Pharmacy professionalism and professional identity: what do regulators need to know? Improving professional regulation in health and social care: interdisciplinary insights March 2014 Rebecca Elvey, Karen Hassell, Ellen Schafheutle, Sarah Willis Centre for Pharmacy Workforce Studies Manchester Pharmacy School

This presentation Pharmacy professionalism and professional identity Context – the GB pharmacy profession and the pharmacy regulator Insights from our research Implications for the pharmacy regulator, professionals and the public

Professionalism and professional identity Regulators work to promote and protect the wellbeing of patients and the public. Interest in healthcare professionalism has grown in recent years. Professionalism and professional identity are abstract concepts, often expressed through attributes and qualities that professionals (should/must) possess. Standards for pharmacy in GB mention professional knowledge, competence, judgement, behaviour… But how well are these concepts defined and understood?

The pharmacy profession in GB Third largest healthcare profession (47,000) Trained in 26 schools of pharmacy (10,599 students in 2011) Most pharmacists practice in community or hospital pharmacy Culturally complex and diverse workforce

Changes to pharmacy roles and regulation Pharmacists’ roles have evolved; supplying medicines is still core, but increasingly expected to provide ‘clinical’, ‘cognitive’ and ‘public health’ services. The regulator, the General Pharmaceutical Council (GPhC), sets standards for: The individual registrant (Standards of conduct, ethics and practice) education, initial training (undergraduate and pre-registration) and CPD pharmacy premises, including staffing

Our research on pharmacy professionalism and PI Study Publication(s) Professionalism in pharmacy education Schafheutle E, Hassell K, Ashcroft D, Hall J, Harrison S. How do pharmacy students learn professionalism? International Journal of Pharmacy Practice, 2012 20:2, 118-128 The development of professionalism during pharmacy pre-registration training Jee SD, Schafheutle EI, Noyce PR. The professional socialisation of trainees during the early stages of pre-registration training in pharmacy. HSRPP conference presentation, 2013. Patient-centred professionalism in early career pharmacists Elvey R, Lewis P, Schafheutle E, Wilis S, Harrison S, Hassell K. Defining professionalism (and its elements) in early career pharmacists. RPS conference, 2011. Professional identity in pharmacy Elvey R, Hassell K, Hall J. Who do you think you are? Pharmacists’ perceptions of their professional identity. International Journal of Pharmacy Practice, 2013 21:5, 322-332

Describing and defining pharmacy professionalism and PI (i) I’ve got a patient that’s refusing [to swallow tablets]…we’re crushing a drug we probably shouldn’t crush…because that’s the only way she’ll have it…she’s taken that risk on, the patient and the consultant’s …said ‘yes, crush it’…deviating from a set of SOPs…you’ve got to weigh it up…risk benefit …to be able to weigh up a clinical situation like that….(Early career hospital pharmacist) Competence Professional knowledge and skills Knowing about medicines, working with accuracy, ability to use professional judgement The pharmacist as scientist, adviser, supplier of medicines Applying professional judgement can involve deviating from SOPs or ‘rules’ Knowledge obviously is vital and portraying the right advice. (Early career community pharmacist) Patients come into a pharmacy and,,,as a professional they see you as the expert in your subject…(Tutor, community pharmacy) [a good pharmacist is]...one who’s full of information about the product, and who knows about the product...(Community pharmacy user)

Describing and defining pharmacy professionalism and PI (ii) Values Honesty, trustworthiness, integrity, compassion, putting the patient first, going the extra mile, resisting pressure from incentives/targets Most pharmacists I know want to put the patient first…they get all these targets thrown at them…it’s not what they want, they want to be patient-centred (Early career community pharmacist)

Describing and defining pharmacy professionalism and PI (iii) Communication Ability to communicate clearly and effectively Being polite, respectful, listening to patients Being confident and assertive I think it’s approachability and the way they’re greeted…if it’s a friendly, warm ‘How are you Mr Jones? How are you getting on?...then they just love that….it can make a difference to them…they’re welcome…and feel free to ask for help and advice if they need to…I always encourage people to ask me questions, but looking around others, a lot of pharmacists would stay in the back and not venture forth very often unless they really have to. (Community pharmacist) Nice young lad but petrified of everything…we had an addict come in…[he had not collected his medicines when he should have done so was not allowed a further supply that day] and he were like proper kicking off…the pharmacist said ‘I don’t know what to do…shall I just give it him?’ I said ‘do not give it him, no’ I told [the patient] straight [I’m used to these situations so they don’t bother me at all]. (Support staff, community pharmacy)

Where and how professionalism is learnt. Through lectures and formal curriculum content on law, ethics at university. Communication skills are taught and assessed using role plays. Through observing teachers and other role models. Pre-registration tutors, other pharmacists and pharmacy support staff in practice.

Discussion and developments in pharmacy regulation This presentation has drawn out strong and challenging areas of pharmacy professionalism. There are similarities and differences between professionalism as understood in pharmacy and other healthcare professions. GPhC are working with new models for regulating premises and individuals.

rebecca.elvey@manchester.ac.uk