The IMPACT directive. It gets in the way, it frustrates. The limitations to practice, the feeling when another request comes through that will trigger a debate between the pharmacist, the requestor and if you are really luck hospital management.
But if you look at the directive and what it is in response of and what goal it is intended for it becomes clear that often frustrations that should be brought to bear on a log jammed bureaucratic process are transferred to a piece of paper.
There is (and was several years ago) consensus that the practice of hospital pharmacy has advanced to the point where the agreed employment structures for pharmacists within the HSE were no longer fit for purpose. Pharmacists in a significant number of hospitals were no longer confined to dispensaries, they were working closer to patients ensuring that all elements of medicines management were covered. Specialism was developed by pioneers in the profession and then became expected as the outcomes of this work filtered out. To this day a wide variation can be seen in the provision of clinical pharmacy services which is not linked to the size or complexity of the hospital covered.
By virtue of being the largest employer this situation impacts the whole of the profession, as both legal, regulatory and market factors are hugely influenced by both the HSE and the Department of Health.
The current career structure does not recognise the work of these pioneers, or give encouragement and support to those that today have the drive and commitment to improve the use of medicines for hospital patients in Ireland. Specialism is happening in a fragmented way, unsupported nationally and in many cases locally (without guidance and direction from national employers). In areas where specialism has occurred support for upgraded job descriptions has faltered once the operational necessity of having people in post has been satisfied. In the case of antimicrobial stewardship pharmacists, we have seen their work develop into a true speciality working as peers with Consultant and Registrar grade medical staff to ensure safe prescribing and monitoring is effective. Outcomes around antimicrobial stewardship have improved partly due to the work of this group of pharmacists. These pharmacists are not recognised by their employer as specialised. We have acted in good faith in the provision of new services but have waited for years for agreed implementation of the career structure which has not been forthcoming from the HSE. In this way we devalue our contribution to Irish healthcare and our perceived value to the HSE.
Compare where we are to the Medical and Nursing profession. We work collaboratively with Doctors and Nurses every day. We are used to seeing individuals in both groups take up opportunities for further training and development in order to specialise and to be recognised as such. They have the apparatus to achieve this which brings a benefit to patient care. The concept of a Senior doctor or nurse who would know everything about anything due to the amount of time they have practiced is inconceivable. Why is this the case for Pharmacy? Specialism is rightly difficult and hard work to achieve but with it should come recognition from colleagues, managers and patients alike.
The IMPACT directive is borne out of the HSE’s failure to implement what it agreed upon. An agreement that was made, based on the principle of providing a structure to enable modern pharmaceutical care for patients. A principle that holds just as true today. Hospital pharmacists are competent and confident that their roles could be expanded, with the underpinning support to drive better patient outcomes. Pharmacists are part of the solution to the question of how to manage increasing complexity in healthcare coupled to an ageing population with the corresponding increase in co-morbidity and polypharmacy.
The HPAI continues to represent Hospital Pharmacists at national industrial relations meetings in an effort to ensure the implementation of the Hospital Pharmacist career structure. The addition of a reference to the implementation of this structure in the HSE Operating plan for 2018 is welcomed by the HPAI. However the sustained support of the membership of the association and for the IMPACT directive is critical to ensure that Hospital Pharmacy is transformed, making it fit for the present and future.