CUHOP has considered carefully over the summer months of 2008 and taken time for the staffs of schools of pharmacy to form and communicate their views before seeking to produce its consensus position on the White Paper.  This paper is itself the result of an iterative process of consultation with all CUHOP members on earlier drafts.  It constitutes an agreed statement from the UK schools of pharmacy.

It is important to preface CUHOP’s views on the White Paper with a few words about university-based pharmacy education in the UK.  Schools of pharmacy have been and are immensely important in the development of pharmaceutical science and pharmacy practice.  Their world-leading science intertwines with their education of sought-after pharmacy graduates and postgraduates who are employed in the highly successful pharmaceutical industry around the world, in the fast developing NHS hospital pharmacy service and in meeting the ever-growing needs of patients and the public through primary care and in the community.  All schools are resourced through the respective higher education funding councils of the Home countries, being funded for teaching pharmacy as a science-based subject.

And so to the White Paper; CUHOP welcomes the document with few reservations (though one or two of them are potentially significant).  The White Paper maps out worthwhile aspirations for pharmacy and what is more, aspirations that appear to be achievable and are built on a groundswell of opinion.  It points a pragmatic way ahead, building on the achievements of the past two to three decades in the managed sector of the NHS; achievements which schools of pharmacy have and continue to contribute to.

With the White Paper quite understandably focused on the needs of the NHS and patients and therefore saying much about the clinical roles and clinical education and training of pharmacists, CUHOP feels it is important to stress that pharmaceutical science must continue to underpin pharmacy practice.  The science base of the profession has been fostered and is maintained to ensure that those other health professionals who pharmacists advise, doctors, nurses and innumerable others and, most importantly, patients are supplied with high quality medicines which they can use safely and with the best possible prospect of efficacy.  It is chiefly pharmacists in the healthcare team who know how drugs are discovered, formulated into medicines, tested and licensed, manufactured, quality assured, and of course used safely and effectively in hospitals, in clinics and in the community.

On the White Paper’s goal of, and measures towards, closer working of hospital and community pharmacy this is commendable, obviously.  Past initiatives have by and large produced modest results but CUHOP welcomes the reinvigorated effort; the prize of better services to patients and improved application of pharmacists’ knowledge and skills is huge.  CUHOP suggests that integration of appropriate clinical placements within the degree course could foster cross-sector understanding and capabilities in future pharmacists.  Indeed the very endeavour of creating and running such schemes would foster cross-sector cooperation, with schools of pharmacy as the agents for change.  At practitioner level, a mechanism for encouraging cross-sector working would be to devise and deliver joint post-registration educational and training programmes.  Many schools of pharmacy have the links in both sectors to be able to attempt this approach with a good prospect of success.

Regarding the possibility of bringing together the degree course with preregistration training, the schools of pharmacy have consistently argued for a close interrelationship.  CUHOP is certainly committed to working with the Department of Health and others to realise the aspiration within the White Paper for the whole of the UG programme to be informed by meaningful clinical placements.  Although we also aspire to full integration of the degree with preregistration training, it is too big a step for CUHOP to commit to at this stage; so much depends on resources and there are other unresolved issues, especially the commitment of employers.

The identification of long-term conditions and other illnesses as priorities for pharmacy public health and pharmaceutical care is a helpful endorsement of recent and continuing directions of curriculum design by schools of pharmacy.  In this regard, CUHOP notes the alignment of the White Paper with Lord Darzi’s Next Stage Review Final Report, High Quality Care for All, particularly common goals to improve access to health services and to achieve better use of medicines.  The prospect of metrics for judging the quality of relevant pharmacy services will also help curriculum development longer term, at the level of quite fine detail, close enough to be able to define students’ required capabilities and competency or performance standards useful in assessment.  Of course, as the White Paper puts it, “meaningful clinical context and experience throughout the undergraduate programme” will be key to a step-change forward; a step-change akin to the effects of postgraduate diploma and Masters programmes over the past three decades.

To achieve the White Paper’s goals for pharmacy education there must be sufficient investment to develop infrastructure and sufficient recurrent funding in the higher education sector and the NHS to achieve proper clinical training within the degree programme and preregistration training either as relatedly reformed programmes or as a single integrated programme .  The hoped for growing numbers of consultant pharmacists have a role to play here, both in programme design and programme delivery.  As part of the reform of pharmacy education, each of them should be formally linked to a school of pharmacy.  The proposed pilot exercises of enhanced clinical contact for students in prospect for a few schools of pharmacy should be to create demonstration sites.  Once they are demonstrably working they must be replicated for all schools, importantly so that there is coordinated and ‘collegiate’ development but chiefly so that benefits for patients nationwide are realised as early as possible.  Consequential funding models should also be equally applied in order to ensure equity of student experience.  The selection of the demonstration site schools should be by a criteria-based and transparent process, to give the best possible chance of success of the overall project.

A final point is a reiteration of the plea to others who read the White Paper to recognise and support its position that pharmacy must remain a science-based health profession.  There is a specific need for schools of pharmacy to produce laboratory-based research and technical services practitioners.  Furthermore, the UK's need for pharmacists is not just for those who will go on to work in or be contracted to the NHS.  A proportion is needed who will go on to produce some of the wealth required to pay for the country's health care.  However, this is not the only, nor even the main reason that the degree course should remain science-based.  Science provides the evidence base for the development of new patient facing services and it provides pharmacists with their unique value in the health care team.  As one CUHOP member has put it: without a thorough knowledge and understanding of chemistry, pharmaceutics [drug delivery in the body], physiology and pharmacology we cannot then layer on the teaching of clinical practice.  It is in fact fundamental to the realisation of the contributions from pharmacy that are aspired to in the White Paper.

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