A dose of the right medicine

Pharmacists are acquiring more responsibility and career opportunities in hospitals, community care and industry. Alison Whyte reports

Under the new community pharmacy contract, rolled out in April this year, pharmacists will be paid according to the quality of their services, not the number of prescriptions they dispense.

The idea is to encourage them to put their clinical skills to better use. Now community pharmacists will liaise with GPs in overseeing patients' use of medicines, and provide clinics on smoking cessation, obesity or minor ailments.

Simon Hulme, HR Director of Alliance Pharmacy (previously Moss) says after a lot of talk about change within pharmacy, change has finally come. "This year we have seen the biggest upheaval since I became a pharmacist. We are providing a better service, we communicate with patients, we are now frontline healthcare providers. It is no longer about putting pills in bottles. Pharmacists have to give quality advice and it's my job to provide skills and knowledge training."

Mr Hulme has enjoyed steady career progression in Alliance Pharmacy, the retail division of Alliance UniChem, one of the largest pharmacy chains in the UK. He started out as a branch manager, then became an area manager, regional manager and Director of Operations before becoming HR director two years ago.

The company is constantly looking for new blood. "We are always trying to attract the right pharmacists to our business. Pharmacists have much more responsibility now than they used to. This is a great time to become a pharmacist if you want to be at the forefront of a changing health service," says Hulme.

Boots is another company that has created new career pathways for pharmacists. Peter Gibson began his career with Boots as a pharmacist in the 1970s and is now the head of UK and EU public affairs. He says: "Pharmacists are ideally equipped to become good managers because they manage healthcare and teams of staff within a pharmacy. Communications skills are hugely important. If you can prove you have ability, you can get to the top. We have 1,400 outlets ranging from very small community health centres to huge department stores employing hundreds of people, so you can be a big cog in a small wheel, or vice versa."

The role of hospital pharmacists has also evolved. "In the past you reached a ceiling in clinical pharmacy quite low down and you had to go into management. But the new consultant pharmacists are at the top of the clinical tree," says David Pruce.

Hospital pharmacists regularly engage with patients on the wards. Consultant pharmacist Mark Tomlin says the attitude of other heath professionals towards hospital pharmacists has completely changed. "A few years ago, I had to ask, 'Would you mind if I come on the ward round?' Now people ring to ask me if I am free."

A shortage of pharmacists in the UK means that the job prospects for pharmacy graduates are excellent and they are likely to find work in whatever field they choose.

For those who choose to work in industry, job satisfaction can also be high. Laura Watson, a clinical pharmacist in pharmaceutical sciences at Pfizer's European research and development headquarters in Sandwich, Kent, says, "I am part of a team contributing to Pfizer's research into new cures for life-threatening illnesses. Working with the latest scientific technology and being involved in all stages of bringing a new medicine to life is really exciting. The ultimate reward is that I am helping to improve the quality of patients' lives. It doesn't get much better than that."

A degree in pharmacy not only equips people to be pharmacists, but opens the door to a career in pharmacology, biochemistry, forensic science, drug discovery, toxicology and many other scientific disciplines. And within each one, it is possible to focus on research, academia, teaching or regulatory work. There are 46,500 registered pharmacists in the UK. Approximately 8,000 work in hospitals, 4,000 in pharmaceutical companies or in industry, and 25,000 in community pharmacies.

For hospital pharmacists, salaries start at £18,733, whilst in community the starting salary can be as high as £30,000.

Although pharmacy courses are geared to those with A-levels in chemistry and two of biology, mathematics or physics, students with chemistry, one other science (preferably biology) and another subject are sometimes considered. Pharmacy graduates are required to have undertaken pre-registration training in the workplace for one year before they can sit the exam to register as a pharmacist in the UK.

"People interested in a career in pharmacy should talk to pharmacists and get some work experience to see just how much is out there," says Gautam Paul, president of the British Pharmaceutical Students' Association. He did his holiday placements with Boots, at a hospital and at AstraZeneca before his pre-registration training at the University Hospitals of Leicester NHS Trust. He is now a medicines information pharmacist at the Trust.

He says pharmacists are branching out everywhere. "I work in a large acute Trust, and there is a huge variety of work available. Pharmacists can even split their time, working two days in a hospital and three in the community. You can teach or work in a Primary Care Trust. It's an exciting and rewarding career and you can go home at night thinking you have done something worthwhile that you really enjoy."

'I chose pharmacy because you can apply science to real-life situations'

Hilda Tang completed her degree at King's College, London and is now a pre-registration trainee at Boots

"I chose to work in the community because I wanted contact with customers. I like to chat to them in a relaxed and unstressful environment, and I like being the first point of contact. Patients often come to us before they go to a GP," she says.

She also enjoys the business side of the work. "I would like to work my way up in management, and at Boots the career progression is very good. You start as a relief pharmacist, then you can become a store manager, then group pharmacy manager and then area manager."

She believes pharmacy has changed for the better. "Now we delegate the dispensing to the dispenser, which gives us more time to give healthcare advice. In my branch we provide a prescription collection service in which, provided a patient's surgery is near the branch, we will collect their prescription for them free of charge. This saves patients on repeat prescriptions going back and forth.

"In a large company, you get lots of support and once you are registered you earn a good salary. I chose to be a pharmacist because you can apply science to real-life situations."

'In terms of professional development, the sky's the limit'

Mark Tomlin is Consultant Pharmacist, Critical Care, at Southampton University Hospital NHS Trust

"My main interest is caring for patients and that is a key part of my role. I review medicines for individual patients each day and work as an integral part of the clinical team. I really enjoy my job."

He has spent 15 years in intensive care, and the last five as a recognised specialist. He was the first person in the UK to be appointed a consultant pharmacist, in 2005. His current role involves working as an expert practitioner, educating, researching and changing professional practice.

"I have always been fascinated by how medicines are used. One of the things I love most is helping other health professionals to gain knowledge. Today medicines are extremely complicated and doctors simply can't know everything about them. I am there to help them with difficult decisions and to individualise treatment".

He says problem-solving is one of the most rewarding aspects of the job. "You know you are really making a contribution by solving medical problems or offering different options with medicines."

"If you want a challenge, you will find one as a hospital pharmacist at many different levels. You work within a big team, and in terms of professional development, the sky's the limit."

Child care: developments in paediatric treatment

This month, a new book throws light on the sometimes mysterious art of treating children with medicines.

The British National Formulary for Children (BNFC), will provide all healthcare professionals with essential information how to select and use medicines for children.

Sharon Conroy, researcher in children's medicines at the University of Nottingham and specialist paediatric clinical pharmacist at Derby Children's Hospital, is on the review panel. She explains that it isn't a simple matter of using smaller quantities of drugs for children. "There are a lot of factors to take into account apart from body weight. Children have different abilities to handle medicines. Small babies have immature livers and kidneys and children have less fat and more water in their bodies than adults."

She says this book is vital because while most adult medicines are licenced, many of the medicines used for children are either not licenced or are being used outside the terms of the licence. "The in-depth clinical studies required by the regulatory authorities to prove the safety and effectiveness of the drugs are simply not available".

In the late 1990s Medicines for Children, produced by the Neonatal and Paediatric Pharmacists Group and the Royal College of Paediatrics and Child Health, filled a huge gap in information about medicines used to treat children. But the book was not adequately funded and was not updated until 2003. The BNFC, jointly produced by the Royal Pharmaceutical Society of Great Britain, the British Medical Association, the Royal College of Paediatrics and Child Health and the Neonatal and Paediatric Pharmacists Group, will be distributed by the Department fo Health free to all relevant health professionals and will be available online.

Ian Costello, lead editor of the BNFC says: "Up-to-date, practical information on the right dose to use in rare as well as common diseases has not been easily accessible, particularly in the community. Although this information has always been around in specialist units, it has never been collated into one resource."

A network of UK health professionals who can advise on a range of conditions has been set up to establish best practice.

Steve Tomlin, principal paediatric pharmacist at Guy's and St Thomas' NHS Trust and Chair of the Faculty of Neonatal and Paediatric Pharmacy (FNPP) Professionals, says one of the problems has been the variation in practice around the UK.. "This book will help to spread good practice throughout the country. It will make GPs more comfortable when using unlicensed drugs and it will give all health professionals much greater confidence in treating children with medicines. Health professionals will no longer feel they are groping in the dark."

There will be a session on Better formulations for children at the British Pharmaceutical Conference on Wednesday 28 September. Call 020-7572 2335 for details.