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NHS England’s Bruce Warner defends ‘clinical’ pharmacist ‘distinction’

Bruce Warner: There are distinctions between pharmacists, based on their training
Bruce Warner: There are distinctions between pharmacists, based on their training

NHS England’s deputy chief pharmaceutical officer has defended its use of the controversial term “clinical pharmacists” by claiming “not all pharmacists can do everything”.

Responding to criticism over NHS England’s continued use of the “clinical pharmacist” term to describe only those working in hospitals or recruited into GP practices, Bruce Warner said: “I do not accept that all pharmacists can do everything just because they are pharmacists.”

“We’ve used the term clinical pharmacist for years to talk about those pharmacists in a very patient-facing role that, more often than not, have post-graduate clinical qualifications and specific skills to do that specific role,” he told the all-party pharmacy group (APPG) at a meeting on Tuesday (January 15).

“A lot of work up until fairly recently in general practice has been doing audits and data work,” Mr Warner continued. “The push now is towards patient-facing, clinical reviews.”

“No such thing as a non-clinical pharmacist”

Mr Warner was responding to criticism from Labour MP Julie Cooper, who argued that “there is no such thing as a non-clinical pharmacist”.

“All pharmacists are clinical [and] they are all trained in the same way. Anybody...with an in-depth understanding will realise that is the fact of the matter,” Ms Cooper stressed.

The term “clinical pharmacist” implies those in community pharmacy are of a “lesser quality”, and can lead to public confusion, she added.

“Pharmacists are not all trained the same”

In response, Mr Warner said pharmacists receive the same training initially, but “over the course of their careers [they] are not all trained the same”.

“Our training throughout our careers leads us down certain paths and so I think there are distinctions between pharmacists,” he added.

During the APPG meeting on how community pharmacy can help deliver the NHS long-term plan – which was published last week – NHS England’s director of new business models and primary care contracts Ed Waller said the commissioning body was committed to expanding the “number of clinical pharmacists in local networks”.

NHS England made six references to “clinical” pharmacists in the plan – hailing them as “a key part of the general practice team in primary care networks”. Community pharmacists and pharmacies were referenced four times in the 136-page document.

What do you make of Mr Warner's remarks?

Charles Whitfield Bott, Pharmacist Director

Just done a rapid HIV test in my consulting room, is that clinical enough?

Leon The Apothecary, Student

Oh Bruce, that's not how you win over Pharmacists.

Michael Achiampong, Community pharmacist

Agreed Leon. I respect dr Warner's achievements etc but on this ocassion, he's got it wrong! One only has to go a CPPE CPCS workshop on a saturday morning to witness the incredible clinical knowledge and transferable skills that my fellow pharmacists and pre-reg's possess. Even the two GP trainers were quietly impressed! In summary, there is no such thing as a non-clinical pharmacist!

Community Pharmacist, Community pharmacist

So if community pharmacists are not 'clinical' pharmacists, why are they expected to do MURs, NMS, PGDs etc. All so called 'clinical' services. How about leaving this work to all the 'clinical' pharmacists and GPs and paying us based on the old contract terms i.e dispensing. And if a GP makes a prescribing error does that mean they are NOT 'clinical' ???? Please let's focus on making the NHS better by recognizing the pivotal role that ALL pharmacists play within the NHS rather then downplaying their efforts. Without pharmacists be it hospital, GP or community the NHS would collapse. This is a FACT!!!! 

Unfortunately community pharmacy is very poor at recording interventions. Who's fault that is could be the individual pharmacists/pharmacy companies for not promoting themselves. Or the NHS for not giving us a proper platform to record these interventions and fazing out commissioned services.

This means that when the powers that be come to analyse community pharmacy's role in healthcare they don't see much of the unpaid work we perform. They see that most of what we do could be done by automation/hub and spoke at a cheaper rate. Which I'm sorry to say, will be the case in years to come unless something fundamental changes.

On the face of it this seems like a trivial debate about titles, but like Mike says below, it gives an insight into the general attitude towards community pharmacists, or "shop keepers" as we are also known by some.

Michael Achiampong, Community pharmacist

I agree with 50% of what you say. However, I am always documenting interventions on patient's PMRs e.g allergy info; OTC purchases; customer feedback. The enablement of SCR read-write access would also make a massive impact. The thing about trivialising community pharmacists and pharmacy teams is when something goes drastically awry then you realise why one pays professional indemnity insuarance! Every day I think of happened to former pharmacists Elizabeth Lee and Martin White [re: prednisolone &propranolol] could so easily happen to any one of us practitioners when we least expect it.

Mike Hewitson, Superintendent Pharmacist

I was criticised for pointing out the semantics of NHS England’s use of language in the NHS Long Term Plan. But everything Bruce says here is entirely consistent with the language in the document. They do see community pharmacists as different to pharmacists in other settings.

When I was a hospital pharmacist I remember thinking that until you had done a clinical diploma nobody really took you seriously which I found sad. Having a diploma doesn’t make you brilliant with patients, in fact many “clinical pharmacists” were rubbish with patients. “Just come from pharmacy to look at your drug chart” was what they’d say. Holistic patient care needs to take wider view of the patient, not just a sterile look at the medicines. 


Michael Achiampong, Community pharmacist

Good points Mike. But the DHSC are blatantly disprespectful to grassroots community pharmacists in using the "individous distinction" of clinical pahrmacists.

Somettimes, I think: "maybe we should go on a march or street protest!"

But we won't because real grassroots, frotnline pharmacists always put patients first!

Graham Phillips, Superintendent Pharmacist

I am astonished and incredibly disppointed to find that Bruce, himself an ex-community pharmacist, propagating the Keith Ridge prejudice against community pharmacists. First of all, around 60% of  GP Pharmacists are ex-community. Do  they suddenly become "clinical" when the cross the GP threshold? Second: the definition of "clinical" as Bruce well knows is "having direct contact with patients. On any reasonable interpretation EVERY community pharmacist is, by definiton, "clinical" whereas Keith Ridge and Bruce Warner are not.  Shame on you, Bruce

Michael Achiampong, Community pharmacist

I completely agree with you Graham. Dr Warner should know better and Dr Ridge is a ....!

Mahesh Sodha, Superintendent Pharmacist


Bruce, remember that many pharmacists who do have post graduate clinical qualifiactions choose to work in a community Pharmacy and provide a very high quality of "clinical" support to patients and manage chronic conditions without any remuneration devoted to this task.

Equally many pharmacists who work in GP surgeries do hardly any "clinical" work but indulge in mainly admisttrative duties. Often these duties inclused the CCG agenda of trivial work such as promoting branded generics.


David Moore, Locum pharmacist

I can recall The Pharmaceutical Society telling pharmacists with doctorates not to use the term Dr, as it would imply that they were better qualified than other pharmacists.
I was a pharmacist for 46 years, and spent all that time in a patient facing role, but never once described myself as a clinical pharmacist.

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