Aims Paediatric hospital care is provided throughout the UK, with a limited number of specialist centres providing specialist and higher acuity care. Outside of the specialist centres, there are a greater number of smaller paediatric services based in District General Hospitals (DGHs), delivering more generalist medical and surgical care. Anecdotally, levels of paediatric pharmacy staffing within DGHs are variable. Staffing standards exist for pharmacist services to paediatric critical care, neonatal critical care and paediatric nephrology,¹ but no standards directly applicable to the DGH setting exist. As the first step to developing paediatric pharmacy staffing standards for DGHs, we aimed to capture and describe current staffing levels within these settings.

Method An electronic survey was developed using SurveyMonkey® and distributed by email to all members of the Neonatal and Paediatric Pharmacy Group (NPPG) - approximately 500 individuals. The survey remained open for three weeks, with a reminder email sent one week before the deadline. A PDF of the survey questions was attached to the email to aid data collection. Respondents were asked to indicate the number of neonatal cots and paediatric beds in their centres, including the levels of care for the neonatal cots and the number of level 2 paediatric beds. The number of pharmacy staff providing ward-based care to neonatal and paediatric patients was requested, including detail of whole time equivalents at each Agenda for Change band. The extent of support provided to other services such as maternity or gynaecology was also captured.

Results 41 centres responded to the survey, including trusts from England, Northern Ireland, Wales, and Scotland. Only four trusts have a pharmacy assistant and 30 (73.3%) did not have a pharmacy technician within their paediatric service. 32 sites have at least one NICU cot, and of these 30 (94%) have band 8a or above pharmacist time. Almost all trusts (n= 38, 92.7%) had a rotational or permanent band 6 or 7 role as part of the paediatric service. Based on the number of neonatal cots at each level of care and the number of level 2 paediatric beds given for each centre, only 18 trusts (43.9%) have sufficient pharmacist resource to meet the published standards for these specialist beds.¹ However, even in the centres where the standards are met, this does not take into account cover for non-critical care paediatric beds or non-paediatric services. Many paediatric teams also provide services to gynaecology wards (ad hoc service 29.3%, full clinical service 12.2%); maternity wards (ad hoc 34.1%, full clinical service 24.4%); and to Paediatric Emergency/Assessment beds (ad hoc 75.6%, full clinical service 4.9%). 39% of paediatric teams also support virtual paediatric wards and/or services providing treatment for children at home. 13 respondents expressed concern about staffing levels in the free text comments box.

Conclusions Paediatric pharmacy provision in UK DGHs is extremely variable. Many teams are under-resourced for the services they provide and do not meet the NPPG staffing standards, for critical care beds/cots. NPPG will seek to develop staffing standards specific for DGH pharmacy teams.

Reference

1. Neonatal and Paediatric Pharmacy Group- Staffing Standards: https://nppg.org.uk/staffing-standards/ (accessed 7th July 2023).