Aim Neonatal services have been subject to multiple reviews over recent years, including the Neonatal Critical Care review (2020),¹Okenden report (2022)² and the Getting it Right First Time (GIRFT) Neonatology report (2022).³ It has been recommended that every centre providing neonatal care must have access to a senior pharmacist practising in neonatology and, where necessary, with experience in the provision of parenteral nutrition⁴. The GIRFT Review (2022) included improving patient safety and reducing medication errors as one of its key recommendations, with pharmacists highlighted as having a key role in this.³

The Neonatal and Paediatric Pharmacy Group (NPPG) alongside the Chief Paediatric Pharmacist Group (CPPG) produced staffing standards for neonatal pharmacists in 2022, which are summarised below,⁴ as well as providing key recommendations on the role of neonatal pharmacists.

NPPG staffing recommendations (for a 5-day service):

• Each Intensive Care cot requires a minimum of 0.12 whole time equivalent (WTE) Band 8a Pharmacist

• Each High Dependency cot requires a minimum of 0.06 WTE Band 8a Pharmacist

• Each Special Care cot requires a minimum of 0.03 WTE Band 7/8a Pharmacist

Method Lead neonatal pharmacists across all 14 hospitals within the ODN were identified and contacted to establish the current pharmacist numbers funded to cover each neonatal unit, as well as their Agenda for Change (AFC) banding. The data collected was mapped against the NPPG neonatal staffing standards using the number of static cots and their care level (data provided by ODN), to calculate the staffing gap for each neonatal unit. The funding gap was then calculated based on a 5-day service at a mid-point band 8a AFC salary.

Results Identified a funding gap of £465,694, equating to a staffing gap of 9.1 WTE pharmacists across the network. Only two units across the network had dedicated neonatal pharmacists (14%), all other pharmacists were part-funded and cross covering paediatrics and/or maternity services. All units except one level 1 unit received daily (Mon-Fri) pharmacist ward visits. Only 1 Trust had regular pharmacist participation in Multidisciplinary Team (MDT) ward rounds.

Conclusion Increased funding is required to optimise the staffing establishment of neonatal pharmacist posts across the network to meet the professional staffing standards. A full report has been sent to the regional commissioning lead for NHSE outlining the staffing gap of neonatal pharmacists across the ODN. Dedicated neonatal pharmacist posts should be considered, to allow neonatal pharmacists to participate fully in MDT ward rounds and to allow sufficient ‘non-patient-facing’ time in order to support the GIRFT drug safety agenda in aiding the implementation of Electronic prescribing, smartpumps and standardised infusion concentrations. Further audits are needed across all hospitals within the network to highlight the clinical importance of the neonatal pharmacist, for example collating medication related incident reports, cost improvement initiatives and development of clinical guidelines. Network pharmacists are perfectly positioned to make recommendations for additional funding for the neonatal pharmacy team, as well as supporting standardisation of care across the network. National recommendations support the introduction of network pharmacists across all neonatal ODNs.³

References

1. NHS England and NHS Improvement. Implementing the Recommendations of the Neonatal Critical Care Transformation Review; 2019 https://www.england.nhs.uk/wp-content/uploads/2019/12/Implementing-the-Recommendations-of-the-Neonatal-Critical-Care-Transformation-Review-FINAL.pdf (Accessed 7 July 2023)

2. Ockenden D. Findings, conclusions and essential actions from the independent review of maternity services at the Shrewsbury and Telford Hospital NHS Trust; 2022. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1064302/Final-Ockenden-Report-web-accessible.pdf (Accessed 7 July 2023).

3. Adams E, Harvey K, Sweeting M. Neonatology GIRFT Programme National Specialty Report; 2022. https://future.nhs.uk/connect.ti/GIRFTNational/view?objectId=130557829 (futureNHS login required) (Accessed 7 July 2023).

4. NPPG Executive Committee. Pharmacy Staffing Standards for Neonatal Services; 2022. https://nppg.org.uk/wp-content/uploads/2022/10/NPPG-Neonatal-Staffing-Standards-V2.pdf (Accessed 07 July 2023).