Royal Stoke Pharmacy Workforce Calculator (RSPWC)

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Case Study Summary
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Overview summary:
The Royal Stoke Pharmacy Workforce Calculator (RSPWC) was developed at University Hospitals North Midlands NHS Trust (UHNM). It was developed to determine local clinical pharmacy staffing levels required to deliver pharmaceutical care to specific patient cohorts. Its algorithm is based on ‘activity standards’ for tasks and ‘unavailable’ staff time, which generates a resource to deliver services sustainably across a full year. It has been utilised by UHNM for a number of years as a method of responding to business case plans.
Challenge identified and actions taken :
Challenges began for the pharmacy workforce at UHNM when there was an increase bed numbers and patient cohort changes, increasing the number of patients requiring pharmaceutical services. This had a clear impact on the pharmacy team’s ability to deliver the pharmaceutical care requirements for patients. Securing adequate resources for pharmacy service delivery was challenging. Often the pharmacy was not considered in financial calculations of associated business cases and when it was, an arbitrary value, insufficient for service needs, was allocated.

This led to the development of the RSPWC as a method to objectively identify and calculate the necessary resources to ensure adequate staffing. The calculator is now a validated tool that identifies the staffing resources required to deliver clinical pharmacy services to in-patients in acute hospital settings. It does this by using the mean time the pharmacy workforce takes to complete patient related clinical pharmacy tasks (the ‘activity standard’) and extrapolating this for a specific cohort of in-patients, using number of beds and average length of stay. This determines workforce staff and resources needed, taking into consideration the ‘unavailable time’ (annual leave, sickness, training etc.) to ensure that the service is sustainable 24/7/365.
Impacts / outcomes:
There are many positive outcomes that have come from the RSPWC. These are discussed below:
  • The RSPWC provides an objective calculation of pharmacy staff resource, to ensure that adequate staffing in a changing health service is provided.
  • The system requires minimal data collection by users as data is readily available from the ward demographic data, which completes the process. The resources that are needed by the pharmacy workforce are then identified and are broken down into staff groups to allow skill mixed opportunities to be identified.
  • The RSPWC has been validated through a process that included a Delphi study with a panel of national experts for application to pharmaceutical care services for acute hospital in-patients, both in general medicine and surgery
  • For the first time, a consensus on required service components for the delivery of pharmaceutical care, across multiple hospital sites nationally in the UK has been established. .
  • Through the application of the calculator to business cases the pharmacy establishment has grown over a number of years. It has increased staff numbers across all grades and staff groups. This has allowed improved patient care e.g. staffing to RSPWC levels an increased number of patients can be discharged directly from the ward area (the surgical team deliver around 85% of discharges in this way. This has reduced turnaround time for medicines required for discharge from 3 hours to 30 minutes.
  • Furthermore, there is evidence from other sites that suggests that staffing to levels suggested by the calculator has had an impact in reducing length of stay and readmission rates of patients.
Supporting quote for the innovation from key stakeholders:
“In this era of standardisation, rationalisation, benchmarking and Carter it [the RSPWC] will support some agreed standardisation of pharmacy so it fits nicely in the political context.”

“I think historically capacity and demand planning have been very much feeling based, but it’s nice to have something that either backs up that feeling or completely challenges it I guess.”

“I did try it just for a ward we’ve got at the moment and one that I thought was reasonably functional and it came out with roughly what we’ve got.”

“I put some figures through it last week due to the Trust opening more beds and have so far got a positive response from finance which has led to getting in two locums based on the figures."
Which local or national clinical or policy priorities does this innovation address:
With the increased focus on pharmacy workforce following the Carter Report 2016, many hospitals are looking at utilisation of pharmacy staff in much greater detail. The need to expand pharmacist roles beyond the traditional ward service is increasing and the RSPWC allows pharmacy managers to understand baseline staffing requirements before addressing changes of role or scope of practice. The RSPWC has been used by other Trusts to support responses to business cases and guide service development eg. Coventry and Warwickshire NHS Trust, East Kent NHS Trust.
Plans for the future:
Future development plans include:
  • Developing and validating versions of the calculator for application to specialist areas. At UHNM we have started developing a Renal version of the tool. This speciality has long had a n accepted patient/pharmacist ratio for guiding staffing however the advantage of the RSPWC is the inclusion of technician and non-registered workforce staff groups, essential for service delivery but not included in the national benchmark. Early approaches have been made for developing a mental health version of the tool, but this will require substantial research in-put and would be available as an MSc project for an interested candidate.
  • Generating outcome data to demonstrate the patient care benefits that staffing to this level will deliver – it is hoped to pilot this through the winter of 18/19.
  • Reviewing the model to consider the impact of pharmacist prescribing on the activity standard – this is an additional role but there will be some overlap of activity and this is not yet understood, but will have implications for staffing levels and skill mix.
Tips for adoption:
If your NHS Trust would like to adopt the RSPWC we have developed, it has been shared on the NHS platform “Kahootz” which is accessible to Chief Pharmacists. All the information you need on how to adopt the system is available on there.
Contact for further information:
If you would like more information on the Pharmacy Workforce Calculator then contact Ruth Bednall via email: ruth.bednall@uhnm.nhs.uk
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