Following the Bristol Baby Scandal in 1995, which exposed the high mortality rate, observed in paediatric cardiac surgery at the Bristol Royal Infirmary, the term Clinical governance became widely used in the medical community. A need to improve and maintain the quality of care provided to general public was felt. This led to the development of the concept of clinical governance by NHS in UK. The publication of Government’s White Paper, “A First Class Service – Quality in the new NHS” brought about the introduction of the term ‘Clinical Governance’ in 1998. This also introduced the National Service Frameworks and the National Institute for Clinical Excellence. Clinical governance is a governance system for health care sector which aims to improve the quality of health services and safeguard high standards of care by creating an environment which promotes clinical excellence and hold NHS organizations accountable for continuous improvement in care deliverance. To guarantee that community pharmacy is fully incorporated in the multi-disciplinary clinical governance strategies, the Royal Pharmaceutical Society of Great Britain published its own policy named “Achieving excellence in pharmacy through clinical governance” in 1999.
Four basic components of quality in health care delivery are identified which include Professional performance, Resource use, Risk management and Patient satisfaction (Scally, 1998). These four components form the basis for quality maintenance in clinical governance in British health care system.
A challenge for clinical governance is the shift from professional development based on unidisciplinary education towards multidisciplinary team based learning. Potential problems in this regard which may act as barriers to effective learning include issues of hierarchy, gender and varied educational achievements in team members (Gillam, 1999).
Improvement in standards of care while protecting the public from unacceptable care, are the aims of clinical governance. The shift in focus from continuing medical education to continuing professional development presents a new challenge for the whole team of health care professionals, including pharmacists. It is observed that the participation of pharmacists in CE and CPD is low. This most common barrier reported for this observation is lack of time (Bell, 2001). A major issue which affects the education and as a result this job is that there is no established educational path to its door. Despite the fact that some postgraduate training does include clinical governance in its curriculum, there is no national qualification which is dedicated to providing training for this kind of career. Till now, the criteria for a clinical governance career are experience and management responsibility. The nature of the job is such that the achievements of clinical governance pharmacists are easily exposed. Moreover, this job requires a certain level interference with the job of other professionals working in the same environment. Therefore, pharmacists working in clinical governance run the risk of being unpopular among their colleagues.
Due to the multi-disciplinary nature of clinical governance, workers of all the disciplines are required to work in close collaboration to produce results which are beneficial to the patient and helpful in the improvement of health service as a whole. Contribution of pharmacists to clinical governance is mainly observed in prescription monitoring which is a part of dispensing process. Pharmacists also play roles in Drug and Therapeutics committees, medicines management, prescribing advice to GPs and hospital doctors, over the counter supply of medicines, hospital prescription monitoring and intervention services, patient counselling, medication reviews in primary care, repeat supply and in pharmacy-led Clinics.
The most common therapeutic intervention carried out in the National Health Service is the use of medicines. A challenging agenda for the practicing pharmacists is set out in the “Pharmacy in the future: implementing the NHS plan” (Department of health, 2000). This not only makes it necessary to modify age-old practices in pharmacy but also forces the practicing pharmacists to expose them to new skills and knowledge, in order to remain updated continuously. The main focus of attention of this plan is “the patient”. So, it becomes mandatory for the pharmacist to have clinical skills for identification and solution of pharmaceutical care issues. Clinical skills should therefore be learned by undergraduates.
The changing role of the pharmacists demands application of a wide range of new skills and knowledge in day to day practice. There is a considerable burden on pharmacists to consider issues relating to their competence after the emergence of clinical governance. The responsibility for maintaining skills and knowledge lies with the individual. Many continuing educational programs are available which address the training requirements of community pharmacists, but very little assistance is available for continuing professional development (CPD). This has resulted in considerable unrest among the pharmacists. Studies have shown that junior grade pharmacists are the least satisfied with respect to job career and other related aspects of work (Rajah et al, 2001).
It has been recognized that the skills and knowledge of pharmacy technicians have been left largely under utilized. It is thought that these workers may prove to be a valuable source for handling the ever growing burden of patients on health care units. Adding to this problem is the fact that there is a shortage of pharmacists on national level. There have been many developments recently which aim to extend the role of pharmacy technicians, due to their shortage (Anon, 1999). Now that the ‘supplementary prescribing’ by pharmacists is becoming part of our health care system, the clinician-pharmacist relationship will become even more significant in the coming times (Root, 2003).
Health care professionals and management should work in collaboration for the identification of priorities for health and improvements in service. This team work should be aimed at benefiting patient care. All clinical risks, errors and complaints should be sources of learning for improvements in services. The response of patients to the care offered to them should be a source for guiding treatment strategies, in order to mould the treatment modalities according to the wills of patients. Sharing of knowledge among the care providers should be encouraged. The importance of the role of pharmacists in health care services cannot be denied. On one hand it is of life saving value to patients and on the other hand the assistance provided by pharmacists to clinicians is of vital importance.