Pharm World Sci (2008) 30:111119 DOI 10.

1007/s11096-007-9153-8

RESEARCH ARTICLE

Developing consensus around the pharmaceutical public health competencies for community pharmacists in Scotland
David E. Peger Lorna W. McHattie H. Lesley Diack Dorothy J. McCaig Derek C. Stewart

Received: 17 June 2007 / Accepted: 31 July 2007 / Published online: 24 August 2007 Springer Science+Business Media B.V. 2007

Abstract Objective The new community pharmacy contract in Scotland will formalise the role of pharmacists in delivering public health services. To facilitate assessment of education and training needs it is necessary to dene the relevant public health competencies for community pharmacists. The objective of this research was to dene and develop consensus around such competencies. Methods The Skills for Health National Occupational Standards for Public Health Practitioners was used to dene an initial set of competencies. A two stage Delphi technique was undertaken to develop consensus. An expert panel, representing public health and pharmacy stakeholders, rated their agreement with the importance of each competency, with the agreement level set at 90%. Main outcome measures Level of agreement (%) with each public health competency; those competencies achieving more than 90% agreement with importance for community pharmacy practice. Results Ten organisations (83% of those invited) and a total of 30 members (88%) agreed to take part in the process. In round 1 of the Delphi, responses were received from 25 (83%) individuals and 22 (73%) in round 2, with consensus being achieved for 25/68 (37%) competencies in round 1 and a further 8/68 (12%) in round 2. Conclusion Public health competencies for community pharmacists achieving consensus predominantly focused on health improvement activities at individual and local community levels and ethical management of self rather than those relating to surveillance and assessment and strategic development. There is a need to research community

pharmacists views of these competencies and to systematically assess their education and training needs Keywords Public health Pharmacist Competency Delphi technique Qualitative research Scotland

Impact of ndings on practice Public health competencies for community pharmacists achieving consensus predominantly focused on health improvement activities at individual and local community levels and ethical management of self rather than those relating to surveillance and assessment and strategic development There is a need to research community pharmacists views of these competencies and to systematically assess their education and training needs Training, facilitation and leadership are needed to raise the perceived level of importance of evaluation and clinical governance activities if public health services are to develop

Introduction Scotlands health continues to improve but remains poor compared to the rest of the UK and Europe [1]. Since 1997 there has been an increasing emphasis in Scotland to deliver services responsive to patient needs [2, 3]. This recognition of the broader determinants of health coupled with a review of the public health function of practitioners [4], identied an expanding role for community pharmacy in health improvement, subsequently reected in Scottish pharmacy policy [5, 6]. More recently Delivering for

D. E. Peger L. W. McHattie H. L. Diack D. J. McCaig D. C. Stewart (&) School of Pharmacy, The Robert Gordon University, Schoolhill, Aberdeen AB10 1FR, Scotland, UK e-mail: d.stewart@rgu.ac.uk

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Health has re-emphasised the need to both address health inequalities and deliver more preventive health activity [7] and Improving Health in Scotland: The Challenge, the need to change health behaviour [8]. The Scottish Executive Review of the Public Health Function (1999) recognised that community pharmacists were well positioned to inform local needs assessments and promote healthy lifestyle messages and programmes. These contributions have been recognised in National Health Service policy through the publication of The Right Medicine: A Strategy for Pharmaceutical Care in Scotland and Pharmacy for Health: The Way Forward for Pharmaceutical Public Health in Scotland [5, 6]. Implementation of the new community pharmacy contract in Scotland began in 2006. Core services are the: Chronic Medication Service (CMS); Minor Ailments Services (MAS); Acute Medication Service (AMS); and Public Health Services (PHS). The PHS is designed to encourage proactive involvement of community pharmacists in supporting self care, offering suitable interventions to promote healthy lifestyles, and provision of a health promoting environment across the network of community pharmacies by participating in national and local campaigns [9]. Walker [10] emphasised the specic role of pharmacy in public health, dening pharmaceutical public health as the application of pharmaceutical knowledge, skills and resources to the science and art of preventing disease, prolonging life and promoting health through the organised efforts of society. Two systematic reviews of the evidence for community pharmacy contribution to health development have been published [11, 12]. These demonstrate the potential for pharmacists to contribute to health development, although evidence of quantitative evaluation was limited. Key topics covered in the reviews are summarised in Table 1. In recent years there has been increasing emphasis on the regulation of health professionals and demonstration of competence. Competencies have been dened as qualities or characteristics of an individual related to effective or superior performance and competency frameworks as the structured collection of individual competencies essential for effective performance [13]. The Kennedy report [14] emphasised the need for regulation to drive professionals maintenance of competence. The need for additional training in public health skills at both undergraduate and postgraduate levels has been made in policy documents [6, 15]. In 2003 the Royal Pharmaceutical Society of Great Britain (RPSGB) published its rst report into the competencies of the future pharmacy workforce [16]. In the public health competency domain, twelve elements were identied, all of which were designated as generic competencies for all health professionals.

The Sector Skills Council for Health developed Skills for Health: Public Health Practice [17] in 2005, a competency framework for people working in health care. National Occupational Standards are developed by relevant stakeholders and are required by the Sector Skills Council to be reviewed and developed further at regular intervals. In 2006, the RPSGB published its report Guidance on linking the NHS knowledge and skills framework and competencies for pharmacy [18] which recommended the Skills for Health: Public Health Practice framework as the source for public health competencies for pharmacists. In addition, PharmacyHealthLink, a charity set up to help broaden the pharmacists role in delivering health improvement called for core pharmacy practitioner and specialist competencies to be developed based around the Faculty of Public Health (FPH) ten key areas of public health practice [19]. At the practitioner level, the new community pharmacy contract in Scotland will formalise the role of pharmacists in the delivery of public health services. The limited available evidence indicates the importance of training in public health in order to deliver health improvement [11]. Therefore it is vital that an assessment of education and training needs for practitioners is undertaken. Key to this assessment is the denition of the relevant competencies required by community pharmacists. The aim of this research was to dene and develop consensus around such competencies, as the rst stage in a systematic assessment of public health education and training needs for community pharmacists in Scotland.

Method The competency framework for public health practice was used to dene the initial set of competencies [17]. These are described in ten core areas (matching those of the Faculty of Public Health) as follows: 1. 2. 3. 4. 5. 6. 7. 8. 9. Surveillance and assessment of the populations health and wellbeing Promoting and protecting the populations health and wellbeing Developing quality and risk management within an evaluative culture Collaborative working for health and wellbeing Developing health programmes and services and reducing inequalities Policy and strategy development and implementation to improve health and wellbeing Working with and for communities to improve health and wellbeing Strategic leadership for health and wellbeing Research and development to improve health and wellbeing

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Pharm World Sci (2008) 30:111119 Table 1 Key health development topics for community pharmacy [11, 12] Accidental injury prevention Asthma CHD: lipid management, identifying risk factors for CHD, secondary prevention with aspirin, anticoagulation, obesity and weight reduction Diabetes Drug misuse Folic acid and pregnancy Head lice management Immunisation Mental health Multi-topic health promotion programmes Nutrition and physical activity Oral health Sexual health (including emergency hormonal contraception) Skin cancer prevention Smoking cessation

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Ethically managing self, people and resources to improve health and wellbeing.

Each of these core areas are supported by a number of sub-elements which explain in more detail how competencies in the core areas can be achieved. These sub elements form a competency framework for public health practitioners. A two stage Delphi technique was used to develop consensus around these competencies. The Delphi technique has been described as a method of structuring a group communication process so that the process is effective in allowing a group of individuals, as a whole, to deal with complex problems [20]. The Delphi technique has three characteristic features of benet to this type of research: Expert panel members of the Delphi study are a discrete group of individuals and make up the cohort; Consulting this expert group follows a structured format that allows the research to be democratic, transparent and time-limited; The conclusions of the Delphi panel carry more weight than those from a less formal decision-making process such as a focus group or one-stage survey questionnaire.

Senior academic pharmacy staff reviewed a draft rst round questionnaire, following which several changes were made to enhance its meaning and clarity. Experts were identied by requesting nominations from the organisations with stakeholder interests in pharmaceutical public health as listed in Table 2. Key individuals in each organisation were contacted by letter and asked to nominate four experts in pharmaceutical public health. An information sheet and pre-paid envelope, were enclosed. Each nominee was subsequently invited in writing to participate. The Internet was used to conduct the Delphi study as it offers an ideal medium for ease and speed of response [21]. One week prior to the Delphi link going live, an email was sent to alert participants to the start of the Delphi. Anonymised, completed questionnaires were submitted to a web address at the university. It was acknowledged that understanding the language of competency frameworks could prove a barrier to completion. An i (information) button was therefore added to each statement explaining the competency and giving an example of pharmacy application. Participants were given a 2 week period to respond to round one of the Delphi, with one email follow up to encourage response. Responses were analysed using SPSS v.13. Anonymised results were collated for each competency and fed back to the entire cohort. At this stage the expert panel had an opportunity to reect and individuals could change their responses, but only for those competencies where the pre-set level of agreement had not been achieved. The second round retained the same format as the round one and based on the levels of agreement achieved, it was decided that there was no need for a third round. The Multi-centre Research Ethics Committee for Scotland advised that NHS ethical approval was not required. Approval was obtained from all Research and Development committees throughout Scotland.

Results Ten organisations (83% of those invited) responded with a total of 34 nominations (ranging from 1 to 4 per organisation). Of the nominees, 30 (88% of those invited) agreed to take part in the study. In round 1 of the Delphi, responses were received from 25 (83%) individuals in round 1 and 22 (73%) responded in round 2, with consensus being achieved for 25/68 (37%) competencies in round 1 and a further 8/68 (12%) in round 2. Competencies achieving consensus predominantly focused on health improvement activities at individual and local community levels and ethical management of self

The Skills for Health sub-competencies were used as validated statements for round one of the Delphi study. Levels of agreement with each statement were measured on a 5-point Likert scale, from strongly disagree to strongly agree. Consensus for each competency was dened as 90% or more panel members rating as strongly agree or agree.

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114 Table 2 Organisations invited to nominate participants for the Delphi Organisation Scottish Pharmaceutical General Council Scottish Specialists in Pharmaceutical Public Health Association of Scottish Chief Pharmacists Scottish Executive Department of the Royal Pharmaceutical Society of Great Britain, Scottish Executive Health Department (Pharmacy) NHS Education for Scotland (Pharmacy) NHS Education for Scotland (non-pharmacy) Faculty of Public Health Consumer Health Council PharmacyHealthLink The Robert Gordon University, School of Pharmacy University of Strathclyde, School of Pharmacy Directors of Public Health Reason for approach

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National contract negotiating body for community pharmacy contractors National group of Specialists in Pharmaceutical Public Health employed by NHS Boards across Scotland National group of Chief pharmacists responsible for strategic and operational pharmacy management in primary and secondary care Professional and regulatory body for pharmacy in Scotland Lead for policy development and implementation in Scotland including the Chief Pharmaceutical Ofcer for Scotland Lead for strategy and provision of postgraduate training for pharmacists in Scotland Lead for strategy and provision of postgraduate training for NHS in Scotland Standard setting body for specialists in public health Body that aims to ensure that the voice of patients is given a central place in policy making and service planning Charity which aims to promote and inuence policy relating to the role of pharmacists and pharmacy in public health Provider of undergraduate and postgraduate pharmacy education Provider of undergraduate and postgraduate pharmacy education Directors of Public Health are the individuals in each NHS Board tasked with leading public health

Note: NHS Education for Scotland, Pharmacy and non-Pharmacy was classed as one organisation giving a potential of twelve participating organisations

rather than those relating to surveillance and assessment and strategic development. Further detail is provided in Table 3. The median percentage of strongly agree/agree rating for those competencies not achieving consensus was 59 (range 582). Competencies with agreement ratings of less than 40% are given in Table 4. Comments were particularly provided for those competencies not achieving consensus and tended to focus on a lack of relevance for community pharmacists and the need for specialist input. For example,

Discussion Main ndings of this study A high participation rate was achieved, with ndings indicating that the expert panel were in agreement that approximately half of the competencies identied by Skills for Health were of importance for community pharmacists. Consensus was achieved for those predominantly focused on health improvement activities at individual and local community levels and ethical management of self rather than those relating to surveillance and assessment and strategic development. These latter competencies were viewed as being more relevant to the specialist practitioner.

Commission, monitor and evaluate projects to advance knowledge and practice (competency) More specialists in public health to assist community pharmacists A central role I am more convinced that every CP needs to know how to commission projects but this may be an area for those with a more specialist interest in public health and research -as opposed to a specialist competency Better suited to PH [public health] specialists/ researchers A few posts only

Strengths and weaknesses Our study has several strengths. Key stakeholder organisations and individuals in Scotland with an interest in pharmaceutical public health participated, giving high levels of response. In particular the use of the Internet to facilitate the study appeared to be particularly effective. To our knowledge this is the rst study, which has systematically researched consensus around such competencies for community pharmacists.

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Pharm World Sci (2008) 30:111119 Table 3 Skills for Health competencies to be achieved or aspired to by community pharmacists Consensus achieved Surveillance and assessment of the populations health and wellbeing Consensus not achieved

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Surveillance and assessment of the populations health and wellbeing Undertake surveillance and assessment of the populations health and wellbeing Collect and form data and information about health and wellbeing and/ or stressors to health and wellbeing Obtain and link data and information about health and wellbeing and/ or stressors to health and wellbeing Analyse and interpret data and information about health and wellbeing and/or stressors to health and wellbeing Communicate and disseminate data and information about health and wellbeing and/or stressors to health and wellbeing Facilitate others collection, analysis, interpretation, communication and use of data and information about health and wellbeing and/or stressors to health and wellbeing Collect, structure and analyse data on the health and wellbeing and related needs for a dened population

Promoting and protecting the populations health and wellbeing Promote and protect the populations health and wellbeing Communicate with individuals, groups and communities about promoting their health and wellbeing Encourage behavioural change in people and agencies to promote health and wellbeing Work in partnership with others to promote health and wellbeing and reduce risks within settings Work in partnership with others to prevent the onset of adverse effects on health and wellbeing in populations Work in partnership with others to contact, assess and support individuals in populations who are at risk from identied Work in partnership with others to protect the publics health and wellbeing from specic risks Develop quality and risk management within an evaluative culture Develop ones own knowledge and practice Contribute to the development of the knowledge and practice of others Support and challenge workers on specic aspects of their practice Manage the performance of teams and individuals Contribute to improvements at work Collaborative working for health and wellbeing Improve health and wellbeing through working collaboratively Build relationships within and with communities and organisations Develop, sustain and evaluate collaborative work with others Represent ones own agency at other agencies meetings Work in partnership with communities to improve their health and wellbeing Develop health programmes and services and reduce inequalities Work in partnership with others to plan, implement and review programmes and projects to improve health and wellbeing

Promoting and protecting the populations health and wellbeing

Develop quality and risk management within an evaluative culture Develop quality and risk management within an evaluative culture

Collaborative working for health and wellbeing Enable the views of groups and communities to be heard through advocating on their behalf Provide information and advice to the media about health and wellbeing and related issues

Develop health programmes and services and reduce inequalities Develop health programmes and services and reduce inequalities Manage change in organisational activities Develop peoples skills and roles within community groups/networks Assess, negotiate and secure sources of funding

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116 Table 3 continued Consensus achieved Policy and strategy development and implementation to improve health and wellbeing Consensus not achieved

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Policy and strategy development and implementation to improve health and wellbeing Improve health and wellbeing through policy and strategy development and implementation Work in partnership with others to plan, implement, monitor and review strategies to improve health and wellbeing Work in partnership with others to assess the impact of policies and strategies on health and wellbeing Work in partnership with others to develop policies to improve health and wellbeing Appraise policies and recommend changes to improve health and wellbeing

Working with and for communities to improve health and wellbeing Improve health and wellbeing through working with and for communities Create opportunities for learning from practice and experience Enable people to address issues related to health and wellbeing Enable people to improve others health and wellbeing Work with individuals and others to minimise the effects of specic health conditions Strategic leadership for health and wellbeing Use leadership skills to improve health and wellbeing Promote the value of, and need for, health and wellbeing

Working with and for communities to improve health and wellbeing Facilitate the development of people and learning in communities Support communities to plan and take collective action Facilitate the development of community groups/networks

Strategic leadership for health and wellbeing Strategically lead the improvement of health and wellbeing and the reduction of inequalities Lead the work of teams and individuals to achieve objectives Design learning programmes Enable learning through presentations Evaluate and improve learning and development programmes

Research and development to improve health and wellbeing Develop and maintain an overview of developments in knowledge and practice

Research and development to improve health and wellbeing Improve health and wellbeing through research and development Plan, undertake, evaluate and disseminate research and development about improving health and wellbeing Develop, implement and evaluate strategies to advance knowledge and practice Commission, monitor and evaluate projects to advance knowledge and practice Contribute to the evaluation and implementation of research and development outcomes

Ethically manage self, people and resources to improve health and wellbeing Ethically manage self, people and resources to improve health and wellbeing Promote peoples equality, diversity and rights Prioritise and manage own work and the focus of activities Manage the use of nancial resources Monitor and review progress with learners Facilitate individual learning and development through mentoring Enable individual learning through coaching

Ethically manage self, people and resources to improve health and wellbeing

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Pharm World Sci (2008) 30:111119 Table 4 Respondents consensus agreement and non-agreement for specic competencies within competency areas Competency Commission, monitor and evaluate projects to advance knowledge and practice Strategically lead the improvement of health and wellbeing and the reduction of inequalities Collect, structure and analyse data on the health and wellbeing and related needs for a dened population Develop peoples skills and roles within community groups/networks Analyse and interpret data and information about health and wellbeing and/or stressors to health and wellbeing Design learning programmes Obtain and link data and information about health and wellbeing and/or stressors to health and wellbeing Assess, negotiate and secure sources of funding Facilitate the development of community groups/networks Percentage agreement 5 14 23 32 32

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32 36 36 36

One key limitation of a Delphi study is the use of an expert group. By denition, the members of such a group are unlikely to be representative of typical community pharmacists, hence introducing bias and reducing generalisability. However, the use of experts was intentional to identify the competencies; community pharmacists views on the competencies and estimation of education and training needs will be explored in the next stage in the research.

Discussion of ndings The role of community pharmacy in delivering the public health agenda in Scotland has been recognised for a number of years in NHS policy [46]. The need for education and training is also widely recognized [6, 19, 22]. In order for pharmacists to be able to assess their competence there is a need to be clear about the competencies required. Previous approaches to dening public health competencies for pharmacists had focused on generic competencies expected of all health professionals [18] and based, in the main, on English health policy documentation. Whilst the evidence base for community pharmacy involvement in health improvement has been recently reviewed [11, 12, 19, 23] little has been published regarding the education and training needs to underpin public health activity. Consensus was achieved for the following Skills for Health competency areas: promoting and protecting the populations health and wellbeing; developing quality

and risk management within an evaluative culture; collaborative working for health and wellbeing; working with and for communities to improve health and wellbeing; and ethically manage self, people and resources to improve health and wellbeing. The importance of collaborative working forms a central theme of the Public Health Institute for Scotland publication, Pharmacy for Health [6]. Walker cites a uniprofessional culture, and undervaluing of partnerships, as being a barrier to developing the public health role of pharmacy [10]. The support demonstrated for competence in collaborative working will be key to the delivery of the role outlined by Bissell [24], who propose a bigger role for community pharmacists in building social capital through activities promoting well being and social cohesion. Given the emphasis on clinical governance in modern healthcare and by the profession [25] it is perhaps unsurprising to see support for competencies around the development of quality and risk management within an evaluative culture. Anderson et al. [11] reviewed evidence for community pharmacys role in health improvement and found that less than a third of pharmacy projects had reported outcomes. Training, facilitation and leadership are needed to raise the perceived level of importance of evaluation and clinical governance activities if public health services are to develop within a quality assurance framework based on, and contributing to, the evidence base. The expert panel did not support the view that community pharmacists should be competent in surveillance and assessment of population health. However, commentators such as Walker have advocated the need for a common pharmacy dataset to underpin public health activity suggesting its absence is a barrier to the development of pharmacys role in this area [10]. The use of pharmacy health data to target health promotion measures, provide data regarding the epidemiology of minor ailments, adverse drug reactions to over the counter medication and to supplement existing data have been advocated [6, 10, 23, 26, 27]. The new community pharmacy contract in Scotland and the introduction of electronic transfer of prescriptions provides a timely opportunity to review community pharmacys contribution to health data collection. In order for pharmacists to deliver health promotion and protection activity successfully it is important that they have both the knowledge and the ability to apply that knowledge. Evidence demonstrates that training and facilitation increases the involvement of pharmacists in health promotion interventions and increases client uptake [19]. In smoking cessation where strong evidence of the role of the pharmacist exists [28] it has been shown that training in behavioural change does improve quit rates [29, 30]. Community pharmacists competence in these areas is

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Pharm World Sci (2008) 30:111119 6. Public Health Institute of Scotland. Pharmacy for health: the way forward for pharmaceutical public health in Scotland. Glasgow: Public Health Institute of Scotland; 2003. ISBN 1-904196-07-1. 7. Scottish Executive Health Department. Delivering for health. Edinburgh: Scottish Executive Health Department; 2005. ISBN 0-7559-4835-1. 8. Scottish Executive. [Need to change health behaviour]. Improving health in ScotlandThe Challenge. Edinburgh: The Stationery Ofce Bookshop; 2003. ISBN 0-7559-0607-1. 9. Scottish Executive Health Department. Public Health Service (PHS) outline specication: SEHD Primary care division [cited May 2007]; 2006. Available from: http://www.community pharmacy.scot.nhs.uk/docs/PHS%20SERVICE%20SPECIFICA TION%20FINAL%20DRAFT%2020.03.06.doc. 10. Walker R. Pharmaceutical public health: the end of pharmaceutical care? Pharm J 2000;264(7085):340341. 11. Anderson C, Blenkinsopp A, Armstrong M. The contribution of community pharmacy to improving the publics health: Report 1: Evidence from peer-reviewed literature 19902001. Great Britain: PharmacyHealthLink & RPSGB; 2003. ISBN 0-9538505-1X. 12. Blenkinsopp A, Anderson C and Armstrong M. The contribution of community pharmacy to improving the publics health: Report 2: Evidence from non peer-reviewed literature 19902002 Great Britain: PharmacyHealthLink & RPSGB; 2003. ISBN 09538505-5-2. 13. Whiddett S, Hollyford S. The competencies handbook. 1st ed. London: Chartered Institute of Personnel and Development; 2000. ISBN 0-85292735-5. 14. Department of Health. The Report of the chief medical ofcers project to strengthen the public health function. London: Department of Health. [cited Feb 2007]; 2001. Available from: http://www.dh.gov.uk. 15. Department of Health. Choosing health through pharmacya programme for pharmaceutical public health 20052015. London: Department of Health. [cited Feb 2007]; 2005. Available from: http://www.dh.gov.uk. 16. Royal Pharmaceutical Society of Great Britain. Competencies of the future pharmacy workforce Phase 1. [homepage on the Internet]. London: Royal Pharmaceutical Society of Great Britain. [cited March 2007]; 2003. Available from: http://www.rpsgb.org.uk/pdfs/compfutphwfph1.pdf. 17. Department for Education and Skills: Sector Skills Council. Skills for health: public health practice national occupancy framework. Bristol: Department for Education and Skills [cited Feb 2007]; 2005. Available from: http://www.skillsforhealth. org.uk/ssa/. 18. Royal Pharmaceutical Society of Great Britain. Guidance on linking the NHS knowledge and skills framework and competencies for pharmacy. London: Royal Pharmaceutical Society of Great Britain; 2006. ISBN 0-9546776-5-X. 19. Armstrong M, Lewis R, Blenkinsopp A and Anderson C. The contribution of community pharmacy to improving the publics health: Report 3: An overview of evidence base from 19902002 and recommendations for action. Great Britain: PharmacyHealthLink & RPSGB. [cited Feb 2007]; 2005. Available from: http://www.pharmacyhealthlink.org.uk. 20. Walley T, Webb DJ. Developing a core curriculum in clinical pharmacology and therapeutics: a Delphi Study. Br J Clin Pharm 1997;44(2):167170. 21. Barrett H, Bion JF. Development of core competencies for an international training programme in intensive care medicine (The CoBaTrICE Collaboration). Intensive Care Med 2006;32(9): 13711383.

key to the delivery of the new community pharmacy contract in Scotland.

Further work There is a need to research community pharmacists views of these competencies and to systematically assess their education and training needs. Further work may be useful in identifying the different roles to be undertaken by practitioners and specialists, particularly for those competencies where consensus was not achieved; for example health surveillance, with perhaps a focus on collection and use of data by practitioners. Specialists may be more effective in designing, collating, analysing, interpreting and communicating trends. There may also be value in comparing public health competencies for community pharmacists in different countries.

Conclusion Consensus was achieved for competencies relating to health improvement and quality improvement activities and ethical management of self rather than those outlining the requirements for surveillance and assessment and strategic development. These latter competencies were viewed as being more relevant to the specialist practitioner.
Acknowledgements The authors would like to acknowledge research funding provided by NHS Education for Scotland; the members of the expert panel for their interest and rapid responses; Laura Binnie for technical support; and Amber Bowbyes for administrative support. Conicts of Interest None declared.

References
1. Leon D, Morton S, Cannegieter S, McKee M. Understanding the health of Scotlands population in an international context: a review of current approaches, knowledge and recommendations for new research directions. 2nd ed. London: London School of Hygiene & Tropical Medicine; 2003. ISBN 1-904196-11-X. 2. Scottish Executive. Designed to care: renewing the NHS in Scotland. Edinburgh: Scottish Executive; 1997. ISBN 0-10138112-3. 3. Scottish Executive. Rural development plan for Scotland. Scottish Executive; 2005. Available from: http://www.scotland. gov.uk/library3/misc/rdps-04.asp. 4. Scottish Executive. Review of the Public Health Function in Scotland. Edinburgh: Scottish Executive; 1999. Available from: http://www.scotland.gov.uk. 5. Scottish Executive. The right medicine: a strategy for pharmaceutical care in Scotland. Edinburgh: Scottish Executive; 2002. Available from: http://www.scotland.gov.uk.

123

Pharm World Sci (2008) 30:111119 22. NHS Education for Scotland. Flavours of pharmaceutical public health. Glasgow: NHS Education for Scotland. [cited Feb 2007]; 2006. Available from: http://www.nes.scot.nhs.uk. 23. Pharmacy Healthlink. The contribution of community pharmacy to improving the publics healthEvidence from peer-reviewed literature (2004 update). [homepage on the Internet]. Pharmacy Healthlink. [cited May 2007]; 2004. Available from: http://www. pharmacyhealthlink.org.uk/. 24. Bissell P, Anderson C, Blenkinsopp A. Has community pharmacy a role in dealing with health inequalities? Pharm J 2001;267:880. 25. Royal Pharmaceutical Society of Great Britain. Achieving excellence through clinical governance: Royal Pharmaceutical Society in Scotlands policy on clinical governance. [homepage on the Internet]. [cited May 2007]; 1999. Available from: http://www.rpsgb.org/pdfs/achiscot.pdf. 26. Layton D, Sinclair H, Bond C, Hannaford P, Shakir W. Pharmacovigilance of over-the-counter products based in community

119 pharmacy: methodological issues from pilot work conducted in Hampshire and Grampian, UK. Pharmacoepidemiol Drug Safety 2002;11(6):503513. Wong C, Siew S, Edmondson H. Childrens over-the counter medicines pharmacoepidemiological (COPE) study. Int J of Pharm Pract 2007;15(1):1722. Sinclair HK, Bond CM, Stead LF. Community pharmacy personnel interventions for smoking cessation. Cochrane Database of Systematic Reviews; 2007, 2. Sinclair K, Bond C, Lennox AS, Silcock J, Wineld AJ, Donnan PT. Training pharmacists and pharmacy assistants in the stages-of change model of smoking cessation: a randomized controlled trial in Scotland. Tob Control 1998;7(3):253261. Maguire TA, McElnay JC, Drummond A. A randomized controlled trial of a smoking cessation intervention based in community pharmacies. Addiction 2001;96(2):325331.

27.

28.

29.

30.

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