Specialisation in hospital pharmacy

Clinical specialisation

Pharmacists can specialise in many clinical areas. Most large National Health Service trusts will have specialist pharmacist posts in areas such as cardiology, critical care, elderly care, gastroenterology, general medicine, haematology, oncology, paediatrics, renal medicine, surgery, trauma and orthopaedics.
As well as being experts in the therapeutics relating to their speciality, these pharmacists are often responsible for producing reports that analyse prescribing patterns and spending on medicines and developing prescribing guidelines in partnership with clinicians. They may also manage junior pharmacists or pharmacy technicians working within their speciality.

Pharmacy specialisation 

Some pharmacists choose a non-clinical speciality. These include dispensary manager, education and training, MI, QA, and sterile and non-sterile production.

Dispensary management

The dispensary is the heart of the hospital pharmacy, and as such needs to be run efficiently to ensure that the right drug gets to the right patient at the right time. Dispensaries have traditionally been managed by pharmacists, but with the development of the role of the pharmacy technician in recent years, many dispensaries are now ‘technician led’. Accredited checking technicians (see Box 4.1) are able to take on more of the pharmacist’s role, performing the technical check of a dispensed prescription. This has reduced the number of pharmacists needed to run a dispensary, allowing them to devote more time to clinical activity, and therefore makes better use of their training and expertise.

Education and training

All staff within a pharmacy department, especially pharmacists and technicians, must keep up-to-date with recent developments in their profession. Indeed, during the next few years continuing professional development (CPD) will become mandatory for pharmacists and technicians to retain their registration.
To facilitate CPD,manypharmacy departments have designated pharmacists and technicians who are responsible for assessing the education and training needs of the staff. They are often also responsible for managing the training and assessment programmes for pre-registration pharmacists and student technicians.
When newly registered pharmacists (junior pharmacists) start work in a hospital pharmacy, they will often enter a clinical training rotation.

This involves working in different areas within the pharmacy department (such as MI, dispensary, or sterile production) and on different wards, for periods (or rotations) of 3–4 months; this enables the junior pharmacist to gain experience and skills in different areas of pharmacy and different clinical specialities. To progress in a career as a hospital pharmacist, it is now more or less mandatory to have a postgraduate qualification in clinical pharmacy.

This is usually undertaken by junior pharmacists when they start on a clinical training rotation, and takes 2–3 years part time. Several universities offer such courses (see above), and individual pharmacy departments tend to send all their junior pharmacists on the same course, so that it is easier to provide support to the
students and to plan work rotas when the group is away on study days, etc., at the same time. The course content is delivered in a variety of ways, such as fortnightly regional study days, weekly 2 hour training sessions or weeklong residential courses. This is supplemented by course work, which usually includes case
studies and presentations, patient profiles and audit projects. Most courses also include exams.

Most pharmacists will study to diploma level; however, it is becoming more common for pharmacists to obtain a masters degree in clinical pharmacy. These are offered alongside the postgraduate diploma. As well as formal courses, hospital pharmacy departments take advantage of study days provided both within their trust and by other trusts. These might involve learning generic skills such as time management, dealing with difficult situations and people management, or might be run by pharmacy staff for pharmacy staff, covering subjects and skills unique to pharmacy, such as clinical pharmacy skills or medicines management topics.

Another way pharmacists and technicians can maintain their knowledge is to attend symposia and conferences relevant to their area of practice. Many such conferences take place around the world each year, providing a useful forum for pharmacy staff to hear up-tothe- minute presentations from international
experts, and to meet other practitioners and exchange ideas and information. Within the UK, popular conferences for clinical pharmacists are the British Pharmaceutical Conference (BPC), run by the Royal Pharmaceutical Society of Great Britain (RPSGB), and conferences and symposia run by the UK Clinical Pharmacy Association (UKCPA) and the Guild of Healthcare Pharmacists (GHP). Specialist conferences
include the annual symposium of the British Oncology Pharmacy Association (BOPA).

Medicines information

MI is a service provided by pharmacists and technicians in many pharmacy departments for other pharmacists, other health professionals such as doctors and nurses, and, in some departments, members of the public. The MI service has developed alongside clinical pharmacy to support clinical pharmacists. MI provides in-depth information on all aspects of drug use. The staff within MI use medical and pharmaceutical texts (e.g. Martindale: The Complete Drug Reference, Trissel’s Handbook on Injectable Drugs, Stockley’s Drug Interactions), pharmaceutical companies and online databases (such as PubMed and Pharmline) to research queries made by the service users. Examples of enquiries include:
• Is drug X safe for use during pregnancy?
• Does drug Y interact with drug Z?
• Can drug A be given intravenously, and if so, how should it be given?

Quality assurance

Pharmaceutical products must be of high quality to ensure patient safety and efficacy of treatment. The  production of pharmaceutical products in the UK is governed by the Rules and Guidance for Pharmaceutical Manufacturers and Distributors published by the Medicines and Healthcare products Regulatory Agency (MHRA) (also known as the ‘Orange Guide’ because of the orange cover). All pharmaceutical products licensed for use in the UK are manufactured and tested according to the Orange Guide by the manufacturers, and therefore can be assumed to be of suitable quality when received by a pharmacy.
Unlicensed products may not be subject to the Orange Guide however, and there must therefore be a mechanism in place to ascertain the quality of these products. For hospital pharmacies, this is carried out by a QA department. Hospitals can have their own QA department, but in some regions QA services have been
centralised to reduce costs, one department serving several hospitals. The staff within this department are often pharmacists and pharmacy technicians, but may also be other scientists and laboratory technicians. All must have the appropriate skills and knowledge to carry out quantitative and qualitative testing on a range of pharmaceutical products, including medicines in various formulations, and medical gases. QA staff are also involved in risk management and clinical governance.

Sterile and non-sterile production Historically, many hospital pharmacy departments had a production unit that made many different sterile (such as bladder irrigation fluids and eye drops) and non-sterile (such as creams, ointments and liquid medicines) pharmaceutical products. With the emergence of a far greater
range of commercially manufactured products available since the 1980s, many of these units have greatly reduced output or have been closed down.

Some production units do remain in hospitals, however, and most commonly they will prepare products with a short shelf life, on an individual patient basis, for instance chemotherapy used in the treatment of cancer. Such units are staffed by pharmacists, pharmacy technicians and ATOs who have specialised in this area of practice. It is increasingly common for technicians to manage these units, rather than pharmacists. Junior staff from the pharmacy department often work in the production unit for a few months as part of a training rotation, to gain some knowledge and skills in this area.


Each area within the hospital pharmacy requires a manager. As discussed above, this may be a pharmacist or technician, depending on the skills that are required for the post. Management roles often filled by technicians include dispensary manager and sterile production manager. Roles such as clinical services manager and medicines information manager are usually filled by pharmacists. The department as a whole is usually led by a chief pharmacist, who will typically have worked in various areas within hospital pharmacy and so have a broad understanding of how it works. They also need to have good communication and time- and people-management skills. 

They are likely to have been registered for a minimum of 10 years. The chief pharmacist takes overall responsibility for the work of all the staff within the department; he or she is responsible for ensuring that the work carried out by the department meets the legal and ethical standards laid out in the legislature (e.g. the Medicines Act 1968), and in Medicines, Ethics and Practice Guide for Pharmacists and Pharmacy Technicians. The Chief Pharmacist is also answerable to the trust’s management with regard to the services provided by the pharmacy department.


by Umaee

source: Foundation in pharmacy practice
image: agamovic student.umm.ac.id
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