiﬁed

the goal, looked at where they stand in terms of achieving this goal and

also explored possible options, they are in a strong position to specify

how they are going to progress towards their goal. For example the phar-

macist will ask the MCA how they intend to complete the distance learn-

ing package or observe more experienced colleagues. Again, this stage is

marked by leading questions from the coach such as:

■ what do you intend to do . . . and when?

■ how will you overcome any problems with this course of action?

■ what else will you be doing?

Coaching is a skill that is invaluable in the community pharmacy setting.

This well-established training tool is dependent on the pharmacist habit-

ually asking leading open questions, listening attentively to the response

and facilitating the ongoing development of both individuals and the

team.

Evaluation of training

The evaluation of training has three main purposes:

■ it provides feedback to the trainer in terms of the extent to which the

78 Community Pharmacy Handbook

training objectives were met, and provides some information on

particular learning activities. Did the training meet its objectives?

■ it offers a control process and allows the manager to assess if the training

delivered ﬁts in with the goals of the wider organisation. Did the training

make a difference to the wider organisation?

■ the opportunity for intervention as the manager is involved in the total

training process by considering training both before and after the

programme has been delivered. Was the training good value for money?

The manager should be aware of the following areas:

■ ineffective training is not only a waste of time and money it is also very

demotivating for employees and will make the trainee less likely to

engage positively with future training programmes

■ there has to be a strong link between training and the overall

performance of the organisation

■ in view of the high cost of training, any training investment will need to

be justiﬁed.

Levels of training evaluation

There are different levels of training evaluation as outlined in Figure 3.3.

The different levels of training evaluation include the stages below:

■ the reactions of the trainees: this is sometimes referred to as the ‘happy

sheet’ as the focus tends to be on the immediate impression of the

Training and development of the pharmacy team 79

Figure 3.3 Different levels of training evaluation.

Performance of the organisation

Balance sheet Key performance indicators

Intermediate outcome of training

Changes in trainee behaviour

Immediate learning

Knowledge and skills

Reaction of the trainee

Immediate impression of trainee

trainee such as the quality of refreshments and clarity of visual aids

rather than the impact of the training on their working practice

■ the immediate learning that has taken place: this is the immediate

impression of the trainee in terms of what they feel they have gained

from the programme

■ the intermediate outcome of the training: this evaluation focuses on the

change in behaviour of the employee and their approach to their

working practice

■ the ultimate outcome: this is the effect of the training on the performance

of the organisation and is usually measured by looking at a balance sheet

rather than the behaviour of an individual.

80 Community Pharmacy Handbook

CASE STUDY

Case study 3.1: evaluation

Julie is an experienced pharmacy technician who was recommended by

her manager to attend a one-day training course. The course was aimed

at technicians providing support to pharmacists interested in launching

a weight-management service to patients. The service involves the pro-

vision of orlistat to suitable patients through a patient group direction

(PGD).

Training evaluation

Reactions of the trainee

Julie enjoyed the one-day course and thought the venue and refresh-

ments were excellent. The practical session on blood pressure monitor-

ing and blood glucose measurement was ‘rather rushed’ according to

the feedback sheet, and her impression was that the ‘trainer assumed

too much prior knowledge’.

The immediate outcome

The pharmacist discussed the training day with the technician and

asked some leading questions about the content of the day and her

understanding of the weight-management programme. The pharmacist

noted that the technician had a good knowledge of the programme

and offered to supplement the practical session with some practice

blood pressure and blood glucose measurements.

→

Implications for practice

Activity 1

Consider each member of your pharmacy team and perform a training

needs analysis (TNA) of your pharmacy. Present your observations in the

following format:

■ types of learning need

■ organisational needs

■ individual needs

■ key task analysis

■ competency analysis.

How does your TNA differ from the reality of what is taking place?

Training and development of the pharmacy team 81

The intermediate outcome

The technician started to work towards a launch date for the new

service and worked with the pharmacist to achieve competence in the

various stages of managing the programme.

The ultimate outcome

After three months of offering the service the pharmacy manager noted

the number of clients that had taken up this service and the proﬁt gen-

erated by each PGD sale. The pharmacist manager looked at the time

taken by the technician and pharmacist and took these costs into

account. The conclusion was that the ﬁrst 3 months had been highly

successful and the projected ﬁgures looked promising.

The initial reactions of the technician were not completely positive

and it appears that a substantial amount of tutorial work was done by

the pharmacist subsequent to the training day. There is some doubt

about the value of the training day and if this type of training event was

necessary in this case. The overall ultimate outcome of the training pro-

vided by the pharmacist appears to have been very positive.

The community pharmacy manager will use different training

providers and approaches to training. It is vital that all training in the

pharmacy is evaluated at different levels to ensure that the training pro-

vision meets the needs of the business.

CASE STUDY (continued)

Activity 2

Select a recent POM to P switch and plan a training event on this prod-

uct area.

■ Plan the event carefully ensuring that it is at a suitable level.

■ Deliver and evaluate the training at different levels.

Multiple choice questions

Directions for questions 1 and 2: each of the questions or incomplete

statements in this section is followed by ﬁve suggested answers. Select the

best answer in each case.

Q1 Bloom’s taxonomy of learning proposes all of the following types of

learning except:

A Cognitive

B Reactive

C Affective

D Psychomotor

E Interpersonal

Q2 Training needs analysis is concerned with all of the following areas except:

A Organisational priorities

B Trainer competence

C Individual trainee competence

D Key task analysis

E Types of learning need

Directions for questions 3 to 5: for each numbered question select the

one lettered option above it which is most closely related to it. Within

each group of questions each lettered option may be used once, more

than once, or not at all.

A Coaching

B Role-play

C Distance learning

D Competence based

E Presentation

Select from A to E which one of the above ﬁts the following statements:

Q3 The GROW model can be used for this training method.

Q4 This informal type of training can be unscheduled and requires a good

working relationship with the trainee.

82 Community Pharmacy Handbook

Q5 A trainer-centred training method.

Directions for questions 6 to 8: each of the questions or incomplete

statements in this section is followed by three responses. For each ques-

tion ONE or MORE of the responses is (are) correct. Decide which of the

responses is (are) correct. Then choose:

A if 1, 2 and 3 are correct

B if 1 and 2 only are correct

C if 2 and 3 only are correct

D if 1 only is correct

E if 3 only is correct

Directions summarised:

A: 1, 2, 3 B: 1, 2 only C: 2, 3 only D: 1 only E: 3 only

Q6 Which of the following statements about medicine counter assistants

(MCAs) is (are) correct?

1 It is a requirement that any MCA should have undertaken or be

undertaking an accredited course relevant to their role.

2 MCAs are allowed up to 6 months before enrolling on an accredited

course.

3 There is no time limit for the completion of an accredited training

course for MCAs.

Q7 Which of the following statements about dispensing assistants is (are)

correct?

1 The competency of a dispensing or pharmacy assistant is deﬁned by

the minimum of a S/NVQ Level 2 qualiﬁcation, or undertaking

training towards this qualiﬁcation.

2 A company training scheme for pharmacy assistants would need to be

accredited.

3 The competency requirement of a dispensing or pharmacy assistant

does not apply if the assistant is only involved in the ordering,

receiving and storing of pharmaceutical stock.

Q8 Which of the following statements about pharmacy technicians is (are)

correct?

1 The title of pharmacy technician will become protected in law.

2 An NVQ qualiﬁcation in pharmacy services (Level 3) is a recognisable

qualiﬁcation for a pharmacy technician.

3 Pharmacy technicians who do not have NVQ qualiﬁcations are not

eligible for registration with the RPSGB.

Directions for questions 9 and 10: The following questions consist of a

statement in the left-hand column followed by a second statement in the

right-hand column.

Training and development of the pharmacy team 83

Decide whether the ﬁrst statement is true or false.

Decide whether the second statement is true or false.

Then choose:

A if both statements are true and the second statement is a correct

explanation of the ﬁrst statement

B if both statements are true but the second statement is NOT a correct

explanation of the ﬁrst statement

C if the ﬁrst statement is true but the second statement is false

D if the ﬁrst statement is false but the second statement is true

E if both statements are false

Directions summarised:

A: True True second statement is a correct explanation of the ﬁrst

B: True True second statement is NOT a correct explanation of the

ﬁrst

C: True False

D: False True

E: False False

■ Statement 1: When assessing an MCA on the ability to receive

prescriptions, the pharmacist will refer to the SOP for this process and

also examples of good, acceptable and poor practice in this area.

■ Statement 2: The use of performance indicators is critical when using a

competence-based training approach.

Q10

■ Statement 1: The most important evaluation of any training is feedback

from the trainee on what they feel they have gained from the training

programme.

■ Statement 2: Training evaluation should be carried out at a number of

different levels.

Case studies

Level 1

A group of third-year pharmacy undergraduates is asked to assess a 15

minute presentation by their colleagues. Before the presentation, their

tutor would like the group to have some ownership over the marking

scheme for this piece of assessed work. The tutor invites suggestions from

84 Community Pharmacy Handbook

all members of the group and intends to use a compilation of these

suggestions to produce a summary mark scheme.

■ Make a list of criteria that you would suggest for inclusion in a marking

scheme for a presentation.

Level 2

Kerry is a preregistration trainee in a large community pharmacy. The

pharmacy has a very intensive medicine counter business which is man-

aged by three able and experienced MCAs. In the next month one of the

counter assistants is moving to the dispensary area to start their training

as a dispensing assistant. Two new part-time members of staff have been

appointed to work on the medicines counter. Both new members of staff

are experienced in working in a retail setting, but neither has experience

of working in a pharmacy. Kerry’s tutor has explained that she will ensure

they are registered on a distance learning MCA course and has asked Kerry

to organise some additional training sessions. As a starting point Kerry’s

tutor has suggested that she arranges a session on the sale of cough

medicines.

■ Kerry is asked to produce an outline plan of a 30-minute training session

on this product area.

■ What speciﬁc preregistration performance standards relate to this

activity?

Level 3

Marie Logan has recently been appointed as the temporary pharmacy

manager of a medium-sized pharmacy of a large multiple. The pharmacy

is based on the edge of the town and is within easy access of several med-

ical centres. There have been a number of staff training problems in this

pharmacy and Marie has been appointed on a temporary basis to try and

improve this area.

Marie makes the following observations about the pharmacy staff:

■ Lorna is an MCA who is struggling to ﬁnd time to complete the distance

learning package that she started a year ago. She appears keen and is

excellent with customers

■ Beth is an MCA who has completed the distance learning package but

still requires a lot of supervision. Marie has some concerns over the

quality of advice that she is providing for customers

■ Dan is at the local sixth form college and works evenings and Saturdays.

He is employed on the medicine counter but is keen to become involved

Training and development of the pharmacy team 85

in dispensary activities. He has completed the MCA course and has a

positive approach to his job

■ Jeanne qualiﬁed as a dispenser several years ago and shows very little

interest in any additional training as she says that she is always too busy

■ Jeanne is assisted by Sharon who is a school leaver and is a trainee

dispenser, but her progress has been rather slow on the course

■ there is a very intensive supply service to 20 large residential care homes

that is well managed by Sandy who is a qualiﬁed pharmacy technician.

Sandy appears to be quite frustrated as she is ﬁnding the demands of the

care homes are increasing and feels quite isolated as she works away from

the main dispensing area

■ there is a vacancy for a trainee dispenser but this has not yet been

advertised.

■ Marie has been asked by her area manager to produce a proposed

training plan for this pharmacy, what should she include?

References

1 Hassell K, Shann P, Noyce P The complexities of skill mix in community

pharmacy. Pharm J 2002; 269: 851–854.

2 Mullen R. Skill Mix in Community Pharmacy: exploring and deﬁning the

roles of dispensary support staff. London: Royal Pharmaceutical Society of

Great Britain, 2004. www.pharmacy.manchester.ac.uk/cpws/publica-

tions/Reports/skillmix.pdf (accessed 4 September 2007).

3 Mullen R, Phul S, Cantrill J. Countdown to January 2005: standard oper-

ating procedures, regulation, training and skill mix issues for commun-

ity pharmacy staff. Int J Pharm Pract 2003; 11: R27.

4 Royal Pharmaceutical Society of Great Britain. Medicines Ethics and

Practice. A guide for pharmacists and pharmacy technicians. London: Royal

Pharmaceutical Society of Great Britain, 2007.

5 Royal Pharmaceutical Society of Great Britain. Training Requirements for

Medicine Counter Assistants. (Revised April 2007) www.rpsgb.org/pdfs/

medcountassiscourses.pdf (accessed 4 September 2007).

6 Royal Pharmaceutical Society of Great Britain. Minimum Competence

Requirements and Pharmacy Technician Registration. Which policy applies to

me? (May 2006) www.rpsgb.org/pdfs/techregdpaclarif.pdf (accessed 4

September 2007).

7 Atherton JS. Learning and Teaching: Bloom’s Taxonomy. www.learning

andteaching.info/learning/bloomtax.htm (accessed 4 September 2007).

8 College of Pharmacy Practice. Competency and the extended role of the

pharmacy support staff. Pharm J 2000; 265: 103–104.

9 Bramley P. Evaluating Training, 2nd edn. London: Chartered Institute of

Personnel and Development, 2003.

86 Community Pharmacy Handbook

Contractual framework for

community pharmacy

This is probably the most signiﬁcant turning point for the NHS and for

community pharmacy in the history of NHS pharmacy services.

(Rosie Winterton, Health Minister – Pharmaceutical Services Negotiating

Committee (PSNC) conference on the new community pharmacy contract)

The main focus of this chapter is on the provision of essential ser vices as

these must be provided by all community pharmacists in England and

Wales. Some of the terminology used in Wales is different, such as the use

of health boards, but the overall principles of the contract are the same.

The arrangements for Scotland are different, and a brief overview of the

Scottish contract is outlined at the end of this chapter. The chapter also

includes sections on standard operating procedures, monitoring of the

new contract and support for people with disabilities.

The main aims of the new contractual framework for community

pharmacy are to:

■ provide a set of minimum standards that reﬂect the needs of Pharmacy in

the Future: implementing the NHS Plan

■ provide a reward system that recognises high-quality services and

promotes best value for money

■ utilise the skills of community pharmacists and their support staff and

encourage the development of community services and integrated

working.

Checkpoint

Before reading on, think about the following questions to identify

your own knowledge gaps in this area:

■ What is the overall structure of the national contractual framework

for community pharmacy?

■ How is the contract monitored?

■ What are the implications of the Disability Discrimination Act 1995

for community pharmacists?

■ What is the general structure of a standard operating procedure?

In 2003, the PSNC, Department of Health and the NHS Confederation

started negotiations for the new contractual framework for community

pharmacy. The new national contract for community pharmacy in

England and Wales was introduced in April 2005. The new contract aims

to enable community pharmacies to contribute to NHS ser vice provision

for patients in four main areas:

■ self-care

■ management of long-term conditions

■ public health

■ improving access to services.

These priority areas are speciﬁed in the Department of Health’s Public

Service Agreement.

Contract overview

An overview of the structure of the new contract for community phar-

macy is provided in Figure 4.1. Pharmacy services are divided into three

categories: essential, advanced and enhanced.

88 Community Pharmacy Handbook

Figure 4.1 Contractual framework for community pharmacists in England and

Wales.

Enhanced services

Locally commissioned services such as:

● smoking-cessation services

● minor ailments schemes

● supervised administration of medicines

Advanced services

● Accreditation of pharmacist/pharmacy

● Medicines use review and prescription-intervention service

Essential services

To be offered by all contractors

● Dispensing of medicines

● Repeat dispensing

● Disposal of waste medicines

● Public health

● Signposting

● Self-care

● Clinical governance

Essential services must be provided by all community pharmacies and

are not open to local negotiation. The list of essential services includes:

■ dispensing of medicines

■ repeat dispensing

■ disposal of unwanted medicines

■ public health

■ signposting

■ self-care

■ clinical governance.

Advanced services require both the pharmacist and the pharmacy

premises to be accredited and include a medicines use review (MUR) and

prescription intervention (PI) service. Practical issues surrounding the

provision of an MUR service will be discussed in Chapter 5.

Enhanced services are commissioned locally by primary care trusts

(PCTs). A service speciﬁcation (for England) or a national enhanced

service template (Wales) and a fee for providing the service will be agreed

nationally. In 2005–2006, the enhanced services most frequently pro-

vided were:

■ stop-smoking support service

■ supervised administration of medicines

■ minor ailments schemes

■ supply of medicines via patient group directions.

The practicalities of offering enhanced services will be discussed in

Chapter 6.

Implications for social care

It is expected that the new contractual arrangements will contribute a

number of beneﬁts to the social care service. Examples of areas of the con-

tract that may impact on social care include:

■ MUR service that aims to improve the way that people use their

medicines may help to reduce the number of hospital admissions as a

result of inappropriate use of medicines

■ repeat-dispensing service will provide a more convenient service for both

patients and carers, and reduce the need to visit the general practitioner

(GP) every time a supply of medication is needed

■ the support offered through the essential service of self-care through the

management of minor ailments and conditions will offer more choice

and access to those who wish to care for themselves or their families.

■ under the Disability Discrimination Act 1995 (DDA), pharmacists will

offer additional support for patients who require help in taking their

medicines due to a disability, for example by providing reminder charts,

large-print labels or other compliance aids

Contractual framework for community pharmacy 89

■ signposting by pharmacists to other health and social care providers may

offer a more co-ordinated approach to the referral of patients to the

appropriate service provider

■ there will be a formal arrangement for the disposal of unwanted

medicines and this will ensure that medicines are less likely to

accumulate in the home and community

■ locally commissioned enhanced services will encourage the development

of new and innovative pharmacy services and it may be that there is the

possibility of increased collaborative working between pharmacy services

and social services.

Essential services

Essential service 1: dispensing of medicines

There are two main aims of the essential dispensing ser vice:

■ to ensure that medicines are dispensed safely. This will involve the

appropriate, legal, clinical and accuracy checks when a prescription is

presented

■ to ensure the patient knows how to use the dispensed item. This will

involve the provision of appropriate advice including broader

information about potential side-effects and interactions.

The service speciﬁcationfor this essential service states that the pharmacy

must maintain a record of all medicines and appliances supplied, which

can be used to assist patient care.

In addition the pharmacy should main-

tain a record of any advice given, and interventions and referrals made,

where the pharmacist judges it to be clinically appropriate.

One of the key issues in the provision of a reliable and consistent

dispensing service is the use of well-written standard operating pro-

cedures (SOPs). The use of SOPs is discussed later in this chapter.

Essential service 2: repeat dispensing

Repeatable prescriptions have been limited by NHS regulations and re-

imbursement processes. In April 2004 legislation came into force to

enable prescribing doctors, independent nurse prescribers and all supple-

mentary prescribers to issue repeatable prescriptions. This legislation

allows pharmacists to dispense and be reimbursed for repeatable pre-

scriptions under the NHS. The aims of this essential ser vice are to:

■ increase patient choice and convenience

■ minimise wastage by reducing the amount of dispensed unwanted

medicine

90 Community Pharmacy Handbook

■ reduce the workload of general medical practice

■ make greater use of pharmacists’ skills.

The Centre for Pharmacy Postgraduate Education (CPPE) distance learn-

ing pack Repeat Dispensing from Pathﬁnder to Practice was circulated to all

pharmacists in England and outlines the stages of the repeat-dispensing

process.

The slightly different repeat-dispensing arrangements in Wales

are covered in the WCPPE package.

The nine stages involved in offering a repeat-dispensing service can

be summarised as follows:

1 Selecting suitable patients

Repeat dispensing is a partnership between the patient, prescriber and

pharmacist; not all patients will beneﬁt from this service. In selecting

suitable patients for repeat dispensing, the criteria used are:

■ patients with long-term conditions

■ patients with conditions that are likely to remain stable during the

repeat-dispensing period.

In practice different GP surgeries have different approaches to selecting

patients. For example some surgeries may target all patients on a par-

ticular drug such as levothyroxine. Another approach is to select patients

who have recently had a medication review and are stable on a num-

ber of medicines. The pharmacist needs to be aware of the selection

criteria that are being used locally so that they can contribute to the

selection process and ensure that patients are aware of the availability of

this service.

2 Gaining patient consent

Participation in a repeat-dispensing service is voluntary and some

patients may prefer to remain with their existing dispensing arrange-

ments. As there will be exchange of information about the patient’s

medication or treatment between the GP and the pharmacist, the patient

needs to give fully informed consent before participating in this service.

The patient must be fully informed of the process and provided with writ-

ten material of how the system operates so that they can make an

informed decision. Medical practice reception staff are generally respon-

sible for this process. The pharmacist needs to be aware of the arrange-

ments that exist for approaching patients to consider this service at local

medical practices. Agreement by the patient is then recorded on an agree-

ment form and a copy retained on the patient’s ﬁle in the surgery.

Contractual framework for community pharmacy 91

3 Managing receipt of a repeatable prescription and associated batch issues

The repeat-dispensing system consists of a repeatable prescription which

is signed by the prescriber and also a number of batch prescriptions which

are not signed. The repeatable prescription forms the legal prescription

for the repeat supply of the medication. The unsigned batch prescriptions

act as invoice for the pharmacist to receive payment for making each sup-

ply of medication. When the repeat prescription is ﬁrst presented the

pharmacist should explain the process so that the patient is fully aware of

the practical details involved.

A clinical and legal check is made of the repeatable prescription and

the ﬁrst batch prescription is dispensed. The prescriber needs to specify

the number of instalments allowed on the prescription. In some cases the

prescriber may specify the instalment interval, and in many cases this will

be monthly. However the instalment interval can be ﬂexible and does not

need to be stated. It is expected that the pharmacist will use professional

judgement to dispense instalments at an appropriate time. The repeatable

prescription will need to be retained by the pharmacy for the duration of

the dispensing period.

If a patient wishes to change pharmacy then they will need to be

referred back to the prescriber. All medicines can be supplied under the

repeat-dispensing arrangements with the exception of Schedules 2 and 3

controlled drugs. A repeatable prescription must be dispensed for the ﬁrst

time within 6 months of being written and is valid for a period of 12

months from this date unless an earlier expiry is speciﬁed by the prescriber.

4 Referral of any medicine-management issues

During the repeat-dispensing period it is part of the regulations that phar-

macists and prescribers will need to contact each other in certain circum-

stances. For example there may be issues reported by the pharmacist such

as compliance problems, adverse reactions or medicines-management

issues. The GP will need to inform the pharmacist of any changes to med-

ication or if changes are required to prescribed items. The pharmacist will

need to be fully informed of local arrangements for this referral process

and ensure measures are in place to maintain a closed loop communica-

tion system.

5 Endorsement of the prescription

The repeatable prescription is stamped in the usual way with the

name and address of the pharmacy. The batch issues are endorsed with

quantities and items dispensed as speciﬁed by the Drug Tariff. A clear

92 Community Pharmacy Handbook

audit trail of dispensed items needs to be in place and this will involve

keeping a record that can be clearly linked to the repeatable prescription.

Many pharmacies attach a record card to the repeatable prescription that

records the dates and quantities supplied of each item.

6 Re-imbursement of batch issues supplied

Batch issue forms are submitted with other prescriptions for re-

imbursement to the NHS Business Services Authority, Prescription Pricing

Division (PPD). Any batch issues that have not been dispensed within the

repeat-dispensing period should be destroyed and a record made of the

destruction.

7 Storage of repeatable prescriptions and batch issues if requested by the

patient

Many pharmacies ﬁnd the management of the repeat-dispensing process

easier if a designated storage area is used for the repeatable prescriptions.

In practice this may mean using a lockable ﬁling cabinet and assigning a

member of the dispensing team to manage the process. Repeat items

should be prepared in advance, to avoid the patient having to wait for

their medication. The repeatable prescription must be retained at the

pharmacy. The batch issues may be retained by the patient to bring in

when they require their repeat medication. In most cases the patient

prefers to leave all the prescription forms at the pharmacy.

8 Making the ﬁnal instalment

When the patient collects their last instalment they need to be reminded

to make an appointment so that the prescriber may review their condi-

tion, and if appropriate issue another repeatable prescription and set of

batch issues. Some pharmacists use a standard written reminder form to

facilitate this process.

9 Final submission of the repeatable prescription to the PPD

The repeatable prescription is ﬁnally submitted to the PPD separately

from the batch issues in the month after it has expired. The repeatable

prescription would be submitted to the PPD earlier if there have been

medication changes that make the form no longer valid.

A repeat-dispensing SOP should be developed for each pharmacy tak-

ing into account arrangements with local surgeries. After testing and

Contractual framework for community pharmacy 93

modiﬁcation the SOP should be made widely available to all temporary

staff to ensure the smooth running of this essential ser vice.

The service speciﬁcation for the repeat-dispensing service speciﬁes

the following:

■ pharmacy contractors are required to undertake appropriate training to

ensure they are competent to deliver this service

■ speciﬁc arrangements must be in place to ensure that there is direct

communication to locum pharmacists to ensure that they are aware of

the practical local procedures in place

■ pharmacy staff will be required to communicate with patients about how

the repeat-dispensing system operates and the importance of ordering

only prescription items that are required

■ the pharmacy will store the patient’s documentation securely

■ the pharmacist is expected to use their professional judgement to decide

if it is appropriate for the item to be dispensed

■ it is the responsibility of the pharmacist prior to supplying the repeat

medication to ensure that the patient is using the medicine appropriately

and there are no side-effects that would require a review of the

treatment. The pharmacist should also check if there have been any

other changes that would suggest that a medication review by the

prescriber would be beneﬁcial

■ each batch issue prescription should be endorsed appropriately and

forwarded to the PPD as speciﬁed in the Drug Tariff

■ the pharmacist may refuse to dispense the batch issue if they are

concerned about safety, for example if there has been a change in the

patient’s medical condition or medication

■ there must be a clear audit trail so that pharmacy staff can easily

determine the dates and quantities of medicines supplied at each

dispensing. Any clinically signiﬁcant interventions should be recorded

and maintained in the patient’s record

■ the prescriber should be informed by the pharmacist of any issues of

clinical signiﬁcance that relate to the repeatable prescription.

Essential service 3: disposal of unwanted medicines

The disposal of unwanted medicines is an essential service that aims to

provide the public with an easy and safe method of disposing of

unwanted medicines. The service should reduce the risk to the public in

the following ways:

■ reduce the quantity of stored unwanted medicine in people’s homes and

reduce the risk of accidental poisonings

■ reduce the risk of exposure to medicines that have been disposed of by

non-secure methods

■ reduced environmental damage caused by inappropriate disposal

methods for unwanted medicines.

94 Community Pharmacy Handbook

Community pharmacists should be aware of the following issues that

surround this essential service:

■ PCT responsibility

■ pharmacy as a collection point

■ storage of waste

■ segregation of waste

■ waste pharmacy medicines

■ waste-management legislation

■ clinical waste.

PCT responsibility

A pharmacy does not have to start providing the service until the PCT has

made suitable arrangements for collecting unwanted medicines from the

pharmacy. This will involve the use of a specialist waste contractor that

will regularly collect waste from the pharmacy. The PCT will need to reg-

ister as a broker for the collection and disposal of medicines with the local

environment agency.

Pharmacy as a collection point

As a collection point for waste, the pharmacy can collect unwanted

medicines from the public. The public is deﬁned as individuals and resi-

dential care homes. The provision for using the pharmacy as a waste-

collection point does not include nursing homes or waste from a general

medical practice as this waste is deﬁned as industrial clinical waste.

Storage of waste

The waste-disposal contractor will provide the pharmacy with approved

containers and all waste must be stored in these containers.

Segregation of waste

Waste should be segregated into four types:

■ solid dosage-form medicines and ampoules

■ liquids – stored in a special liquid waste container

■ aerosols

■ Schedules 2 and 3 controlled drugs (CDs) should be denatured before

disposing as the waste contractor is not authorised to possess a CD. It is

important that waste CDs are stored in a CD cabinet until the items are

denatured and therefore are no longer classiﬁed as a CD. At present the

Environment Agency regard the denaturing of CDs as a low-risk activity

Contractual framework for community pharmacy 95

and deem it is not necessary to have a waste-management licence to

carry out this procedure.

Waste pharmacy medicines

The Special Waste Regulations 1996 specify that different categories of

waste should not be mixed. Different categories of medicine for the pur-

pose of waste disposal can be deﬁned by the following list:

■ waste medicine items returned by the public

■ waste medicines from a pharmacy such as dispensing stock that is out of

date

■ waste prescription only medicines from a pharmacy are classiﬁed as

special waste and cannot be mixed with pharmacy (P) or general sales list

(GSL) medicines.

If P or GSL medicines have hazardous properties, for example if they are

ﬂammable, oxidising, irritant, harmful, toxic or corrosive, they are

regarded as special waste.

It is a requirement that waste medicines that have originated from

a pharmacy will not be mixed with waste items handed in by the public

for disposal.

Waste-management legislation

The community pharmacist needs to be aware of the relevant waste-

management legislation and ensure the following measures are in place:

■ the pharmacy premises are registered with the local ofﬁce of the

Environment Agency as exempt from the Waste Management Licensing

(WML) Regulations 1994 as they are storing waste medicines returned

from the public

■ if the pharmacy employs a driver to collect waste medicines from

patients’ homes, the driver will need to be registered as a waste carrier

with the local ofﬁce of the Environment Agency. This would include the

driver bringing unwanted medicines from a residential home

■ the secure storage of waste medicines should not exceed 5m

at any one

time and the storage should be for no longer than 6 months at a time.

■ the pharmacy will need to retain descriptions and transfer notes of waste

collected for at least 2 years. Any special waste-management consignment

notes will have to be retained on a register for at least 3 years

■ the pharmacy contractor will need to make staff aware of the risks

associated with handling waste medicines. Pharmacy staff will need

appropriate protective equipment and clothing and materials to deal

with any spillages. It would be expected that there are gloves, overalls

and suitable materials available to deal with spillages near to the area

where the waste medicines are stored.

96 Community Pharmacy Handbook

Clinical waste

Diagnostic testing in the pharmacy can generate a certain amount of clin-

ical waste such as used sharps and swabs for ﬁnger prick blood tests.

Needle-exchange schemes also involve the storage and disposal of

contaminated sharps. This type of clinical waste is deﬁned as a separate

category to medicines waste and can be collected from the pharmacy by

a licensed waste disposal contractor. A full waste-management licence is

not required for this activity.

Essential service 4: promotion of healthy lifestyles

Public health has always been a part of the community pharmacist’s

agenda and there is an increasing emphasis on this role. Pharmacists will

play a key role in the ‘health-promoting NHS’ as outlined in the Govern-

ment’s white paper Choosing Health: making healthy choices easier.

This role

is expanded further in the document: Choosing Health through Pharmacy. A

programme for pharmaceutical public health 2005–2015.

An overview of

some of the areas of pharmacist involvement is summarised in Figure 4.2.

Promoting healthy lifestyles consists of two separate areas:

■ prescription-linked intervention

■ involvement in public health campaigns.

Prescription-linked intervention involves offering opportunistic advice

on public health topics to patients that present a prescription. Offering

public health advice has always been part of the role of a commun-

ity pharmacist, and the new contract aims to formalise pharmacist input

in this area. Promotion of healthy lifestyles will include offering advice

when patients from any of the following groups present a prescription:

■ patients with diabetes

■ people at risk of coronary heart disease such as smokers, those with high

blood pressure and those who are overweight.

It is expected that pharmacists will have a structured discussion about rel-

evant health issues such as stopping smoking, recommended alcohol

intake, nutrition advice and the importance of increased physical activity.

The verbal advice should be backed up by written information such as

leaﬂets if necessary, and the advice given will be recorded on the patient’s

pharmacy record. The record will allow the pharmacist to follow the

progress of individual patients, follow up the consultation with further

advice, and facilitate audit of this service.

Systems and procedures need to be in place to ensure that appropri-

ate advice is given to patients. This may include the use of appropriate

Contractual framework for community pharmacy 97

98 Community Pharmacy Handbook

Figure 4.2 Pharmacist involvement in the promotion of healthy lifestyles.

Men’s

health

Child health

problems

COMMUNITY PHARMACY

Local

Accessible

Convenient

Extended opening hours

Tackling health

inequalities

Stop-smoking

services

Lifestyle

assessments

Weight

management

Long-term

conditions

Sexual health

services

National contract

Promotion of healthy lifestyles

Signposting

Support for self-care

reminder prompts on the patient medication record (PMR) system such

as a prompt to ask open questions regarding lifestyle, when new pre-

scriptions are presented for antihypertensive drugs.

The involvement in public health campaigns will be decided by the

individual PCT. Public health campaigns aim to engage the pharmacist in

promoting key healthy lifestyle messages, especially to hard-to-reach sec-

tors of the population. It is envisaged that the pharmacist will be involved

in up to six public health campaigns each year. During the campaign

pharmacy staff will be proactive in providing public health information

to both patients and general visitors to the pharmacy. A record of the

number of people who receive advice related to the campaign should be

recorded.

The essential service of promoting healthy lifestyles is linked to two

other essential services: signposting and supporting self care.

Essential service 5: signposting

The community pharmacist has always provided the public with infor-

mation about other agencies that can provide additional support, advice

or treatment. The essential service of signposting patients in this way is

now formalised in the national contract. The aims of this service are to:

■ inform or advise people who require assistance from health and/or social

care providers

■ enable people to access further care and support appropriate to their

needs

■ minimise inappropriate use of health and social care services.

It is the responsibility of the PCT to provide the pharmacy with referral

contact details of appropriate health and social care providers such as

local patient groups. To comply with this service it is expected that phar-

macy staff will inform or advise people visiting the pharmacy of where to

ﬁnd extra support to meet their health and social needs. In some cases a

written referral note may be provided to the patient if this is deemed to

be necessary. If the pharmacist makes a judgement that the advice given

to the patient is of clinical signiﬁcance and the patient is known to the

pharmacy staff, then a record of the signposting advice may be made on

the patient’s pharmacy record.

Essential service 6: support for self-care

In common with signposting and promoting healthy lifestyles, the

support of people requesting advice on self-care is a well-established role

for the community pharmacist. The aims and intended outcomes of this

Contractual framework for community pharmacy 99

essential service as described in the service speciﬁcation are to provide

people and their carers with enhanced choice and access to support for

self-care.

This involves providing people and their carers with:

■ appropriate advice to help them manage self-limiting or long-term

conditions, including advice on the selection and use of non-prescription

medicines

■ health-promotion advice in line with advice provided in other essential

services

■ information and advice about treatment options, including non-

pharmacological options to enable improved self-management of

conditions.

This service will involve pharmacy staff in providing management advice

and information on both minor illness and long-term conditions. The

advice to people and their carers will include information on non-

prescription medicines and opportunistic healthy lifestyle interventions.

Self-care referrals are received by community pharmacists from NHS

Direct and other healthcare professionals. In common with the signpost-

ing essential service, community pharmacists will direct patients to other

health and social care providers. A record on the patient’s pharmacy

record will be made if the patient is known to the pharmacy staff and the

pharmacist deems the advice to be of clinical signiﬁcance. The record

should include any advice given, products purchased or details of any

referrals made.

Essential service 7: clinical governance requirements

The community pharmacy contract is based on quality; therefore com-

pliance with clinical governance requirements is an essential service. This

essential service speciﬁes that all community pharmacies have an identi-

ﬁable clinical governance lead and apply clinical governance principles to

the delivery of all services. This lead person does not necessarily have to

be a pharmacist.

There are three principles of clinical governance in relation to the

community pharmacy contract:

■ clinical governance (continuous quality improvement) should be

embedded into all professional services

■ clinical governance is driven by a genuine desire to improve the service

delivered to patients

■ the development of clinical governance should be supported and

encouraged by primary care organisations.

The Healthcare Commission promotes quality in healthcare through pro-

viding an independent assessment of the standards of services provided by

100 Community Pharmacy Handbook

the NHS, private healthcare and voluntary organisations. There are seven

components of clinical governance as used by the Healthcare Commission

to assess how well an organisation meets clinical governance require-

ments. All of these requirements are embedded into the activities of the

pharmacy that impact on patient care. Each component will be considered

separately, but it should be recognised that there is a signiﬁcant overlap

between these areas. The seven areas are summarised in Figure 4.3.

Patient and public involvement

The ﬁrst requirement of the clinical governance section of the contract is

that pharmacies should have a practice leaﬂet that will inform patients of

the NHS services offered by the pharmacy. Community pharmacy con-

tractors will also have to annually administer a patient satisfaction

survey. The survey is based on a national template and asks for feedback

from patients on the promptness of supply, quality of service and quality

Contractual framework for community pharmacy 101

Figure 4.3 Overview of the clinical governance requirements for the

community pharmacy contract.

Patient and

public

involvement

Clinical

governance

Use of

information

Training and

development

Staff

management

Clinical

effectiveness

Risk

management

Clinical

audit

of facilities. The minimum number of returned surveys required is

dependent on the average monthly prescription volume. It is expected

that the pharmacist will review the surveys and make improvements

where necessary. Patient and public involvement with community phar-

macy will also include visits from local patient and public involvement

forums, which are made up of volunteers and exist in every PCT in

England. The role of patient and public involvement forums is to inde-

pendently monitor service providers. The NHS trust has a legal obligation

to respond to the issues raised by this monitoring activity. The contractor

is also expected to work with other external organisations such as the

Healthcare Commission and local authorities. Similar arrangements exist

in Wales where the pharmacy should co-operate with local health boards

and other appropriate external bodies such as the Health Inspectorate in

the monitoring and auditing of pharmacy services.

As a means of improving communication with patients and the pub-

lic, a complaints system should already be in place in the pharmacy. This

system should be formalised and involves two stages. The ﬁrst stage is to

bring a complaint to the attention of the practitioner or the organisation.

If the complaint is unresolved it will be referred to the second stage to be

managed by the Healthcare Commission. Speciﬁc procedures for respond-

ing to complaints and dispensing errors are discussed in Chapter 7.

Clinical audit

A simple deﬁnition of audit is ‘improving the care of patients by looking

at what you are doing, learning from it and, if necessary, changing prac-

tice’. Clinical audit is part of quality assurance, ensuring that the best

possible service to patients is offered and the risk of errors minimised.

Involvement in clinical audit has several advantages:

■ it demonstrates a willingness to maintain good professional standards

■ it improves the quality of working life

■ it enhances the efﬁcient use of resources

■ it helps to support change by producing objective information about the

quality of care.

The objective of an audit needs to be clearly stated, for example:

To ensure that all members of the pharmacy team provide appropriate and up-

to-date information when they receive requests for weight-management advice.

Contractors are expected to participate in two clinical audits each year to

comply with this component of clinical governance. One audit is practice

based and the other audit involves a multidisciplinary approach which is

determined by the PCT. Both audits must have a clear outcome and be

used to contribute to the development of patient care. Both clinical audits

102 Community Pharmacy Handbook

should be able to be completed within 5 days of pharmacist time, and it

is expected that the PCT will give the pharmacist adequate notice of any

meetings involved in the multidisciplinary audit so that they can make

arrangements to leave the pharmacy premises.

Risk management

The management of risk covers a diverse range of activities in the phar-

macy and the service speciﬁcation covers the following areas:

■ stock-sourcing and handling procedures

■ equipment maintenance

■ patient safety incident log for reporting to the National Patient Safety

Agency (NPSA)

■ analysis and monitoring of critical incidents

■ root cause analysis

■ standard operating procedures for many of the pharmacy’s functions

■ waste-disposal systems for clinical and conﬁdential waste

■ compliance with health and safety legislation and child-protection

procedures.

Clinical effectiveness

Clinical effectiveness is a general term used to describe a range of activ-

ities that help the healthcare professional to measure, monitor and

improve the quality of patient care that they provide. This is not the same

as clinical governance but forms part of clinical governance. For the com-

munity pharmacist to practise in a clinically effective way, they must

ensure that they work within best current practice and evidence-based

guidelines for all patient and customer interactions. This will involve

working within policies that are intended to manage risk and reduce

harm to patients.

To ensure that appropriate self-care advice is given there should be

systems in place such as protocols, SOPs and algorithms. Pharmacies

should also contribute to the clinical effectiveness of prescribing through

the management of repeatable prescriptions and the MUR service. To

demonstrate clinical effectiveness, the pharmacist will need to maintain

accurate records and undertake clinical audit to demonstrate improve-

ment in their practice.

Staff management

It is a requirement that all contractors ensure that all pharmacy staff and

locum pharmacists are provided with induction training that covers

Contractual framework for community pharmacy 103

issues such as conﬁdentiality, health and safety and security. All staff

members are provided with training that is appropriate to their role and

there is support for their ongoing development needs. When employing

new staff who are providing NHS services, references should be taken up

and all qualiﬁcations checked. A list of employed pharmacists and locums

will be held by the PCT.

Training and development

Pharmacists will have to be able to demonstrate a commitment to con-

tinuing professional development (CPD) using a CPD record in line with

the Royal Pharmaceutical Society of Great Britain (RPSGB) requirements.

There is a requirement for pharmacists to become accredited before pro-

viding advanced or enhanced services.

Use of information

It is expected that pharmacy staff will be able to access up to date refer-

ence sources such as the British National Formulary (BNF) and Drug Tariff

and have appropriate IT links to electronic reference sources.

Conﬁdentiality policies need to be in place to protect patient data and

conﬁdentiality. Full records of any interventions and advice given should

be made where this will improve patient care. The pharmacy will also

need to provide the PCT and NHS Direct with updated information on

their opening hours.

Standard operating procedures (SOPs)

From January 2005 the RPSGB required all pharmacies to have written

SOPs covering the dispensing process. This requirement applies to both

hospital and community sectors and covers all of the activities which

occur from the time that prescriptions are received in the pharmacy or

by a pharmacist until medicines or other prescribed items have been

collected or transferred to the patient.

A SOP is a written document that speciﬁes what should be done,

when, where and by whom. The RPSGB consultation document on SOPs

in a community pharmacy stated that SOPs have the following beneﬁts:

■ help to assure the quality of the service

■ help to ensure that good practice is achieved consistently

■ enable pharmacists to delegate more readily and may possibly free the

pharmacist’s time for other activities

104 Community Pharmacy Handbook

■ help to avoid confusion over who does what and clarify roles within the

pharmacy

■ provide advice and guidance to locums and part-time staff

■ provide useful training tools for new members of staff

■ provide a contribution to the audit process.

The main driver behind the introduction of SOPs is the compliance with

clinical governance requirements to put in place strategies for risk man-

agement and risk minimisation. Pharmacists are accountable for the

dispensing process but the development of SOPs will allow pharmacists to

examine current dispensing practice and benchmark good practice in this

area.

There are three general principles that apply to all SOPs:

■ the SOP must be pharmacy speciﬁc. There is wide recognition that

pharmacies vary considerably in their working environment and the SOP

will be speciﬁc to a pharmacy

■ the SOP will depend on the competence of the staff working in a speciﬁc

pharmacy. For example there may be more stages and more explanation

in the SOP where there are lower numbers of competent staff

■ the SOP will be applicable at all times in a speciﬁc pharmacy. The SOP

should not be dependent on the presence of the pharmacist under whose

authority the procedure was prepared.

Anatomy of an SOP

Each SOP has two main parts:

The ﬁrst part is an outline or summary that includes:

■ the aim or purpose of the overall SOP

■ objectives – what is the procedure trying to achieve?

■ scope – what areas of work are to be covered by the procedure?

■ risks – are there any risks associated with the task?

■ review date – to ensure that the procedure continues to be useful and up

to date

The second or main part of the document includes:

■ stages of the process – describe how the task is to be carried out step by

step

■ responsibility – who is responsible for carrying out each stage of the

process: (1) under normal operating conditions; (2) in different

circumstances, for example when staff are on holiday or there is a

computer failure

■ other useful information – is there any other information that could

usefully be included in the procedure? Does the SOP incorporate

mechanisms for audit?

A speciﬁc example of an SOP for waste disposal is provided in Figure 4.4.

Contractual framework for community pharmacy 105

106 Community Pharmacy Handbook

Figure 4.4 Standard operating procedure (SOP) in a ﬂow chart format for the conﬁdential waste disposal of medicines other than

controlled drugs.

Dispose of via

standard waste route

Remove any information

that would identify

the patient

Is there any specific patient

information on the packaging?

e.g. name or address

Refer to disposal of unwanted

medication SOP and dispose of

unwanted medication

Shred the waste regularly and

dispose of with standard waste

Does the package contain any

medication? e.g. monitored dose

system packs

Is it possible to

shred the waste?

Is it possible to

remove the patient

information?

Treat waste as

clinical waste and dispose

of in containers provided

by PCT

Yes

For the purposes of writing an SOP the RPSGB has divided the dispensing

process into six main steps:

■ taking in prescriptions

■ pharmaceutical assessment

■ interventions and problem solving

■ assembly and labelling

■ accuracy checking

■ transfer to the patient.

As a minimum, all of these six areas should be covered by SOPs. Indi-

vidual pharmacies will then go on to develop SOPs for areas that are

speciﬁc to their practice. Examples that may be relevant for an individual

pharmacy include:

■ dispensing methadone or other items to drug users

■ providing services to nursing or residential care homes

■ prescription collection and delivery services

■ telephone requests for prescriptions

■ the use of child-resistant containers (CRCs)

■ recording interventions

■ queries from other healthcare professionals

■ supply of specials

■ dealing with ‘owings’, including the procedure to be followed at the time

of the second dispensing.

Contractual framework for community pharmacy 107

Top tips for producing SOPs

■ Take into account practical variables such as sickness, holidays,

volume of work and the resources available.

■ Avoid long wordy instructions. Keep the stages small and simple to

follow.

■ Use diagrams and ﬂow charts where possible.

■ Cross reference to other information such as ‘in house’ training

manuals or documents or computer manuals.

■ Experiment with different layouts such as using algorithms or the

use of bulleted points

■ Involve different members of staff in the writing process. The

accountability for the SOP is with the pharmacist but it is useful to

have input into the writing process.

■ Decide if responsible staff will be named on the SOP or whether job

titles will be used, for example ‘dispenser’ or ‘counter assistant’

■ Make sure the SOP matches the layout and workﬂow of the

pharmacy. For example an unusual dispensary layout may mean

that the SOP for assembling and labelling needs to be very speciﬁc

for the SOP to work. A speciﬁc SOP also informs locum staff of the

differences in procedures in an individual pharmacy.

continued overleaf

Pharmacists working for a large organisation will be supplied with SOP

templates from their central ofﬁce that require local adaptation. The tem-

plate is then adapted by each pharmacy to specify how each task is done,

which member of staff is responsible and what level of training the

person performing the task must have. There is usually the facility for

local stores to opt out of this system and produce their own SOP, which

will then require approval by the superintendent pharmacist or their

representative.

If a pharmacist works for an independent pharmacy they are start-

ing with a clean sheet of paper. The advantage in this is that the phar-

macist can take individual circumstances of their pharmacy into account

from the outset.

There are various sources of support for pharmacists writing SOPs:

■ the RPSGB website provides guidance on writing SOPs for the six

dispensing steps

■ the Centre for Pharmacy Postgraduate Education (CPPE) has a

multimedia distance learning package called SWEEP. This package is

aimed at helping pharmacists write a variety of SOPs within the

pharmacy and not conﬁned to the area of dispensing

■ National Pharmacy Association (NPA) members can access a training

package developed in conjunction with GlaxoSmithKline’s Plus

programme.

Monitoring of the contract

Compliance of pharmacy contractors with the national contract in

England is monitored by the PCT. It is suggested that the PCT involve the

local pharmaceutical committee (LPC) to discuss the format of the

monitoring process. In most cases the monitoring visit by the PCT is an

annual visit to the pharmacy premises.

108 Community Pharmacy Handbook

■ Keep all SOPs in a designated folder and also give out copies to

members of staff who are involved in the dispensing process. Make

sure that locum staff can access the information easily.

■ Allow all members of staff to become involved once the SOP has

been drafted, and invite comments. Trial the SOP for a few months

and modify the procedure according to input from the pharmacy

team. The review date will be stated on the SOP document and

should be at least annually. Change the SOP before the review date

if there is a dispensing error related to the SOP or there is a change

in company procedure or legislation changes.

The NHS Primary Care Contracting (PCC) monitoring toolkit

generally used as the basis for monitoring the contract. This consists of a

nationally designed and agreed format of indicators and quality markers

that a pharmacy can be measured against.

To assist the contractor in preparing for the contract, reference can

be made to the PSNC New Contract Workbook.

This document contains

full details of the contract and assists the contractor to collate import-

ant information that may be required during the monitoring visit. The

PCC monitoring toolkit contains a self-assessment tool that enables

the contractor to assess compliance with different parts of the contract. A

series of statements under the different essential services are self-assessed

by the contractor as: always doing (green), mostly doing (amber) and

rarely doing (red). Examples of self-assessment monitoring statements

include:

■ ‘All prescriptions have legal, clinical and accuracy checks’

■ ‘Appropriate protective equipment and spillage kits are available for staff

to use’.

The monitoring visit should not impact on the running of the pharmacy

or disrupt the concentration of the pharmacy staff. It is important that

the visit is prepared for and all the necessary documentation is to hand.

A formative self-assessment by the contractor may reduce the amount of

time spent on the actual visit and also the breadth of the visit. After the

visit, the pharmacy contractor should be given a minimum of 3 months’

written notice to rectify any areas of non-compliance, before any action

is taken. Guidelines on non-compliance with the contract are provided in

a Department of Health brieﬁng paper.

Support for people with disabilities

The new contract initially proposed an essential service entitled ‘Support

for people with disabilities’. This service was not included in the new

contractual framework. However, under the Disability Discrimination Act

1995 (DDA),

pharmacists providing services in the UK have a legal

obligation to make reasonable adjustments to their services and provide

auxiliary aids where appropriate for people with disabilities.

Before the DDA there was a register of disabled persons that was

maintained under Section 6 of the Disabled Persons (Employment) Act

1944. A person on the register for a period of 3 years was deemed to be a

disabled person within the meaning of this Act. There is now no register

on which a person with a disability is recorded. For example before the

Contractual framework for community pharmacy 109

DDA a person may have been registered disabled for reasons such as

difﬁculty in walking, becoming easily tired, or conditions such as emphy-

sema. All of these conditions could satisfy the former deﬁnition of a

disabled person but the person would not necessarily have difﬁculties

with their medicines.

Under the DDA a person is considered disabled if he, or she, has a

mental, sensory or physical impairment that would have a substantial

and long-term adverse effect on his or her ability to carry out normal day-

to-day activities.

The DDA will apply if at least one of the following is affected by the

impairment:

■ mobility

■ manual dexterity

■ physical co-ordination

■ continence

■ ability to lift, carry or otherwise move everyday objects

■ speech hearing or eyesight

■ memory or ability to concentrate, learn or understand

■ perception of the risk of physical danger.

The DDA has been amended to cover conditions such as cancer, HIV and

multiple sclerosis that cause an intermittent disability or progressive

disability. The amendment has also removed the criteria for a mental

impairment to be clinically recognised.

The following requirements apply to pharmacy services under the

DDA:

■ disabled people should not be treated less favourably than other people

for any reason related to their disability

■ reasonable adjustments for disabled people include providing extra help

or changing the way that services are provided

■ reasonable adjustments to the physical features of pharmacy premises to

overcome barriers to access should be made.

A contribution for the adjustments made by pharmacies for patients

eligible under the DDA is made within the practice payment received by

the pharmacy and detailed in the Drug Tariff.

Provision for the payment

of auxiliary aids for patients not eligible under the DDA will not be

covered. In some cases patients not covered by the DDA will be covered

by negotiated arrangements with the PCT or social services.

There are two stages for a community pharmacist when considering

their service provision to people with disabilities:

1 to assess the patient to conﬁrm that they are covered by the DDA

2 to decide what reasonable adjustments are needed in order to comply

with the DDA.

110 Community Pharmacy Handbook

An example of different patients with disabilities and how they may

affect their access to pharmacy services is provided in Table 4.1.

The assessment of the patient could involve an informal discussion,

or a more formal approach can be adopted by using assessment forms.

One of the assessment tools for pharmacy contractors has been commis-

sioned by the Department of Health on the NHS Primary Care Contracting

website.

In some cases the use of a variety of other assessment methods

may be more appropriate. The assessment must be carried out in a suitable

environment that offers privacy and conﬁdentiality. The following issues

should be considered when carrying out a patient assessment:

■ assessments should ignore corrective interventions that have been made

to support a disability. The exception to this is visual impairment which

should only be assessed when the patient is using spectacles or contact

lenses. If large-print labels are being considered it may be appropriate to

refer the patient to an optometrist for an updated eye check

■ the disease may have progressed, even though symptoms have improved,

and the patient may need reassessment

■ communication pathways with other health and social care professionals

should be developed. In some cases the pharmacist will be unable to

support the patient appropriately and will need to be able to signpost the

patient to a health and social care assessment or a local support group.

Contractual framework for community pharmacy 111

Table 4.1 Examples of patients with disabilities and how they may affect their

access to pharmacy services

Is the person disabled Are they are able to access

within the meaning of pharmacy services

Patient the Act? (medicines)?

Person with severe Yes A child-resistant

arthritis container would be

unreasonably difﬁcult or

impossible for this patient

Person who cannot Yes No particular constraints

walk unaided on the use of medicines

Person with short-term Yes Loose medicines in a

memory loss that has bottle may be a problem.

a substantial impact The supply of a calendar

on day-to-day living pack or monitored dosage

system may improve

compliance

The next stage is to decide what reasonable adjustments are required by

the patient, in order to access the services being offered. Potentially a

difﬁcult situation can arise if the patient demands or believes that they

need a particular adjustment to the service and the patient assessment

demonstrates that this is not necessary.

Examples of reasonable adjustments to dispensing services include:

■ removing tablets from packaging if the patient is unable to remove

tablets from blister packs

■ providing wing caps for patients who are unable to open ordinary screw

caps

■ provision of pen and paper to facilitate communication if the patient is

unable to speak clearly

■ supplying smaller lighter-weight plastic liquid medicine bottles for

patients who have difﬁculty pouring from a large heavy glass bottle.

There are numerous examples of reasonable adjustments, and it is import-

ant that the pharmacist works in partnership with the patient to nego-

tiate a reasonable approach to supplying their medicines. For example it

may be considered unreasonable for the pharmacist to install an expen-

sive hearing loop or purchase a Braille typewriter to produce Braille labels

for the visually impaired. These are examples of situations where the PCT

may have to commission a locally enhanced service to cater for the needs

of patients who require these costly adjustments.

Community pharmacy contract for Scotland

The Scottish contract for community pharmacists differs from the con-

tract in England and Wales. The contract is based on four core services:

an acute medication service (AMS), a minor ailment service (MAS), a

chronic medication service (CMS) and a public health service (PHS).

Unlike the contract for England and Wales the contract is effectively a

single tier that consists of four services that all community pharma-

cists in Scotland must provide. Any additional services such as harm-

reduction services, care home services, out-of-hours services and waste

collection are to be agreed locally but will be based on national speciﬁca-

tions. The Scottish contract, in common with England and Wales, also

underlines making better use of pharmacists’ skills and the development

of pharmacy services. The Scottish Executive’s 10-year plan for NHS

Scotlandemphasises the value of community pharmacists based in local

communities and the importance of public health and preventative

healthcare.

The main focus of the contract is on the provision of phar-

maceutical care.

112 Community Pharmacy Handbook

In summary, the four core services include:

■ acute medication service (AMS) which is essentially the regular dispensing

service

■ minor ailment service (MAS) that offers patients who are exempt from

prescription charges the provision of having minor ailments treated free

of charge in the pharmacy. This will involve the patient in registering

with a pharmacy via an electronic central patient registration system

■ chronic medication service (CMS) that involves a pharmacist in the

management of a patient’s long-term medication for up to 12 months.

This will include the provision of medicines and the associated

monitoring and reviewing of medicines. In some cases there will be a

shared care agreement between the patient the GP and the community

pharmacist. Payment for the CMS will be on a capitation basis

■ public health service (PHS) which includes the provision of information on

public health issues and the participation in national and local public

health campaigns. There is an emphasis on using the community

pharmacy network as healthy living walk-in centres to communicate

healthy lifestyle messages to local communities.

The Scottish contract was introduced in April 2006 and a phased imple-

mentation process is planned as supporting information management

and technology becomes available.

Implications for practice

Activity 1

■ Visit the audit section of the RPSGB website:

www.rpsgb.org.uk/registrationandsupport/audit/index.html

■ Examine the audit templates and consider designing a new audit that is

particularly relevant to your current practice.

Activity 2

Carry out a review of a minimum of three different SOPs that are com-

monly used in your practice. Ask your pharmacy team for their comments

on each SOP under the following headings:

■ compliance with SOP

■ ease of use

■ suggested improvements (if any).

■ Are there any common themes that emerge from this assessment?

■ Modify the SOPs to take into account any suggested improvements.

Contractual framework for community pharmacy 113

Multiple choice questions

Directions for question 1: each of the questions or incomplete state-

ments in this section is followed by ﬁve suggested answers. Select the best

answer in each case.

Q1 Which of the following services requires accreditation of the pharmacist

and premises?

A Disposal of unwanted medicines

B Promoting healthy lifestyles

C Medicines use review

D Repeat dispensing

E Signposting

Directions for questions 2 and 3: for each numbered question select the

one lettered option above it which is most closely related to it. Within

each group of questions each lettered option may be used once, more

than once, or not at all.

A Prescription intervention service

B Minor-ailments service

C Repeat dispensing

D Clinical governance

E Support for self-care

Select from A to E which one of the above ﬁts the following statements

Q2 An advanced service

Q3 An enhanced service

Directions for questions 4 to 8: each of the questions or incomplete

statements in this section is followed by three responses. For each ques-

tion ONE or MORE of the responses is (are) correct. Decide which of the

responses is (are) correct. Then choose:

A if 1, 2 and 3 are correct

B if 1 and 2 only are correct

C if 2 and 3 only are correct

D if 1 only is correct

E if 3 only is correct

Directions summarised:

A: 1, 2, 3 B: 1, 2 only C: 2, 3 only D: 1 only E: 3 only

Q4 Which of the following organisations were involved in negotiation for the

contractual framework for community pharmacy?

1 Department of Health

114 Community Pharmacy Handbook

2 NHS Confederation

3 PSNC

Q5 Which of the following statements about essential services in the contract

for England and Wales is (are) correct?

1 They are provided by all pharmacies.

2 The services are not open to local negotiation.

3 There must be the provision of a MUR service.

Q6 Which of the following statements about the dispensing service is (are)

correct?

1 All prescriptions should have a legal, clinical and accuracy check.

2 The pharmacy must make a record of all medicines dispensed.

3 The pharmacy must record any advice given, interventions made and

referrals, where the pharmacist judges this to be clinically appropriate.

Q7 The essential service ‘promoting healthy lifestyles’ includes offering

opportunistic advice to the following when a prescription is presented. A

community pharmacist would offer advice to:

1 Patients with asthma

2 Patients who smoke

3 Patients with high blood pressure

Q8 Which of the following statements about clinical effectiveness is (are)

correct?

1 Clinical effectiveness is the same as clinical governance.

2 Accurate records of clinical audit are needed to demonstrate clinical

effectiveness.

3 Pharmacists can contribute to the clinical effectiveness of prescribing

through the MUR service.

Directions for questions 9 and 10: the following questions consist of a

statement in the left-hand column followed by a second statement in the

right-hand column.

Decide whether the ﬁrst statement is true or false.

Decide whether the second statement is true or false.

Then choose:

A if both statements are true and the second statement is a correct

explanation of the ﬁrst statement

B if both statements are true but the second statement is NOT a correct

explanation of the ﬁrst statement

C if the ﬁrst statement is true but the second statement is false

D if the ﬁrst statement is false but the second statement is true

E if both statements are false

Contractual framework for community pharmacy 115

Directions summarised:

A: True True second statement is a correct explanation of the ﬁrst

B: True True second statement is NOT a correct explanation of the

ﬁrst

C: True False

D: False True

E: False False

■ Statement 1: Out-of-date spironolactone tablets removed from the

dispensary cannot be disposed of with out-of-date ibuprofen 400 mg

tablets (pack size 24) from the stock room.

■ Statement 2: The special waste regulations 1996 specify that different

categories of waste cannot be mixed.

Q10

■ Statement 1: A monitored dosage system should be offered to all

elderly people requesting this service.

■ Statement 2: Under the Disability Discrimination Act 1995, pharmacists

providing services in the UK have a legal obligation to make

reasonable adjustments to their services.

Case studies

Level 1

Tamara is a third-year pharmacy undergraduate who is part of an inter-

professional group of four students. The other students in her group are

studying medicine, nursing and social work. The tutor has asked each

student to talk informally to the rest of their group about their profession

and how it may relate to other professional groups.

■ Prepare a brief summary for Tamara, using bullet points, of how the

contractual framework for community pharmacy can relate to GPs,

nurses and social workers.

Level 2

Ryan is a preregistration trainee who is only in the ﬁrst few weeks of his

training. He is enjoying his work but had a difﬁcult incident today when

handing out a prescription. The customer asked him if she could have her

tablets in weekly blister packs as she is a bit forgetful and ﬁnds it hard to

remember to take her tablets. She also said that she has difﬁculties with

116 Community Pharmacy Handbook

her hands and ﬁnds the glass medicine bottles far too heavy to handle.

Ryan asked the dispensary team if this was possible. They were very dis-

missive as they were extremely busy at the time and the relief pharmacist

was on the telephone. He decided to show some initiative and told the

customer that it would not be possible. She started to become angry and

upset and said she would be making a formal complaint. Ryan came into

work early the following morning as he wanted to discuss the incident

with his tutor.

The preregistration tutor asks Ryan to think about the following

areas:

■ what are the issues involved in this case?

■ what could Ryan have done differently?

■ what preregistration performance standards could this incident relate to?

Level 3

Ben has completed the second year of his pharmacy degree course and is

pleased to have been offered a 4-week summer placement in his local

community pharmacy. He has not worked in community pharmacy

before and is looking forward to the opportunity to gain some experience.

On his ﬁrst day he is disappointed to ﬁnd that the regular pharmacist he

arranged the placement with, has just started his 3-week holiday. The

senior assistant seems quite distracted and appears only vaguely aware

that Ben is due to start work today. One member of staff has called in sick

and the locum pharmacist arrives only one minute before opening time.

Ben is quickly assigned to the prescription reception area and the

process of receiving and handing out prescriptions is hurriedly explained.

He is also instructed to shadow the staff on the medicines counter and

help to ﬁll some shelves as there is a large section of remerchandising

taking place.

The morning proceeds quite quickly and Ben is keen to learn from

his experience. His ﬁrst impression is that the pharmacy seems quite

disorganised. He decides to keep a diary record of some of the main

events of the day.

Extracts from Ben’s diary – Day 1

■ A customer asked me some questions about prescription-collection and

delivery services. I was unsure how to answer his questions so I asked the

pharmacist and dispensing assistant. The dispensing assistant spoke to

the customer brieﬂy and I listened to their conversation. My impression

is that the staff did not seem particularly helpful to the customer.

Contractual framework for community pharmacy 117

■ An elderly man got quite upset with me because he said I had given him

the wrong tablets as he had misheard me when I asked for his name. The

pharmacist managed to sort it out but it caused quite a big problem at

the time. The pharmacist reassured me that I was not to blame. I kept

thinking about why it had happened but everyone seemed too busy to

take much interest in the details

■ A customer had a repeat prescription that she leaves in the pharmacy

without seeing her doctor. It seemed to take the dispensing assistant a

long time to ﬁnd the prescription. The customer then had to come back

to collect her medication.

■ In the afternoon I was left on the medicines counter on my own as the

other staff were busy completing a new display of holiday healthcare

products. I did not feel at all comfortable and was embarrassed to keep

asking the pharmacist questions.

■ Identify the clinical governance issues in this case study.

References

1 Department of Health. Pharmacy in the Future: implementing the NHS

Plan. A programme for pharmacy in the NHS. London: Department of

Health, 2000. www.dh.gov.uk/en/Publicationsandstatistics/Publications/

PublicationsPolicyAndGuidance/Browsable/DH_4098182 (accessed 5

September 2007).

2 Department of Health. Spending Review 2004 Public Service Agreement.

London: Department of Health, 2004. www.dh.gov.uk/en/Aboutus/

HowDHworks/Servicestandardsandcommitments/DHPublicServiceAgre

ement/DH_4106188 (accessed 11 September 2007).

3 News item. Bulk of enhanced services made up of four types. Pharm J

2006; 277: 628.

4 Pharmaceutical Services Negotiating Committee. NHS Community

Pharmacy Contractual Framework. Essential Service – Dispensing. www.

psnc.org.uk/uploaded_txt/Service%20Spec%20ES1%20%20Dispensing

%20_v1%2010%20Oct%2004_.pdf (accessed 5 September 2007).

5 Centre for Pharmacy Postgraduate Education. Distance Learning Pack:

repeat dispensing from pathﬁnder to practice. Manchester: Centre for

Pharmacy Postgraduate Education.

6 Welsh Centre for Pharmacy Postgraduate Education. Distance Learning

Pack: repeat dispensing arrangements in Wales. Cardiff: Welsh Centre for

Pharmacy Postgraduate Education.

7 Pharmaceutical Services Negotiating Committee. NHS Community

Pharmacy Contractual Framework. Essential Service – Repeat Dispensing.

www.psnc.org.uk/uploaded_txt/Service%20Spec%20ES2%20

%20Repeat%20dispensing%20_v1%2010%20Oct%2004_.pdf (accessed

5 September 2007).

118 Community Pharmacy Handbook

8 Royal Pharmaceutical Society of Great Britain. The Hazardous Waste

Regulations (England and Wales) 2005 and Information for Scotland. Interim

practice guidance for community pharmacists. www.rpsgb.org.uk/pdfs/

hazwastecommphguid.pdf_

(accessed 5 September 2007).

9 Department of Health. Choosing Health: making healthy choices easier.

London: Department of Health, 2005. www.dh.gov.uk/en/Publications

andstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/

DH_4097491 (accessed 5 September 2007).

10 Department of Health. Choosing Health Through Pharmacy. A programme

for pharmaceutical public health 2005–2015. London: Department of

Health, 2005. www.dh.gov.uk/en/Publicationsandstatistics/ Publications/

PublicationsPolicyAndGuidance/DH_4107494 (accessed 5 September

2007).

11 Pharmaceutical Services Negotiating Committee. NHS Community

Pharmacy Contractual Framework. Essential Service – Support for Self-care.

www.psnc.org.uk/uploaded_txt/Service%20spec%20ES6%20-%20

Support%20for%20self-care%20_v1%2010%20Oct%2004_.pdf

(accessed 5 September).

12 Royal Pharmaceutical Society of Great Britain. Practice and Quality

Improvement Directorate. Pharm J 2005; 275: 203–204.

13 Royal Pharmaceutical Society of Great Britain. Medicines Ethics and

Practice (30). Practice guidance 4.3.30. London: Royal Pharmaceutical

Society of Great Britain, 2006.

14 Royal Pharmaceutical Society of Great Britain. Guidance document.

Consultation on SOPs for dispensing. Pharm J 2001; 266: 616–619.

15 News feature. Writing SOPs, where should you start? Pharm J2003; 271:

443–444.

16 Royal Pharmaceutical Society of Great Britain. Developing and

Implementing SOPs for Dispensing. London: Royal Pharmaceutical Society

of Great Britain, 2001. www.rpsgb.org.uk/pdfs/sops.pdf (accessed 5

September 2007).

17 NHS Primary Care Contracting. Community Pharmacy Assurance

Framework. www.primarycarecontracting.nhs.uk/114.php (accessed 5

September 2007).

18 Pharmaceutical Services Negotiating Committee. New Contract

Workbook 2005–2006. www.psnc.org.uk/uploaded_txt/WORKBOOK

%20-%20FINAL%20VERSION.pdf (accessed 5 September 2007).

19 Department of Health. Pharmacy Contract: non compliance and dis-

pute resolution. http://www.primarycarecontracting.nhs.uk/uploads/

Pharmacy/jul06_uploads/noncompliance_and_dispute_resolution.pdf

(accessed 5 September 2007).

20 Disability Discrimination Act 1995. www.opsi.gov.uk/acts/acts1995/

1995050.htm (accessed 5 September 2007).

21 Pharmaceutical Services Negotiating Committee. Pharmacy and the

Disability Discrimination Act. www.psnc.org.uk/index.php?type=

page&pid=93&k=4 (accessed 10 May 2007).

Contractual framework for community pharmacy 119

22 Rosenbloom K, Wakeman R, Scrimshaw. The Disability Discrimination

Act. Pharm J 2005; 275: 747–750.

23 Department of Health. Drug Tariff (published monthly) Part VIA.

London: Department of Health.

24 NHS Primary Care Contracting. Disability Discrimination Act – A Resource

Kit. www.primarycarecontracting.nhs.uk/98.php (accessed 5 September

2007).

25 Bellingham C. Introducing the new Scottish contract. Pharm J 2005;

275: 637.

26 Scottish Executive. Delivering for Health. www.scotland.gov.uk/

Publications/2005/11/02102635/26360 (accessed 5 September 2007).

Further information

Royal Pharmaceutical Society of Great Britain. National Resources Available to

Support the Community Pharmacy Contract (England and Wales).

www.rpsgb.org/pdfs/cpcontractnatresources.pdf (accessed 5 September

2007).

120 Community Pharmacy Handbook

Medicines use review

Community pharmacy will need to make changes in order to provide the

services that patients and the new NHS want and need.

(A Vision for Pharmacy in the New NHS, Department of Health

)

Advanced services form the second tier of the national contract.

Medicines use review (MUR) and prescription intervention (PI) were the

ﬁrst advanced services to be introduced. These services are considered

together as they both involve a review of medicines usage. An MUR is

planned in advance and is undertaken regularly. A PI service is unplanned

and is initiated as a result of a prescription that has signiﬁcant medication

issues that need to be discussed in more detail. The provision of these

advanced services involves accreditation of both the pharmacist and the

premises. The community pharmacist has always been involved in

the review of medicines usage on an informal basis. The introduction of

this advanced service is signiﬁcant, as this is the ﬁrst time that commu-

nity pharmacists have been involved in a nationally recognised and

remunerated clinical review service.

There has been some confusion about the purpose and limitations

of the MUR service. The MUR is essentially a compliance and concord-

ance review that aims to help people use their medicines more effectively.

It involves identifying problems with medicines, providing advice and

suggesting changes to the general practitioner (GP). The MUR is not

intended to be a full level 3 medication review and the pharmacist does

Checkpoint

Before reading on, think about the following questions to identify

your own knowledge gaps in this area:

■ What is the main purpose of a medicines use review (MUR)?

■ How does an MUR differ from a prescription intervention (PI)

service?

■ What are the requirements to become accredited to offer an MUR

service?

■ Describe how suitable patients can be identiﬁed for an MUR.

not have access to the patient’s notes and test results. Initially an MUR

looks at the patient’s compliance with taking medicines as directed by

the prescriber. The pharmacist can then make recommendations to the

patient, carer or other healthcare professionals to improve compliance

and reduce drug-related problems.

The initial participation of pharmacists in offering this advanced

service was signiﬁcantly below the anticipated 200 MURs per pharmacy

by April 2006.

Some of the reasons suggested for the lack of involvement

in this essential service are:

■ lack of acceptance of this new service by both the patient and the GP

■ confusion about the amount of time required to conduct an MUR

■ lack of pharmacy resources in terms of both staff and time

■ problems with the provision of a suitable consultation area

■ the paperwork and record keeping involved in the process is overly

complicated.

Potentially the offering of an MUR and PI service will beneﬁt patients and

lead to improved pharmaceutical care. Involvement in this service is also

rewarding for the pharmacist both professionally and ﬁnancially. This

chapter aims to offer a practical guide to offering a MUR service in the

pharmacy.

Accreditation

As a quality-assurance mechanism both the pharmacy premises and the

pharmacist need to be accredited to offer an advanced service. The essen-

tial requirements for offering an MUR service are outlined in Box 5.1.

122 Community Pharmacy Handbook

Box 5.1 Accreditation of pharmacist and premises for an MUR service

■ Premises must have a consultation area that:

– is clearly designated and distinct from the general area of the

pharmacy

– allows the pharmacist and the customer to sit down together

– is somewhere that they can talk at normal volumes without being

overheard by staff and customers.

■ The pharmacist must have:

– an MUR certiﬁcate from a relevant higher education institute

– sent the certiﬁcate to the appropriate primary care organisation

– complied with the clinical governance requirements under the new

contract.

Pharmacist accreditation

A competence-based framework has been developed for the assessment of

pharmacists providing the MUR ser vice.

The framework is not designed

to be an exhaustive list of competencies but includes key elements that

can be subject to reliable assessment. Higher education institutions (HEIs)

will make arrangements for the assessment of pharmacists within this

framework. Individual HEIs will approach the competency framework in

different ways and have different methods of assessment. Universities

offering this assessment as higher education providers have quality-

assurance processes in place for learning and assessment. For consistency

there will be no accreditation of prior learning, and all pharmacists wish-

ing to become accredited will need to pass the assessment. There are ﬁve

competencies and each competency is linked to a number of behavioural

statements. The competency framework is summarised in Table 5.1.

There are a number of training options to choose from depending

on the pharmacist’s preferred learning method, and their prior knowledge

and experience. Some pharmacists may wish to update their clinical skills

Medicines use review 123

Table 5.1 Main competencies for accreditation of pharmacists to deliver an

MUR service

Main area Speciﬁc competencies

Clinical and pharmaceutical 1 Demonstrate relevant clinical and

knowledge pharmaceutical knowledge to deliver

MUR, taking into account the

patient’s individual needs

2 Demonstrate the ability to identify

and make recommendations around

therapeutic issues relating to patient

safety and clinical and cost-

effectiveness

Accessing and applying 3 Demonstrate the ability to identify,

information access, evaluate and use available

written sources of information

4 Demonstrate the ability to reach a

shared agreement with patients

Documentation and referral 5 Ensure recommendations agreed

with the patient are documented and

appropriately communicated in a

timely manner

and knowledge before undergoing the assessment. In some cases this

may be inappropriate and the pharmacist will be ready to undertake the

competence-based assessment without any additional training. Choices

of online and paper-based assessment methods are available. Some HEIs

that offer postgraduate clinical programmes such as diplomas have inte-

grated the competency-based assessment into their existing postgraduate

courses. Further details of training and assessment for offering an MUR

service are available on the Pharmaceutical Services Negotiating

Committee (PSNC) website.

Premises accreditation

One of the common criticisms of community pharmacy premises by

both customers and patient groups is their lack of privacy. A study evalu-

ating NHS Direct referrals to community pharmacies noted that lack of

privacy was of some concern to patients.

The introduction of consulta-

tion rooms has been a positive step in addressing this issue. Under the

current terms, the provision of a consultation room is not a requirement

if the contractor is only aiming to provide essential services. However, if

the pharmacist wishes to deliver an MUR service then the installation of

a consultation room is essential. In the majority of cases the MUR will

be carried out face to face with the patient in the pharmacy consulta-

tion room. If a pharmacist wishes to provide the MUR service in another

location, for example in a patient’s home or in a day care centre, appli-

cation must be made to the primary care trust (PCT) using standard

documentation.

The three requirements of the pharmacy consultation room for the

purposes of delivering an MUR service are clearly stated in the service spe-

ciﬁcation,

and summarised in Box 5.1. The speciﬁcation is deliberately

loose to allow contractors to work within the physical limitations of their

individual pharmacies.

Guidance on how to make space for a new consultation room has

appeared in the Pharmaceutical Journal.

If a pharmacy is planning a new

consultation room the main issues to consider are:

■ the provision of adequate space from the beginning

■ meeting the needs of pharmacists and customers

■ future prooﬁng for new services or technology

■ compensating for any lost retail sales space.

There is no minimum or maximum size for the room speciﬁed but the

requirement for at least two people to be able to sit down will inﬂuence

the size of the room. In addition the Disability Discrimination Act will

need to be taken into account when considering ease of access into the

124 Community Pharmacy Handbook

room. The room needs to be sited in a suitable location. For example, if

the room is installed between the medicines counter and the dispensar y

this can interrupt the natural ﬂow of work in this busy area of the phar-

macy. For the purpose of offering an MUR service the room requires very

little equipment. The main resources required are a seating area for two

people, a suitable table or desk and the appropriate storage of recording

forms, reference materials and information leaﬂets. To future-proof the

room it is necessary to consider how the room will be used to fulﬁl future

advanced and enhanced services. Examples of areas to be considered

above the basic speciﬁcation include:

■ the installation of a networked computer to access patient records and

make electronic records

■ the facility to print information for use by the patient and the

pharmacist

■ storage facilities for diagnostic-testing equipment and consumables

■ secure ﬁling facilities for paper records

■ the safe disposal of clinical waste

■ access to hot and cold water and waste disposal

■ a suitable number of electrical power points for any equipment.

Unless the pharmacy has a suitable under-utilised area of stock room or

other non-sales area, there will be a loss of retail sales space. The design

and integration of the room into the pharmacy therefore needs specialist

planning to minimise the impact this will have on sales.

The ﬁnal stage of the accreditation process is the completion of a

self-certiﬁcation form.

The pharmacist makes a declaration that:

■ there is an acceptable system of clinical governance

■ patients will be recruited to the MUR service in line with local PCT

patient group priorities

■ the consultation room complies with the service speciﬁcation.

The completed form and a copy of the pharmacist’s accreditation certi-

ﬁcate are sent to the PCT.

Planning the MUR service

Once accredited, the pharmacist needs to consider a number of practical

issues before being able to deliver the MUR service.

Identiﬁcation of suitable patients

To identify suitable patients the pharmacist must ensure that the patient

is included in the MUR service speciﬁcation criteria. The following

conditions need to be satisﬁed:

Medicines use review 125