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Copyright © 2015 International Pharmaceutical Federation (FIP)

Fédération Internationale Pharmaceutique (FIP)

Andries Bickerweg 5
2517 JP The Hague
The Netherlands
www.fip.org – fip@fip.org

All rights reserved. No part of this publication may be stored in any retrieval system or transcribed by any form or means – electronic,
mechanical, recording, or otherwise – without citation of the source. FIP shall not be held liable for any damages incurred resulting from the
use of any data and information from this report. All measures have been taken to ensure accuracy of the data and information presented in
this report.

This report is available for electronic download from: www.fip.org/educationreports

Editor:

Andreia Bruno
FIP Education Initiative (FIPEd) Project Coordinator and Researcher

Authors:

Kirstie Galbraith
FIPEd Education Lead for Advanced Practice Ian Bates
Faculty of Pharmacy and Pharmaceutical Director of the FIPEd Development Team
Sciences, Monash University University College London, School of Pharmacy

The publication of this report would not be possible without the commitment and expertise provided by the report authors and analysts.
The FIP Education Initiative gratefully acknowledges the direct and indirect support of the following institutions for their assistance with
producing this report: Faculty of Pharmacy and Pharmaceutical Sciences, Monash University and University College London, School of Pharmacy.

Design:
www.bug-group.com

ISBN 978-0-902936-33-1
EAN 9780902936331

Recommended citation:
International Pharmaceutical Federation (FIP). Advanced Practice and Specialisation in Pharmacy: Global Report 2015. The Hague: International
Pharmaceutical Federation; 2015.

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Contents
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Foreword 4

Part 1. Key messages 5

Part 2. Introduction 6

Part 3. A global advanced practice and specialisation description 11

Part 4. Trends and innovations: case studies

Key messages of the case studies 17
Argentina: Seven recognised specialties 19
Australia: Nationally agreed advanced practice framework 22
Canada: Pharmacy associations working collaboratively on a blueprint for pharmacy 26
China: Clinical pharmacy recognised and supported by standardised training 28
United Kingdom (Great Britain): Professional recognition programme of advanced practice 29
India: Advance pharmacy practice via development of regulations 32
Ireland: Nationally approved model of continuing professional development 34
Japan: Lifelong learning support system includes a clinical ladder with 10 steps of skills development 36
Malaysia: MAP to support provision, credentialing and accreditation of specialists
and advanced level practitioners 38
New Zealand: Government policy supports pathway for advanced practice, and credentialed services 41
Philippines: Enhancement of professional competence, supported by mandatory CPD 44
Portugal: Four recognised specialties 46
Singapore: Accreditation and registration of specialist pharmacists available 49
South Africa: Development of scopes of practice and required qualifications for specialist pharmacists 53
and pharmacist prescribers
Spain: Specialisation is largely governed by regulations covering all healthcare professionals 56
Switzerland: pharmaSuisse responsible for programmes and titles of recognition 57
and maintenance of federal titles
USA (California, North Carolina): States differ in the recognition of specialty and advanced pharmacy practice 59, 61

Part 5. Overview of terminology 64

Part 6. Summary and conclusions 70

Annex 1. Acknowledgements
71

3
 Foreword

Human resources for health are at a critical low. The World Health Organization estimates that the current shortage of health
workers is in excess of 7.2 million worldwide and that, by 2035, the shortage will reach 12.9 million. Pharmacists, in particular,
are lacking in the workforce in many countries. In addition, education and training needs to be strengthened globally.
Pharmacy needs a global vision that encompasses the sharing of experiences, gathering of evidence and collaborative guidance
to facilitate country-level initiatives.

FIPEd is the name given to the component group of the International Pharmaceutical Federation (FIP) that is bringing together
all of the federation’s efforts in transforming and strengthening professional pharmacy and pharmaceutical sciences education
globally. It is organised as a cross-cutting initiative that includes both of the boards of FIP as well as its governance bodies.
More than 100 practitioner and scientific educators and over 130 deans of schools of pharmacy from throughout the world
are involved in congress programming on educational issues.

The FIPEd team prepares technical and policy papers on key areas of education, contributes to an online international journal on
pharmacy education, gathers leaders in education to establish a future agenda for transformation of pharmaceutical education,
and links educational policy issues to national needs for workforce development, capacity building and quality assurance.

All of these initiatives are closely tied to enhancing appropriate medicines use in global health systems, with a strong emphasis
on competency development across the continuum of the pharmaceutical workforce for practice and science.

Education and workforce development are the foundations for advancement in both pharmacy practice and the pharmaceutical
sciences, and the strengthening of educational programmes in the global community of universities and training centres are
integral parts of FIP’s Vision for 2020. This report additionally links to two other FIP reports published in 2015: ‘Global Pharmacy
Workforce Intelligence: Trends Report’ and ‘Interprofessional Education’. FIP stakeholders have identified all these topics as
being globally important and valuable for professional leadership bodies worldwide. Expansion of pharmacists’ roles and scopes
of practice to assure safe, effective and efficient medication use is strongly reliant on educational programmes that are socially
accountable and meet international standards for quality. In that vein, FIPEd has partnered with the World Health Organization,
the United Nations Agency for Education and Social Development (UNESCO) as well as several leading universities and national
organisations.

FIPEd’s Global Report on Advanced Practice and Specialisation in Pharmacy is the first publication of its kind to provide
a baseline on the current growing global trend to formally recognise the advancement of practice, which includes elements
of specialisation and professional recognition. We share this knowledge from our members to our members and beyond,
to trigger dialogue and action towards stronger policies. We hope that this will stimulate collaborations/partnerships
between all stakeholders, including professional organisations and universities taking up the important role of advocating
transformation of professional development education at the national level.

This report, and others like them, are only possible due to the commitment and expertise provided by the principal authors and
the personnel who have contributed to case studies and the provision of evidence and data. This report represents a significant
commitment of time and effort, and on behalf of the FIPEd, I am sincerely grateful to the individuals, organisations and
institutions who have made these significant contributions. Without their contribution and commitment, these influential and
helpful publications would not be possible.

William N. Charman, BPharm, PhD

FIP Education Initiative (FIPEd) Steering Committee Chair
Sir John Monash Distinguished Professor
Dean, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University

4
PART 1
KEY MESSAGES
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FIP Education Initiative surveyed 48 countries and territories The data retrieved from case studies also makes clear that
worldwide to obtain information concerning specialisation recognised “advancement” and “specialisation” (independent
and advanced practice policy and implementation at country of how countries may define these terms locally) must be
level. Both terms were described within the context of the linked with a modern understanding of competence and
survey in order to assist with responses. Specialisation capability of performance. Consequently, professional
was taken to mean advanced with narrow scope; advanced recognition of practitioner advancement must be clearly
practice was taken to mean overt advanced (beyond identified as including both education and practice
foundation) with broad scope of practice. The survey obtained development components.
48 country and territory level responses ranging across WHO
regions, economic and demographic characteristics. There is a close association in those countries with formal
recognition processes in place (for specialisation and
In addition, a series of case studies (17 countries) illustrates advancement) and acknowledgement of tangible benefits for
trends in policy development related to specialisation and workforce access to specialisation and advancement. These
advancement. From these, and the initial quantitative survey, benefits included enhanced career pathways, enhanced
a preliminary series of definitions and a glossary has been remuneration for practitioners and enhanced individual
formulated in order to seed global debate about advancement esteem and prestige.
of practice and professional understanding across borders.
The global trend is for pharmacy to continue to become
This report is the most comprehensive collection of data and a more clinical, patient-facing profession, with enhanced
evidence that relates to practitioner advancement of practice responsibilities and accountabilities for pharmaceutical care
and policy, and maps out a wide range of national initiatives in clinical environments; hence, clear pathways for workforce
worldwide. This report should be viewed as a first attempt to development, coupled with professional recognition and
map out global trends and will stimulate further reportage and credentialing of practitioners, becomes an important
analysis as engagement in this practice continues to progress. consideration. There is a clear opportunity for transnational
collaboration and further opportunities for transnational
In our sample around half of the respondents (23, 48%) recognition of advanced capabilities for the pharmacy
indicated the existence of an agreed national level definition workforce.
of “specialisation” although there is variance between these
definitions. “Advanced practice” as an agreed country level The public and our patients expect the highest possible
definition was indicated by fewer countries (11, 23%) with a pharmaceutical care from professional practitioners
smaller number of nine countries (19%) indicating country worldwide, without exception. A clear demonstration of
level consensus on both specialisation and advanced practice. competence and capability that is commensurate with
Advanced practice in this context was taken to mean a broad advanced and expert practice is a strong message to policy
scope of practice, beyond foundation level. makers and civil society that pharmacists possess this
expertise. Professional recognition, credentialing and quality
There are no clear associations with the existence of country assured specialisation are part of the demonstration of
level definitions of specialisation or advanced practice with competence and capability.
national pharmacist capacity; high-capacity countries do
not have a tendency to have definitions compared with low It is in the interest of patients, health systems and our
capacity countries. However there is a level of association with profession that a common and shared understanding of
economic development; higher income countries tend to have what we mean by “specialisation” and by “advanced practice”
a provision of formalised specialisation and advanced practice is developed. This is a key driver for future workforce
contrasted with lower-income countries. development and this report can be seen as a starting point for
this global discussion.
For workforce development of advanced and specialised
practice a number of countries stated categorically that
practitioner frameworks were currently available — or under
active development — and accounted for 58% (28 nations)
in this sample. It was notable that 10 countries indicated
that frameworks had been adapted from the work of other
countries showing potential collaborative practice between
countries and leadership organisations. It is clear to us that
the use of national developmental frameworks, ideally linked
with the concept of “professional curricula”, is a key workforce
development activity in order to progress professional role
enhancement and pharmaceutical service delivery.

5
 PART 2
INTRODUCTION
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Authors Current entry-level pharmacists practice within a broad scope

and at a general foundation performance level.
Kaitlyn Craddock, St. Louis College of Pharmacy, kaitlyn.
craddock@stlcop.edu; Sara Twillmann, St. Louis College of As the profession of pharmacy continues to expand to
Pharmacy, sara.twillmann@stlcop.edu; Kirstie Galbraith, FIPEd include more complex roles and responsibilities, entry
Lead for Advanced Practice and Director of the Postgraduate level performance associated with skills, knowledge, and
Studies and Professional Development Unit, Faculty of behaviours does need to be shown
Pharmacy and Pharmaceutical Sciences, Monash University, to meet defined foundation competency expectations
Australia, kirstie.galbraith@monash.edu; Andreia Bruno, FIPEd to provide public and patient trust and assurance.6
Project Coordinator and Researcher, education@fip.org; Ian
Bates, Director of the FIP Education Development Team, FIP Internationally, a number of countries have developed
Collaborating Centre, University College London School of and implemented frameworks to describe foundation
Pharmacy, UK, i.bates@ucl.ac.uk. competencies for pharmacy practice. One of the first countries
using developmental frameworks was the United Kingdom,
through the Competency Development and Evaluation Group
Pharmacists are expected to have the professional expertise (CoDEG), that developed the General Level Framework (GLF) -
to effectively manage complex patient cases and complex a Framework for Pharmacist Development in General
combinations of medicines. The concept of medication Pharmacy Practice.
therapy management (MTM)1 and similar services continue
to be introduced and developed within healthcare systems Based on this work and others, FIP developed the Global
across the world, and there is strong evidence demonstrating Competency Framework (GbCF) v1. The GbCF v1 is an
improved health and system outcomes as a result of example of a developmental framework, which can support
pharmacists providing MTM-type services.2 As current health countries to adapt and develop their own. It contains a core
systems and patient care continue to evolve in complexity and set of behavioural competencies synthesised from several
challenge, there is more demand for pharmacists to provide documents that are generally applicable for the pharmacy
complex services and to take on roles which are extended, workforce globally. It acts as a mapping tool for the creation
specialised and more advanced than current entry level scope of country specific needs for the development of practice
of practice. In order to ultimately provide these services, and practitioner professional development. In synergy with
pharmacists would benefit from having clear developmental assessment tools, countries can implement the GbCF into
pathways from foundation practice to practice, which is more practice, developing education and training infrastructures
advanced, and to have opportunity to be formally recognised for their practitioners.4,7
as advanced practitioners.
In 2010 collaboration between CoDEG, Monash University and
the Society of Hospital Pharmacists Australia resulted in the
development of the clinCAT (Clinical Competency Assessment
Foundation practice Tool), which has been implemented nationally for peer review
of professional practice.8 Recently the GLF has been adopted
In a report prepared for the Royal Pharmaceutical Society (GB)
and revised by the Royal Pharmaceutical Society (RPS) as
“Professional Recognition and Professional Advancement”, by
the “Foundation Pharmacy Framework”. This underpins the
the Joint Partners Credentialing Task Group, it was identified
RPS’s new Foundation Programme that supports pharmacists
that healthcare professionals’ ability to enhance therapeutic
to deliver safe and effective pharmaceutical care, for both
outcomes, patients’ quality of life, scientific advancements
early careers and for ‘return to practice’ or career break
and public health imperatives, depends upon a sound
practitioners.7
foundation of competence and capability that should be
acquired during initial education and experiential training.3  
There are a variety of other initiatives developed globally to
encourage and recognise advancing practice and there exists
Competency refers to the combination of skills, knowledge,
an opportunity to develop a validated global competency
behaviours, and attitudes that an individual develops
assessment tool to support more advanced practice.
through education, training, and experience.4 These
behavioural competencies can be used to develop an
individual’s performance and are a necessary prerequisite
for a practitioner to move forward in advanced practice or Advancing practice
specialisation.5 It is necessary for pharmacists globally to
demonstrate an appropriate foundation practice before The knowledge and skills that pharmacists acquire through
obtaining the capabilities required to be considered foundation practice provide the platform for advancing
competently specialised, or advanced in their practice. practice. An evaluation of competency development
It is crucial for professional leadership bodies to support frameworks in pharmacy education has recommended
pharmacists, in various stages of their career progression, developing a formal structure to offer support of post-
through use of developmental frameworks.4 registration pharmacists through mentoring and supervision.9

6
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Recent experience in Australia has identified the importance Other jurisdictions have taken a slightly different approach
of recognising capable pharmacy practitioners.10 Some areas to describing and recognising advanced practice. Rather than
of the Australian pharmacy workforce have begun using a competency framework some have requirements
to recognise advanced practitioners and there is currently including a combination of certification by dedicated
a pilot program underway to formally credential advanced structures (i.e. Board of Pharmaceutical Specialties in the USA),
practice pharmacists.11 There is recognition that the ability specific continuing education, a specified number of years
of an advanced pharmacy practitioner to make clinical in practice, and designated postgraduate courses of study.
decisions and deliver patient care is at a significantly higher This report attempts to describe the current global practices
level than the abilities of an entry-level pharmacist.10 This supporting development and recognition of advanced practice.
observation supports the need for recognition of more
advanced practice and for competency frameworks to develop
capable pharmacy practitioners, possessing a competence Benefits of more advanced practice
level beyond that of entry-level pharmacists, to deliver the
best possible patient care. There are benefits from developing and recognising
advancement in pharmacy practice. Pharmacists working
Similar work has been underway in Great Britain for a number at a recognised level of advancement, with a higher set of
of years and has culminated recently in the establishment of competencies, improve and safeguard patient safety and
the Royal Pharmaceutical Society Faculty, a service aiming at more effectively manage complexity in many areas of expert
recognising and validating advanced practice. Membership of practice. Professional recognition of advanced practice
the Faculty is a quality assurance marker that a practitioner improves acceptance by other colleagues in the clinical team,
is more advanced, a confirmation that they can handle but also in other areas of practice such as research, education
complexity and make complex decisions with confidence.12 and management.  It also provides role models and a source
of mentorship for novice and less experienced pharmacists,
including pre-service or pre-licensed pharmacists. Recognising
Requirements for more advanced practice pharmacists as advanced practitioners enables employers
and senior managers to have evidence of capability.13 Overall,
A key requirement for advancing practice in the profession will the movement towards recognising advanced practice in
be to provide a sufficiently robust definition and description of pharmacy represents progression of the pharmacy workforce.
“advancement” that will resonate with professional leadership
bodies and service providers globally.
Challenges and barriers
One model adopted by Australia (Advanced Pharmacy
Practice Framework - APPF)13 and the GB (Advanced Pharmacy There are challenges and barriers to the development and
Framework - APF)14 aims to support pharmacists to determine recognition of more advanced pharmacy practice. Global
their current competency levels, and the skills, knowledge, recognition of advanced pharmacy practice is not yet optimal,
behaviours, and values that need to be developed to move and there is lack of agreement regarding what constitutes
forward on the continuum of advanced pharmacy practice. advanced practice. Barriers to consider include differences
Both frameworks have identified similar key competency in the structure of healthcare systems, pharmacist initial
clusters that are considered necessary for development of education, and variances in scope of practice.6 In countries
advanced stages of practice. While the terminology differs where pharmacists can be recognised as “advanced
slightly between the two frameworks, there is clear resonance practitioners”, collaborative practices between pharmacists
with the identified domains or clusters, which can be and physicians, for example, are often already well established
represented by the APF as follows12: and pharmacists tend to provide pharmaceutical and clinical
services directly to patients.

1. Expert professional practice One of the greatest challenges in encouraging pharmacists

2. Collaborative working relationships to seek recognition of more advanced pharmacy practice is
3. Leadership that pharmacists may not receive adequate compensation/
4. Management reimbursement for their services. For example, in California,
5. Education, training, and development, USA, the designation advanced practice pharmacy (APP) was
6. Research and evaluation created to recognise the expansion of a pharmacist’s scope
of practice through Collaborative Practice Agreements (CPA).
Even with the APP designation and growing establishment
These domains of advanced competency tend to recur in of CPA between pharmacists and physicians, there is no
other professions and have an evidence base to support their law in California that authorises pharmacists to receive
relevance and credibility.14 reimbursement.2 This shows that even in places where
advanced practice pharmacy is growing and being recognised,
there are still barriers to overcome. There is starting to be some
evidence that this issue is slowly being addressed.

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Specialisation However, it is commonly recognised that specialisation is seen

in more advanced areas of practice and should not be focused
In some jurisdictions advancement and specialisation are principally on job description or functional task list, but rather
used almost synonymously and this can result in confusion a certain (defined) level of competence within a sector of
regarding the use of these terms. There have been attempts practice. Figure 1 depicts this generalised concept.
to clearly define these two concepts.11,15 In Australia the term
“specialist” is protected under national law and can only be The PHARMINE report outlines a competency-based approach
used by designated healthcare practitioners. As pharmacists to specialisation and focuses on a “set of learned behaviours
are not included in this group more generic terms such as “area which possess the following attributes: not dependent on
of focus”, “area of expert practice” or “defined area of practice” job descriptions or functional task lists; generalisable, and
are used, further complicating global understanding in this hence transferable across jobs and expected tasks; and
area. educational and developmental in nature… hence can be
applied to practitioner development across sectors and scope
The ‘PHARMINE’ (Pharmacy Education in Europe) report of practice”. A Specialist and Advanced Level Framework for
Identifying and Defining Competencies: A clear map for Hospital Practice was developed in collaboration with the
scientific and professional competencies as applied to European partners and contains two components:
hospital pharmacy outlined a European context for “core clusters” and “specialisation competency clusters”.
specialisation and delivered a consensus derived set
of competencies required for specialisation within pharmacy The “core clusters” represent competencies, which are
practice. The aim of this European consensus was to develop common to all sectors of pharmacy practice and include:
a core set of competencies for specialisation that are
applicable across sectors of advanced levels of practice.
The report stated that specialisation is taken to mean, 1. Leadership
“becoming an expert in one particular skill or area” but 2. Management
also stated that there is no universal consensus on what 3. Education, training, and development
“specialisation” denotes.16 It can be argued that specialisation 4. Innovation and evaluation [analogous
denotes a specific sector of practice such as hospital pharmacy to ‘research and evaluation’]
or community pharmacy and is a “horizontal” differentiation
from other practitioners (describing scope of practice), while
advancement is a “vertical” differentiation (referring to and a set of related competencies for each area, with three
level of performance).15,17 It can also be argued that within levels of performance demonstrating advancement. This is
each practice sector exist narrower fields of specialisation, consistent with the idea that many advanced competencies
for example “oncology pharmacy” or “drug information are generic regardless of sector, or area of expertise.
pharmacist”.

Figure 1: Advanced and specialist - broad and narrow scope.

Stages of knowledge, skills, experience

Advanced; broad scope Advanced; narrow scope

Competency ‐ Performance

(for example, general (specialist roles)

practice roles)

“Day 1” post-‐registration Specialist, foundation level

initial education outcomes (for example, technical roles)
and early career years

Technical/support cadres

Broad focus Narrow focus

8
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The core framework is intended to be used as a tool to RPS peer review panels have now been established for the
progress, within a specific area of practice, toward a level of purpose of professional recognition and credentialing, and to
mastery in each of the four areas or domains. This approach enable advanced support for practitioners.3 Access to a formal
shows a consistency in the identification and characterisation framework such as this allows pharmacists to evaluate their
of domains that relate to “advanced practice”.17 own performance against a framework and to determine the
support required for continued development as evaluated by
peers.10
Professional recognition,
credentialing and privileging
Continuing professional development
In a wider context, Australia, Europe, and North America have
taken a special interest in the credentialing of healthcare As pharmacy practice continues to progress, so do the
professionals. Within this context, credentialing is used as requirements for continuing education (CE). Continuing
an umbrella term to encompass processes to ensure that education is evolving into more complex, competency-based
individuals and/or organisations have complied with accepted education, which incorporates application of knowledge and
standards, therefore acting as an evaluation of a professional’s demonstration of skills. The term “continuing education” is
training, experience, and competence. In North America, the transforming into “continuing professional development”
term “board certification” is equivalent to credentialing. (CPD). CPD is essential in order to maintain modern pharmacy
There is evidence supporting the notion that “credentialed” practice in a healthcare system that continually advances.20
healthcare practitioners, including pharmacists, tend to be
associated with provision of a higher quality of patient care
(including complex care), improved clinical outcomes, and an Summary
increase in patient safety as compared to non-credentialed
or non-board-certified practitioners.18 In order to utilise pharmacists to their full potential as
advanced practitioners, the development and global
In the USA, the Council on Credentialing in Pharmacy says acceptance of standardised competencies, which pharmacists
that the current set of credentials required assures that an are required to meet, is essential. A competent pharmacist will
entry-level pharmacist is qualified to provide a standard level be able to provide the highest quality of healthcare to their
of care. These credentials include earning “an accredited patients, with a lower rate of medication errors, leading to
professional pharmacy degree and a license awarded increased health outcomes and patient satisfaction.
upon successful completion of a national postgraduate
examination administered by the National Association of Additionally, a pharmacist who possesses the qualities
Boards of Pharmacy on behalf of state boards of pharmacy”.15 of competence and capability will allow other healthcare
Although this is a standard process, the continuously growing professionals to recognise the expertise of advanced practice
healthcare system requires pharmacists to provide skills that pharmacists. Several frameworks have been developed at
are beyond entry-level. national level and internationally such as the FIP GbCF. The
development of competency frameworks will be useful for the
The Board of Pharmacy Specialities (BPS), in USA, has been inevitable progression of the profession of pharmacy toward
credentialing pharmacists in special areas of practice since advanced practice.4,5
1976. BPS has promoted and recognised the value of specialty
pharmacy training as well as the knowledge and skills required Pharmacists continue to improve their expertise and value to
to obtain a specialty board certification. This initiative ensures the healthcare workforce. Before improved competence and
improved patient care and optimal medication outcomes.19 recognition of advanced pharmacy practice can be achieved,
Recognition of specialty practice in other countries is more standard competency requirements must be established.
extremely variable, both in the pathways followed and the There are still several barriers to overcome before pharmacists
responsible organisation. can be recognised as advanced practitioners, but overall
the benefits of creating a competency system for advanced
In 2010, following new legislation in the UK, professional practice outweighs the challenges that may be faced along
regulation and professional leadership were separated and the the way.
re-formed RPS in Great Britain was able to commence activities
associated with professional recognition and credentialing,
along lines similar with the medical ‘Royal Colleges’. The
subsequent Joint Partners Credentialing Task Group report
determined the role of the professional leadership body in
creating a professional recognition based on peer assessment
and developmental frameworks.

9
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References 10. Coombes I, Kirsa SW, Dowling HV, Galbraith K, Duggan C, Bates I.
Advancing Pharmacy Practice in Australia: the importance of National and
Global Partnerships. Journal of Pharmacy Practice and Research. 2012;42(4):
1. The American Pharmacists Association and the National Association of 261-263.
Chain Drug Stores Foundation (APhA and NACDSF). Medication Therapy
Management in Pharmacy Practice: Core Elements of an MTM Service 11. Advanced Pharmacy Practice Framework Steering Committee. An
Model (on-line); 2008. Available from: www.accp.com/docs/positions/misc/ advanced pharmacy practice framework for Australia. October; 2012.
CoreElements.pdf Available at: www.advancedpharmacypractice.com.au

2. Isasi F, Krofah E. The Explanding Role of Pharmacists in a Transformed 12. Royal Pharmaceutical Society (RPS). Advanced Pharmacy Framework.
Health Care System. National Governors Association Center for Best London: Royal Pharmaceutical Society; 2013.
Practices (on-line); 2005. Available from: http://www.nga.org/cms/home/
nga-center-for-best-practices/center-publications/page-health-publications/ 13. Australian Pharmacy Council (APC). Advanced and Extended Pharmacy
col2-content/main-content-list/the-expanding-role-of-pharmacist.html Practice: An environmental snapshot (on-line); 2013.

3. Joint Partners Credentialing Task group (JPCT). A Report for the Royal 14. Competency Development and Evaluation Group (CoDEG). Advanced To
Pharmaceutical Society and the wider Profession Evidence - based Consultant Level Framework, A Developmental Framework For Pharmacists
recommendations: credentialing of practitioners. London: Royal Progressing to Advanced Levels of Practice. London: Competency
Pharmaceutical Society; 2013. Development and Evaluation Group; 2009.

4. International Pharmaceutical Federation (FIP). Global Competency 15. Council on Credentialing in Pharmacy (CCP). Credentialing and privileging
Framework (GbCF v1) for Services Provided by Pharmacy Workforce. The of pharmacists: A resource paper from the Council on Credentialing in
Hague: International Pharmaceutical Federation; 2012. Pharmacy. American Journal of Health-System Pharmacists, 2014;71:1891-
1900.
5. Bates I, Bruno A. Competence in the global pharmacy workforce: a
discussion paper. International Pharmacy Journal. 2009;22:30-33. 16. Middleton H. Why advanced is not the same as specialist. Clinical
Pharmacist, 2012;4:180.
6. Lucas A, Manasse HR. Advanced Pharmacy Practice: The US Landscape.
International Pharmacy Journal. 2005;33:35-37. 17. PHARMINE. Identifying and Defining Competencies. A clear map for
scientific and professional competencies as applied to hospital pharmacy;
7. Royal Pharmaceutical Society (RPS). Foundation Pharmacy Framework, 2011.
a Framework for Professional Development in Foundation Practice across
Pharmacy. London: Royal Pharmaceutical Society; 2014. 18. UK Department of Health (DoH). Literature Review Relating to
Credentialing in Medical Training. MACE; 2010.
8. The Society of Hospital Pharmacists of Australia (SHPA). Clinical
Competency Assessment Tool (shpaclinCAT version 2). Journal of Pharmacy 19. Board of Pharmacy Specialities White Paper (BPS). Five-Year Vision for
Practice and Research 2013;43:2 (suppl). Pharmacy Specialities; 2013. Available from: http://www.bpsweb.org/pdfs/
BPS_Whitepaper_Jan2013.pdf
9. Wright D, Morgan L. An Independent Evaluation of Frameworks for
Professional Development in Pharmacy. Report of the MPC Workstream 20. International Pharmaceutical Federation (FIP). Continuing Professional
2 Project: Independent evaluation of competency frameworks within Development/Continuing Education in Pharmacy: Global Report 2014. The
pharmacy education in the UK (on-line); 2012. Available from: http://hee. Hague: International Pharmaceutical Federation; 2014
nhs.uk/healtheducationengland/files/2012/10/Independent-evaluation-of-
professional-development-frameworks.pdf  

10
PART 3
ADVANCED PRACTICE AND
SPECIALISATION DESCRIPTION
.................................................................................. ..................................................................................

Authors • Twenty countries (42% of the sample) indicated that

formal post-nominal titles for individuals were available for
Ian Bates, Director FIPEd Education Development Team, professional recognition of advancement or specialist practice.
i.bates@ucl.ac.uk; Andreia Bruno, FIPEd Project Coordinator Examples are provided. Professional organisations, rather
and Researcher, education@fip.org; FIP Collaborating Centre, than statutory regulators, seemed to be predominant in the
University College London, School of Pharmacy, UK; Kirstie recognition and awarding of specialist post-nominal titles.
Galbraith, FIPEd Lead for Advanced Practice and Director of
the Postgraduate Studies and Professional Development Unit, • Prescribing as a specialisation was present in 19% of the
Faculty of Pharmacy and Pharmaceutical Sciences, Monash sample (9 countries).
University, Australia, kirstie.galbraith@monash.edu.
• There is a close association in those countries with formal
recognition processes in place (for specialisation and
advancement) and acknowledgement of tangible benefits for
Key messages workforce access to specialisation and advancement. These
benefits included enhanced career pathways, enhanced
• FIP Education Initiative surveyed 48 countries and territories
remuneration for practitioners and enhanced individual
worldwide to obtain information concerning specialisation
esteem and prestige.
and advanced practice policy and implementation at country
level. Both terms were described within the context of the
survey in order to assist with responses. Specialisation
was taken to mean advanced with narrow scope; advanced 3.1 Introduction and methods
practice was taken to mean overt advanced (beyond
foundation) with broad scope of practice. The survey obtained There is a growing global trend to formally recognise
48 country level responses ranging across WHO regions, the advancement of practice, which includes elements
economic and demographic characteristics. of specialisation and professional recognition. There
is evidence presented in this report suggesting there
• In this sample around half of the respondents (23, 48%) are benefits in developing a clear definition for scope
indicated the existence of an agreed country level definition of practice, for advanced practice and specialisation,
of “specialisation”. “Advanced practice” as an agreed national and that these benefits support workforce development
level definition was indicated by fewer respondents (11, 23%) and progressive service delivery of pharmaceutical care.
with a smaller number of nine countries (19%) indicating
country level consensus on both specialisation and advanced This section of the report presents a summary of the survey
practice. Advanced practice in this context was taken to mean administered to membership organisations or countries
a broad scope of practice, beyond foundation level. that are represented by FIP. The survey was developed in
collaboration with the FIP Collaborating Centre, University
• There are no clear associations with the existence of country College London School of Pharmacy, Faculty of Pharmacy
level definitions of specialisation or advance practice with and Pharmaceutical Sciences at Monash University, and FIP
national pharmacist capacity; high capacity countries do Education Initiative. The survey was validated by an expert
not have a tendency to have definitions compared with low working group, drawn from a cross-section of FIP sections
capacity countries. However there is a level of association with and special-interest groups.
economic development; higher income countries tend to have
a provision of formalised specialisation and advanced practice The 2015 advanced practice and specialisation survey was
contrasted with lower income countries. conducted between January 2015 and May 2015. FIP member
organisations, country and territory level contacts from
• For workforce development of advanced and specialised regulatory, professional and government agencies and
practice a number of countries stated categorically that universities were approached for responses to a survey,
practitioner frameworks were currently available – or under asking for quantitative and multiple-choice responses
active development – and accounted for 58% (28 nations) concerned with advanced practice and specialisation in their
in this sample. It was notable that 10 countries indicated country. Demographic and economic data was also collected.
that frameworks had been adapted from the work of other The survey tool was made available in 2 languages (English
countries potentially showing a high degree of collaborative and Spanish). The dataset was cleaned and checked with
practice between countries and leadership organisations. respondents before being prepared for analysis. The survey
tool, data tables and the report are available for download
from www.fip.org/educationreports.

Frequency counts and valid percents (taking into account

missing data for some items) are reported here.

11
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3.2 Terminology, nomenclature

. 3.3. Survey summary
and language and sample demographics
The survey reported here was necessarily administered In total, FIP Education Initiative was able to obtain broad data
to member organisations before the full report data set had from 48 countries and territories worldwide. The data were
been retrieved and analysed. Hence, the survey terminology subject to quality assurance and checking processes, before
and language was given careful consideration beforehand, being coded and entered into a database for subsequent
and use of expert opinion and consensus from FIP sections analysis. Analysis was conducted primarily by descriptive
was sought. The terminology used for responding to the statistics. The analysis presented here should be interpreted
survey item set used “specialisation” and “advanced practice” within the limitations of generalisation and based on the best
as labels and a definition of contextual meaning was provided available data collected by the FIPEd team. It is clear from an
within the survey. overview of the detail provided by respondent countries that
codifying and defining advanced practice and specialisation
“Specialisation” was taken to relate to a higher, but narrow, is complex. Nonetheless this section of the report will provide
focus on scope of practice. a first view of the global situation for advancement of
pharmacy practice. Table 1 shows responses by WHO region of
“Advanced practice” was intended to relate to a higher, origin.
but broad, scope of practice.

Both terms, de facto, relate to practice that is beyond Table 1: Respondent frequencies by WHO region.
initial education and training, and beyond what can
be broadly considered as foundation practice or training, FIP Advanced
and both cases, generally relate to practice beyond three & Specialisation % All WHO %
Report 2015 Member States
years post-registration/licensing. See Figure 1 for a schematic
of this concept. Africa 6 12.5 46 23.7
Eastern Mediterranean 4 8.3 22 11.3
For the interpretation of the survey data, this was the context
Europe 20 41.7 53 27.3
for organisations to provide responses.
Pan America 8 16.7 35 18.0
South-East Asia 2 4.2 11 5.7
Figure 1: Advanced and specialist - broad and narrow scope. Western Pacific 8 16.7 27 13.9
Total 48 100 194 100
Stages of knowledge, skills, experience

Advanced; broad scope Advanced; narrow scope By comparing with the proportions of WHO member states
Competency ‐ Performance

(for example, general

practice roles)
(specialist roles) within regions it can be seen that the survey returns are
weighted more towards European countries and less on
African countries. For the other WHO regions there are similar
sample proportions.

The respondent countries were also classified by income

“Day 1” post-‐registration
initial education outcomes
Specialist, foundation level level using the current World Bank categorisation and this
(for example, technical roles)
and early career years information is shown in Table 2 for interest and context.

Technical/support cadres
Table 2: Responses by World Bank income classification.

Broad focus Narrow focus Count %

Low Income 3 6.3

Lower Middle Income 6 12.5
Upper Middle Income 14 29.2
High Income 25 52.1
Total 48 100

12
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In this sample, there are higher proportions of responses from The sample of 48 countries and territories in this report has
upper and higher income countries, the largest proportional an equitable distribution between high and low capacity
responses from European countries, which may contribute to countries, as seen in Figure 2. The sample mean capacity
this weighting. In addition, Table 3 shows the organisations statistic for the 48 countries and territories represented is
responding to the survey in this sample (noting that some 8.4 pharmacists/10,000 population, which is larger than a
responses, especially those with university affiliations, global mean published by FIP Education Initiative in its 2012
were responding on behalf of membership and leadership Workforce Report (a mean of 6.02 pharmacists/10,000 with
organisations). a sample size of n = 109 countries) and is a consequence of
sample size difference (www.fip.org/education). We would
conclude that we have relatively fewer lower capacity
Table 3: Responding organisations and affiliations. countries represented in this survey. Nonetheless, the
survey represents a range of capacities and economies for
Count % generalisability of the analysis.

Higher Education Institution 21 43.8

Licensing agency/Regulator 5 10.4
Professional Leadership Body 22 45.8
Total 48 100

Figure 2: Pharmacist capacity standardised as per 10,000 population

(n=48 countries who responded to this survey).

25.0
Capacity: Pharmacists per 10,000 population

20.0

15.0

10.0
Sample mean 8.4

5.0 Global mean (FIP 2012) 6.0

.0
Malta
Japan
Jordan
Egypt
China Taiwan
Italy
Iceland
Portugal
Republic of Korea
Belgium
Australia
Ireland
New Zealand
Canada
Germany
F.Y.R. Macedonia
USA
Grenada
Switzerland
UK
Costa Rica
Romania
Denmark
Philippines
Finland
India
Hungary
Saudi Arabia
Norway
Israel
Turkey
Uruguay
Singapore
Netherlands
Malaysia
South Africa
Ghana
Nigeria
Zimbabwe
Nepal
Uganda

13
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3.4 Specialisation and advanced practice In contrast, organisational respondents were asked if
definitions, or agreed descriptions, of the terminology related
to “advanced practice” were available at country level. There
In the survey, respondent organisations were asked if was a 23% response to this question, with 11 countries
there was a clear separation of regulation (licensing) from claiming an agreed definition of “advanced practice”, and 9
professional leadership (membership organisation) at country countries and territories (19%) providing evidence of defined
level. Thirty-eight (38) countries and territories indicated that practice that covered “specialisation” and “advanced”.
there is separation of responsibilities, with 10 countries and Matching the availability of having, at country level, either a
territories (20.8%) indicating non-separation of regulation from defined process or acceptance of specialisation or advanced
leadership. practice, 25 countries (52%) report one or the other being in
place.
The survey asked respondent organisations for data
concerning agreed definitions, or scope of practice, for For those countries and territories that do have a defined
their contextual understanding of advanced or specialist notion of “specialisation” or “advanced practice” there is
practice (see Section 5 of this report for deeper context and no measurable correlation with capacity, so this does not
discussion). Of the 48 countries and territories in this sample, appear to be confined or driven by numbers of pharmacists
23 (47.9%) indicated a country level agreement on a definition in any particular country. However, there does appear to be
of “specialisation”. Table 4 indicates the lead agency or an association with income level or national GDP, with the
organisation for this country level definition, and shows that high-income classified countries having a greater weighting
leadership or “ownership” of definitions for specialisation on provision or acceptance of formalised specialisation and
lie more or less equally shared (in this sample) between advanced practice (chi2, p=0.025, see Figure 3).
professional bodies and government or regulatory agencies
(35% against 48%).
Figure 3: Availability of Specialisation/Advanced definition
with income levels (n = 48).
Table 4: Lead agency for country level definition of “specialisation”.
Country income level (World Bank)

Count %
Specialisation and Advanced definitions available

Professionally led 8 34.8 No

60.0% Yes
Government or Ministry 7 30.4
Regulator/Licensing agency 4 17.4
Not stated 4 17.4
Total 23 100
% within bar category

40.0%

Those respondents indicating a country level definition, or

understanding, of the term specialisation (contextualised
20.0%
within respective countries) are listed in Table 5.

Table 5: Countries stating a definition of “specialisation” 0.0%

of scope of practice.
Lower Upper
Low Income Middle Income Middle Income High Income

Belgium Japan Singapore

Costa Rica Macedonia (Rep. of) Slovenia
Finland Netherlands South Africa
Germany Peru Switzerland
Ghana Portugal Turkey
Hungary Republic of Korea United Kingdom
Iceland Romania Uruguay
Israel Saudi Arabia

14
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3.5 Frameworks for specialisation Examples of these post-nominal titles include:

and advanced practice Country Post-nominal titles
Australia Adv. Prac. Pharm. [Advanced Practice Pharmacist]

A number of countries and territories – 18 (38%) – stated New Zealand RegPharmNZ [Prescriber]

categorically that frameworks were available for practitioners Nigeria FPCPharm [Fellowship of Postgraduate
to use for guidance to describe specialisation (narrow scope of College of Pharmacists]
practice) or advancement (broader scope of practice). A smaller Romania Farmacist Sp. [Specialist]
number of countries and territories in this sample also said
United Kingdom MFRPS I, MFRPS II, FFRPS [Advanced Stage I/II
that activity was underway to provide framework guidance;
(Great Britain) or Fellow of Faculty Royal Pharmaceutical Society]
in total, 58% (28) indicated that frameworks were available or
were being developed. Of these, it is striking that 38.5% (10) USA APP [Advanced Practice Pharmacist]

have either used directly, or are adapting, frameworks from (California) CPP [Clinical Pharmacist Practitioner]
other countries, which potentially shows a high degree of USA BPS [Board of Pharmacy Specialties]
collaboration in progress globally. However, it is apparent that
high-income countries have a tendency to have developed The responsibilities for awarding professional recognition
frameworks, or are more likely to do so as shown in Figure 4. or use of a post-nominal to individual practitioners, in this
There is scope here for further collaborative working practice sample, seems mainly to stem from professional leadership
between countries and leadership organisations. bodies, with 84% (16) of those countries and territories (who
indicate a form of professional recognition status) stating
that either professional leadership bodies (or combined with
Figure 4: Specialisation/Advanced framework development by Income level. regulators) are the “awarding” organisation, rather than
government agencies.

Country income level (World Bank)

3.6 Prescribing as a specialisation
Availability of framework to describe
specialisation (narrow scope) and/or advanced The survey investigated the prevalence of prescribing rights by
pharmacy practice (broad scope) pharmacists. Member organisations were asked if, at country
level, there existed overt legal provision for pharmacists to
60.0% No independently prescribe medicines (‘independent prescribers’
Under development
Yes
and specifically not “over the counter” medicines). In this
sample, 9 countries (19%) indicated that legal prescribing
rights did exist and these are listed in Table 6.
% by category

40.0% Table 6: Countries indicating legal prescribing rights available to Pharmacists.

Countries indicating legal prescribing

rights available to Pharmacists
Canada
20.0%
Ghana
Israel
Namibia
Saudi Arabia
0.0%
Low Income Upper South Africa
Lower Middle Income
United Kingdom
Middle Income High Income
USA
Zimbabwe

Combining responses, 23 countries and territories (49% of The requirement for formal qualifications for pharmacist
valid sample) stated that there was availability of professional prescribing for these 9 countries indicated that further
recognition of specialisation and/or advanced practice specialist and CPD training was a requirement and for 3
roles within that country and indicated an award of “titles” countries, collaborative practice agreements were also
associated with this and 20 countries (42% of the sample) required. For at least 5 of these countries, pharmacist
indicated the use of a formal post-nominal for individuals that prescribing rights was also formally linked with recognition
match this professional recognition. of specialisation and/or advanced practice.

15
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3.7 Benefits of specialisation 3.8 Summary

and advanced practice
This survey of 48 countries and territories is the first of its
kind to attempt to look at the variety of specialisation and
Respondent organisations were asked to list tangible, professional recognition for advanced practice worldwide.
or visible, benefits of the reasons for specialisation and The complexity of data arising from the survey was surprising,
advancement – particularly those related to professional and will result in further work from FIP Education Initiative to
recognition processes rather than direct subject-specific support FIP member organisations.
specialisation (for example, specialist training to become a
radio-pharmacist). What is clear from this first data set is that professional
advancement and the recognition of advancement in practice
Respondents were divided on this question, with 49% is clearly a developing trend worldwide. This can be attributed
(22) stating that there are clear benefits for having overt to a number of reasons, such as the increasingly complex role
professional recognition mechanisms at country level; there of pharmacists, the enhancement of more patient facing roles
is a close association (at p<0.0001 level) with those countries and greater extent of clinical pharmacy with the associated
who have introduced professional recognition process risk this entails, and a consequent need to be able to endorse
for advancement and stating clear and tangible resultant professional capabilities. Comparisons and parallels with
benefits. Table 7 shows in more detail the categories of benefit medical practice and the advancement of physicians, for
stated by respondent organisations. Developing career example, are notable.
pathways is common together with links to remuneration for
advancement. If we are to become a more clinical profession, with enhanced
responsibilities and accountabilities for pharmaceutical care
Table 7: Categories of stated benefits for pharmacists.
in clinical environments then clear pathways for workforce
development, coupled with professional recognition and
credentialing of practitioners, is a policy imperative. There is a
Count % clear opportunity for transnational collaboration and further
opportunities for transnational recognition of advanced
Enhanced career pathway 7 36.8 capabilities for the pharmacy workforce.
Enhanced remuneration 11 57.9
Individual Esteem/prestige 1 5.3
Total 19 100

16
PART 4
TRENDS AND INNOVATIONS
CASE STUDIES
.................................................................................. ..................................................................................

Key messages of the case studies Ireland: The Irish Institute of Pharmacy has been established
to enable pharmacists to engage with an approved model
Argentina: There are seven recognised specialties, which of continuing professional development. Identification of
relate to sector of practice (hospital, community, sterilisation, skills required by pharmacists to support national healthcare
industrial, health and legal, nutrition and food analysis, strategies will ensure alignment in future development of
biopharmacy). Recognition is via professional bodies, some advanced practice and specialisation. Advanced practice
of which have developed formal pathways. Recognition of frameworks will be developed to reflect requirements for the
hospital pharmacy as a specialty is the most developed, with Irish healthcare system.
a comprehensive training programme, a residency programme
and an agreed model of practice. Japan: There is no standardised pathway for the professional
recognition of pharmacist specialists currently, however areas
Australia: There is a nationally agreed advanced practice of more advanced practice are increasing. Currently there is a
framework, which describes practitioner development in all range of credentials available to pharmacists that are awarded
sectors of pharmacy practice, along a continuum, with three by professional organisations and educational bodies. The
defined levels of advancement. The Australian Pharmacy Japanese Pharmaceutical Association has developed a life-long
Council is currently undertaking a credentialing of advanced learning support system, which includes a clinical ladder
practice pharmacists pilot programme prior to a full roll out of with ten levels of skills development. Support for foundation
an advanced practice credentialing programme. levels (1-5) is currently available, and is in development for
more advanced levels (6-10), including linking to areas of
Canada: All major pharmacy associations in Canada are specialisation.
working collaboratively to develop a blueprint for pharmacy,
which will align pharmacy practice with the healthcare Malaysia: There is currently no formal specialised training
needs of Canadians. Work is currently underway on a and recognition, however specialty practice has developed
needs assessment of specialisation in pharmacy. This will in a number of clinical areas. Clinical pharmacists are
include agreement on a definition for the term “pharmacist required to undertake mandatory training and observation
specialisation”. in approved hospitals, and some have the opportunity for
postgraduate study. The Malaysian Academy of Pharmacy has
China: Clinical pharmacy has been recognised and is now a role to advocate and facilitate provision, credentialing and
supported by standardised training through accredited accreditation of specialists and advanced level practitioners in
training sites. Specialisation in areas such as oncology and pharmacy practice.
anti-coagulation is beginning, however there are not yet
agreed competencies or an accreditation system for this New Zealand: A funded pathway for advanced practice, and
activity. a number of funded cognitive, collaborative and advanced
pharmacy services, has been accompanied by government
Great Britain | United Kingdom: The professional body in policy to support pharmacists’ role in the healthcare team.
Great Britain - Royal Pharmaceutical Society (RPS) provides a Credentialed services include prescribing, vaccination,
professional recognition programme for advanced practice. anticoagulation, and supply of emergency contraception,
The “RPS Faculty provides resources and services to assist trimethoprim and sildenafil without prescription.
practitioner development by meeting competencies outlined
in the Advanced Pharmacy Framework (APF). There are three Philippines: Work is underway to develop an advanced
developmental stages of recognition and credentialing pharmacy practice framework by revising and adapting
available to advanced practitioners based on review of a a framework in use internationally. There is currently no
submitted professional practice portfolio, peer-assessment licensing of specialist pharmacists, however there are
evidence and scope of practice evidence. Post-nominal workshops available to support pharmacists wishing to
endorsement is granted by the RPS at each Faculty stage. undertake specialty certification in the USA. Enhancement
of professional competence has recently been supported
India: The Pharmacy Council of India is aiming to advance with the introduction of mandatory continuing professional
pharmacy practice via development of regulations to define development.
aspects of practice. More patient-centred care has been
facilitated by implementation of PharmD programmes and Portugal: There are four recognised specialties, which relate
mandatory continuing professional development for all to sector of practice (clinical analysis, regulatory affairs,
pharmacists. hospital pharmacy, pharmaceutical industry).Approximately
14% of Portuguese pharmacists are recognised as specialists.
The Portuguese Pharmaceutical Society is developing
a competency-based model to recognise these four areas
and plans to pilot the framework in one of the recognised
specialty areas.

17
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Singapore: Under the current career structure, pharmacists

working in the public healthcare sector can develop their
career in either professional, clinical or research tracks,
and can progress to become advanced practitioners in each
of these tracks. Accreditation and registration of specialist
pharmacists is available, and there are scholarships
to support specialist training.

South Africa: There are four recognised specialties which

relate to sector of practice (radiopharmacy, pharmacokinetics,
clinical pharmacy, public health and management). Scopes of
practice and required qualifications for specialist pharmacists
and pharmacist prescribers have been developed and are
expected to be regulated shortly. This has been accompanied
by enhanced career paths for pharmacists in the public sector

Spain: Pharmacy practice in Spain, including specialisation,

is largely governed by regulations covering all healthcare
professionals. The titles of “Hospital” and “Primary Care
Pharmacists” are exclusive to pharmacists and require training
as a resident intern pharmacist. Other areas of specialisation
(e.g. clinical analysis and biochemistry, clinical genetics)
are multi-disciplinary and have education and training
requirements.

Switzerland: The professional society (pharmaSuisse) is

responsible for providing the programmes and titles for
recognition and maintenance of federal titles in community
and hospital pharmacy. Holders of these titles are required
to undertake continuous professional development. It will be
now compulsory for pharmacists-in-charge of a hospital or
community pharmacy to have a postgraduate title.

USA (California, North Carolina): There are many state based

differences in the recognition of specialty and advanced
pharmacy practice. The profession is advocating for
federal recognition of pharmacists as healthcare providers,
which would enable payment for cognitive and clinical
services. Some states have developed innovative advanced
practice models, and many pharmacists are pursuing board
certification in a growing number of specialties.

18
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Argentina: Seven recognised specialties Tools, frameworks and support mechanisms

There are a number of activities that encourage the
Authors development of hospital pharmacy. Argentina was the first
country in Latino America to set up residencies in hospital
Marcela Rousseau, President, Argentine Association of pharmacy (1981). Currently, there are hospital pharmacy
Hospital Pharmacists and Coordinator Clinical Pharmacy, residencies in 28 private and public hospitals across six
Garrahan Hospital, Buenos Aires, rousseau.marcela@gmail. provinces, and in Buenos Aires City.
com; Viviana Bernabei, Treasurer, Argentine Association
of Hospital Pharmacists and Chief of Hospital Pharmacy, The AAFH have organised two symposia of Pharmacy
Tetamanti Hospital, Mar del Plata, Province of Buenos Aires, Education, including an international symposium in 2013,
vivianabernabei@gmail.com; Silvia Campos, Vice President, in which we defined how to achieve specialty certification
Argentine Association of Hospital Pharmacists and Provincial in Argentina according to international standards. In 2015
Director of Health Regulation, Ministry of Health, Province we continue working with the Ministry of Health and
of Jujuy, silviabcampos@gmail.com; Alicia Avila, President international colleagues to develop an accreditation
Scientific Committee, Argentine Association of Hospital system for residencies.
Pharmacists and Chief of Hospital Pharmacy, Complejo
Sanitario San Luis, Province of San Luis, aliciabarca@yahoo. In 2014 AAFH, in collaboration with hospital pharmacists,
com.ar; Pamela Bertoldo, Secretary and Scientific Committee, established the Professional Standards Model for Hospital
Argentine Association of Hospital Pharmacists and Chief of Pharmacy Services (MPPFH). The challenge remains to increase
Hospital Pharmacy, Principe de Asturias Hospital, Province awareness and implementation of these standards.
of Córdoba, Teacher and Researcher Catholic University of
Córdoba, pamela.bertoldo@gmail.com. The AAFH offers an annual course for hospital pharmacy
(Comprehensive Training Program in Hospital Pharmacy -
PROCIFH). The first level comprises 485 hours in basic topics
delivered by virtual education with the support of Pan
Summary American Health Organisation (PAHO). This level includes:
management, drug evaluation and selection, clinical, and
• In Argentina, seven pharmacist specialties were determined development of medicines in hospital. In 2014 PROCIFH had 686
by the National Ministry of Health in 2013: hospital pharmacy, pharmacists studying at least one of the four blocks of content.
community pharmacy, sterilisation, industrial pharmacy,
health and legal pharmacy, nutrition and food analysis, The second level of PROCIFH includes: critical care, medication
and biopharmacy. There are the following formal reconciliation, medical devices & management in hospital
mechanisms to recognise specialities: pharmacy, and HIV therapeutics. This annual online program
includes assessments and activity blocks. Its overall objective
• Academic professor related to the specialty, is to update the conceptual and methodological knowledge of
• Written test to pharmacists with five years of practice, or hospital pharmacists.
• Accredited residency
Other education sessions offered include an annual congress,
• Currently only hospital pharmacy and sterilisation have activities in patient safety, and an annual pharmacovigilance
established mechanisms to certify its specialist: meeting.

• AIn 2013, the Argentina Association of Hospital Pharmacy These topics allow the integration of pharmacists in health
(AAFH) and the Argentina Society for Industrial Pharmacy teams (mainly in hospitals), an important activity encouraged
and Biochemistry (SAFyBI) began the process of formal by authorities through quality programs and awards.
recognition as certification authorities for specialty
in hospital pharmacy and sterilisation Sterilisation is also recognised as a specialisation for
• Written test to pharmacists with five years of practice, or pharmacists in Argentina, either in hospital or industrial
• Accredited residency pharmacy. There are university courses in sterilisation and
different organisations that support its development.
Development of industrial pharmacy is very important in
Argentina, which leads the production of drugs in Latino
America. The Argentine Association of Industrial Pharmacy
holds a prime position in training especially in new
developments such as biopharmaceuticals.

19
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Alignment with national strategies for Ongoing progress

healthcare services and delivery
In 2014 the AAFH developed the Model of Practice in hospital
The Argentine health system has a strong operational pharmacy, and during 2015 developed an evaluation
decentralisation, and provincial governments are responsible instrument. In November 2015, to recognise excellence
for health planning according to the needs of each in implementation of the Model of Practice, the AAFH will
jurisdiction. Due to this decentralisation, the inclusion of present the inaugural Best Related Initiative Award at the
hospital pharmacy in the strategies of the different local Annual Meeting of the Hospital Pharmacy Section.
health services varies greatly. The accreditation of hospitals
by the Joint Commission (http://www.jointcommission.org) The Professional Standards Model for Hospital Pharmacy
is another important support in hospital pharmacy. Services (MPPFH) is a consensus on the skills, knowledge
and competencies that a hospital pharmacist should have
There are very few hospitals that undertake this process to comply with certain provisions with the aim of ensuring
of accreditation and so hospital pharmacy in those hospitals the provision of individualised, safe pharmacotherapy, which
is recognised and valued. is cost effective, and based on the best available scientific
evidence in hospitals and related care system.1
There is very good integration in the biggest province, Buenos
Aires, which has a central commission of hospital pharmacy. In 2016 it is expected the assessment tool for the MPPFH
In Buenos Aires City, private hospitals generally have more will be implemented and validated.1
technology and offer more complex professional services
than public hospitals. However, there are some public hospital The AAFH offers an annual course for hospital pharmacy
pharmacies who offer a high level of pharmaceutical services (PROCIFH), which is described above.
in, for example, pharmacovigilance, clinical pharmacokinetics,
quality management systems, management of medical
devices, and IV compounding. Traceability is an official Lessons learned
regulation, which requires hospitals to develop Unit Dose
Distribution Systems. Public primary care programs encourage The Ministry of Health Resolution 1086/2013 was an important
pharmaceutical care in HIV and other chronic diseases in step to enable implementation of specialty certification. This
hospital pharmacies. directive will allow the recognition of pharmacist specialties
in different practice environments and it is essential for the
beginning of the certification process.
Supporting regulation
Hospital pharmacy is the most developed specialty, with
• Resolution 241/00. Standards of organisation and a consolidated system of pharmacy residency at the
operation of pharmacies in health care facilities; postgraduate level. Currently the residencies are not
• Resolution 1023-2012. Minimum requirements for accredited and graduates of the residency programmes cannot
services and areas of hospital pharmacy. National access the formal title of ‘specialist’.
Quality Assurance Program;
• Resolution 1086/13 Recognises specialisation A pharmacist may become a ‘Specialist in Sterilisation’ after
in pharmacy’s profession; completing two or more years of postgraduate training in a
• Resolutions 3683-11, 1881-12, 247-13, 963-2015 Drugs university centre of sterilization. This modality for reaching
traceability application in Hospital Pharmacy; specialist certification is not currently effectively implemented
• Resolution 2303-2014 Traceability of medical products; in Argentina.
• Resolution 209/ 1996 and Sterilization Standards
(modified 102-2008). The development of Standards of Practice for hospital
pharmacists and the definition of a Model of Practice are
expected to promote similar actions in other pharmacist
specialties. In Argentina, each jurisdiction has different
Professional recognition professional realities and regulations, with different ways
of practice. Therefore, the effective application of a Model of
The Argentinian Ministry of Health, and its scientific societies Practice, including minimum standards, will have a favourable
or professional associations/boards, award pharmacists’ impact on practice, shortening these inter-jurisdictional
specialist certification. differences.

20
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Formal recognition of the professional associations as

certification authorities for specialty in hospital pharmacy
and sterilization needs to be effectively implemented for other
areas of specialisation. Similarly, it is necessary to achieve a
common legal recognition in all jurisdictions of the country.
It is important that health authorities stimulate the
formation of specialists. The professional organisations and
other educational institutions should continue working in
education, accreditation and certification to achieve optimal
outcomes with the professional recognition of specialisation.

Key stakeholders
Institutions involved in the recognition for advanced practice
and specialisation are Ministry of Health, Universities and
Associations (e.g. AAFH, SAFYBI).

References
1. Asociación Argentina de Farmacéuticos de Hospital (AAFH). Modelo de
práctica profesional en farmacia hospitalaria, Revista De La Aafh. AAFH. 2014;
1:2. Available from: http://www.aafhospitalaria.org.ar/revista/descarga/
Revista_AAFH_V1N2.pdf

21
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Australia: Nationally agreed advanced Figure 1: Domains for demonstrating advanced practice in Australia within
an individual’s scope of practice for the purposes of credentialing.
practice framework
Profession’s scope of practice
(as reflected by the Pharmacy Board definition of practice)
Any role, whether remunerated or not, in which the individual uses their skills and
Authors knowledge as a pharmacist in their profession. Practice is not restricted to the provision
of direct clinical care. It also includes working in a direct, non-clinical relationship with
clients; working in management, administration, education, research, advisory,
Andrew Matthews, Director Credentialing, Australian regulatory or policy development roles; and other roles that impact on safe, effective
Pharmacy Council, andrew.matthews@pharmacycouncil. delivery of services in the profession.

org.au; Bronwyn Clark, Chief Executive Officer, Australian

Pharmacy Council, bronwyn.clark@pharmacycouncil.org.au;
Kylie Woolcock, Consultant, Australian Pharmacy Council,
kylie.woolcock@iinet.net.au.

Summary
• The impetus for an advanced practice framework grew from
the review of the National Competency Standards Framework
for Pharmacists in Australia in 2010.

• In 2011, the Advanced Pharmacy Practice Framework Steering

Committee (APPFSC) was established with representative
membership of pharmacy organisations (Australian
Association of Consultant Pharmacy, The Australian College of
Pharmacy, Australian Pharmacy Council, Council of Pharmacy
School Australia and New Zealand, National Australian
Pharmacy Students’ Association, Pharmaceutical Defence
Limited, Pharmacuetical Society of Australia, Pharmacy Board
of Australia, Professional Pharmacists Australia, The Pharmacy
Guild of Australia, The Society of Hospital Pharmacists of
Australia) in Australia.

• The APPFSC developed the Advanced Pharmacy Practice

Framework (APPF). This was released in October 2012. Individual’s scope of practice Advanced Pharmacy Practice Framework
A time-sensitive, dynamic aspect The five domains for demonstrating advanced
of practice which indicates those practice, where Expert Professional Practice
• The APPF was designed to be sufficiently flexible to serve as a professional activities that a refers to a particular field or subject in which
pharmacist is educated, competent an individual has acquired the knowledge,
template for describing advanced practice expectations in all and authorised to perform and for skills and experiences for them to be accepted
areas of professional practice (as seen in Figure 1). which they are accountable. as an expert.

• In December 2013, the Australian Pharmacy Council (APC)

was endorsed via the APPFSC as the independent entity being
responsible and accountable for the credentialing of advanced
practitioners in Australia.

• In 2015, APC began a Credentialing of advanced practice

pharmacists pilot programme, to test the APPF and APC
policies/procedures prior to implementing a full roll out
of an advanced practice credentialing programme.

• One hundred and thirty-eight Expressions of Interest were

received from pharmacists wanting to be part of the pilot. Fifty
were selected to participate. The participants were selected
across a broad range of pharmacy practice environments (e.g.
hospital, community pharmacy, industry, research, education).

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Tools, frameworks and support mechanisms Requirements for CPD/CE

The Advanced Pharmacy Practice Framework (APPF) for The mandatory requirements for continuing professional
Australia was based on the UK CoDEG Advanced and development (CPD) for all registered pharmacists in
Consultant Level Competency Framework and adapted for Australia are specified in the Pharmacy Board of Australia’s
Australian needs. Pharmacy CPD registration standard. However, there are no
specific requirements that link CPD to advancing practice or
The Australian Pharmacy Council (APC) undertook a literature specialisation recognition. Of course, if pharmacists do not
review of advanced and extended practice in pharmacy and meet the CPD expectations as specified in the registration
other health professions in 2013. This project informed the standard then their right to practise is at risk. It is expected
development of a contemporary and sustainable pathway that anyone pursuing advanced practice recognition would
for recognition of pharmacy practitioners in extended and undertake CPD over and above that required for continuing
advanced practice roles See Advanced and Extended Pharmacy registration.
Practice - an environmental snapshot.
There is also no formal academic pathway to specialisation
In February 2015, the APC developed: and/or advanced practice in Australia, though it is envisioned
• Evidence Guide - evaluation and credentialing that pharmacists who achieve the credential of Advanced
of advanced practice pharmacists; Practice Pharmacist will have postgraduate qualifications.
• Application form - credentialing of advanced
practice pharmacists.
Supporting regulation
Both documents were prepared for the APC Credentialing of
advanced practice pharmacists pilot programme. The Australian Health Workforce Ministerial Council (AHWMC)
The APC Evaluation Standards, Policies and Procedures and has previously provided guidance to National Boards who
Evidence Guide were developed through a process involving are the regulators of healthcare professions in Australia
two rounds of stakeholder consultation. (including the Pharmacy Board of Australia), on the approval
of specialities in a health profession for the purposes of
specialist registration under the National Registration and
Alignment with national strategies Accreditation Scheme. The AHWMC agreed that for approving
for healthcare services and delivery specialties a case for action must be established and a range
of feasible policy options considered, including self-regulation,
A fundamental premise of effective health care is the provision regulatory and non-regulatory approaches, and their benefits
of services that meet the needs of the public. When these and costs assessed. Consistent with this guidance, there is no
needs change, appropriate modification to the type and regulation by the Pharmacy Board of Australia in recognising
manner in which health care services are delivered is required. advancing practice and specialisation.

Credentialing of advanced practice is not intended to be

applied in a way that restricts or constrains the delivery of Professional recognition
professional services. The credentialing of advanced practice
pharmacists will provide a pathway for pharmacists to The APC Credentialing of advanced practice pharmacists pilot
progress to a more prominent place as an expert in medicines programme will recognise the first wave of pharmacists in
use, recognised and respected by other health professions and Australia with the credential of Advanced Practice Pharmacist.
the public, and encourages a culture of lifelong learning and The post-nominal that will be used is Adv Prac Pharm. The
on-going professional development. duration of the credential is currently being determined. The
APPF has three potential levels for professional recognition: L1
(Transition); L2 (Consolidation); L3 (Advanced).

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Ongoing progress Challenges:

The APC is undertaking (from January 2015 - September 2015) • “Genericising” the APPF in order to ensure its practical
an initial pilot programme of credentialing of advanced application for credentialing of advanced practice
practice pharmacists that will see the first wave of pharmacists from potentially all practice environments
pharmacists credentialed in Australia. Candidates for and expert areas.
recognition of advanced practice must prepare a practice
portfolio for evaluation by a credentialing evaluator panel • The pilot programme has chosen participants along
(each panel has three evaluators). Governance is by the APC all points of the advanced practice continuum to test that
Advanced Practice Credentialing Committee. the APPF and associated APC policies and procedures can
properly differentiate those that should be recognised
Timelines at L1 (Transition); L2 (Consolidation); L3 (Advanced)
April 2015: Submission of practice portfolios; However, it is clear that those likely at L1 and possibly
L2 need a lot more support to prepare a practice portfolio
May 2015: Training of credentialing for evaluation.
evaluators;
• Introducing new terminology and concepts (e.g. the
May – June 2015: Evaluation of portfolios; concept of using practice portfolio for evaluation) and
enforcing mandatory requirements such as the inclusion
June – July 2015: Portfolio interviews; and of multi-source feedback in practice portfolios.

August – September 2015: Outcome notifications to pilot • Consistency in provision of information between APC
participants. and the RSOs.

• Developing a robust and valid practice portfolio

Lessons learned evaluation process.
Positives:
• Timelines for the pilot and the volume of work
for participants to prepare a comprehensive
• A united commitment from pharmacy organisations
practice portfolio.
in Australia to establish a steering committee and
work together to develop an Advanced Pharmacy Practice
• Defining scope of practice and area of expert professional
Framework for Australia (via the APPFSC).
practice - it is clear that advanced practice applicants
have broad expertise in leadership, research, education
• Agreement of the pharmacy organisations to support
and communication, and are not just experts in ‘oncology’
a model for recognition of advanced practice
or ‘diabetes’.
and endorse the APC as the independent entity
for credentialing of advanced practice pharmacists.
• Communicating the message that the recognition process
supports professional development; those evaluated
• Enthusiasm for recognition of advanced practice by
at L1, or L2 have not ‘failed’ but will be provided peer
the profession and support from member
advice on where to focus their professional development
organisations, as reflected by support for the 2015
in order to pursue advanced practice recognition in future.
credentialing pilot.

• Member organisations as ‘readiness support organisations’

(RSOs) for their members, working together with APC. Key stakeholders
• Profession-wide consultation process and feedback on APC The pharmacy organisations are the key stakeholders, via
guidance documents, policies, procedures and standards an all of profession representative committee known as
that will be used for credentialing of advanced the Pharmacy Practitioner Development Committee (PPDC
practice pharmacists. - formerly the APPFSC). The regulator (Pharmacy Board of
Australia) is a member of the PPDC.
• Preparation of guidance documents and forms for the 2015 The implementation of the credentialing programme for
credentialing pilot e.g. Evidence Guide. advanced practice pharmacists, is being driven by the APC, the
independent accreditation, and credentialing organisation.
• A demonstration of the breadth and depth of the pharmacy Once the pilot program is completed in 2015 and the
profession as reflected by the mix of pharmacists selected evaluation results released, the pharmacy organisations will
for the pilot programme. need to actively support the recognition of advanced practice
more broadly through marketing and promotion to the
• Relatively smooth roll-out of pilot programme. profession, and not just via the PPDC.

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Bibliography
• Advanced Pharmacy Practice Framework Steering Committee (APPFSC).
An Advanced Pharmacy Practice Framework for Australia. Canberra: APPFSC
Secretariat; 2012. Available from: http://advancedpharmacypractice.com.au/
publications/

• Australian College of Pharmacy (ACP). Guidelines for the Awarding of Post-

Nominals. Canberra: Australian College of Pharmacy; 2015. Available from:
www.acp.edu.au/site.php?id=2333

• Australian Health Practitioner Regulation Agency (AHPRA). Accreditation

under the Health Practitioner Regulation National Law Act (the National
Law). Melbourne: AHPRA; 2012. Available from: www.ahpra.gov.au/
Publications/Accreditation-publications.aspx

• Australian Health Workforce Ministerial Council (AHWMC). Guidance

for National Board submissions to the Australian Health Workforce
Ministerial Council for approval of specialties under Section I3 of the Health
Practitioner Regulation National Law. Canberra: Australian Health Workforce
Ministerial Council; 2014. Available from: http://www.ahpra.gov.au/About-
AHPRA/Ministerial-Directives-and-Communiques.aspx

• Australian Pharmacy Council (APC). Advanced practice pilot shows depth

and breadth of pharmacy profession [media release]; 2015. Australian
Pharmacy Council Ltd. Available from: http://pharmacycouncil.org.au/
content/assets/files/Media%20Releases/20150121-MR---APC-Advanced-
Practice-Pharmacists.pdf

• Australian Pharmacy Council (APC). Application form - credentialing of

advanced practice pharmacists. Canberra: Australian Pharmacy Council
Limited; 2015.

• Australian Pharmacy Council (APC). Evidence Guide - evaluation and

credentialing of advanced practice pharmacists. Canberra: Australian
Pharmacy Council Limited; 2015.

• Australian Pharmacy Council Advanced and Extended Practice Steering

Committee (APCA and EPSC). Advanced and Extended Pharmacy Practice - an
environmental snapshot. Canberra: Australian Pharmacy Council Limited;
2013. Available from: https://www.pharmacycouncil.org.au/

• Competency Development and Evaluation Group (CoDEG). Advanced to

Consultant level Framework - a developmental framework for pharmacists
progressing to advanced levels of practice. London: Competency
Development and Evaluation Group; 2009. Available from: http://www.codeg.
org/fileadmin/codeg/pdf/ACLF.pdf

• Pharmacy Board of Australia (PBA). Pharmacy continuing professional

development registration standard. Melbourne: Pharmacy Board of
Australia; 2015. Available from: www.pharmacyboard.gov.au/Registration-
Standards.aspx

• Pharmacy Board of Australia (PBA). Registration Standards. Melbourne:

Pharmacy Board of Australia; 2015. Available from: www.pharmacyboard.gov.
au/Registration-Standards.aspx

• Pharmacy Board of Australia (PBA). Supervised practice arrangements

registration standard. Melbourne: Pharmacy Board of Australia; 2015.
Available from: www.pharmacyboard.gov.au/Registration-Standards.aspx

• Society of Hospital Pharmacists of Australia - SHPA. Fellowship of the

Society of Hospital Pharmacists of Australia. Melbourne: Society of Hospital
Pharmacist of Australia; 2012. Available from: http://www.shpa.org.au/lib/
pdf/about/fellow_doc.pdf

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Canada: Pharmacy associations working The Canadian Council on Continuing Education in Pharmacy
(CCCEP) agreed to take a leadership role in the implementation
collaboratively on a blueprint for pharmacy of the Key Actions 1.4 (Lifelong Learning) and 1.7 (Continuing
Professional Development and Continuing Education - CPD/
CE) of the blueprint for pharmacy implementation plan and
Authors co-hosted a CPD/CE Policy Summit in 2010 with the Canadian
Pharmacists Association. At this summit, eight Action Ideas
Jonathan Penm, Postdoctoral fellow, James L Winkle College were identified for implementing the framework and system
of Pharmacy University of Cincinnati, jonathan.penm@uc.edu; for recognition of specialisation and specialty areas of
Neil Mackinnon, Dean and Professor, James L Winkle College pharmacy practice.
of Pharmacy University of Cincinnati, RxDeanMac@uc.edu;
Jennifer Smith, President, Intergage, jlsmith@intergage.ca; 1. Key stakeholder meeting to define and describe key
Derek Jorgenson, Associate Professor of Pharmacy, University of concepts such as special area of practice and specialty
Saskatchewan, derek.jorgenson@usask.ca. and to develop a schedule for implementation;
2. Development of a white paper on credentialing and one
specialising in pharmacy;
Summary 3. Conduct needs assessment for certification and
recognition of specialties;
• Extended practice pharmacists and pharmacists with 4. Develop a funding model;
advanced prescribing authority exist in Canada, however there 5. Meeting with national certification bodies to engage and
is no official definition for advanced practice or pharmacist get buy-in;
specialisation. 6. Meeting with educators to discuss role and get buy-in;
7. Communication strategy to inform pharmacy
• So far, pharmacists in Canada are encouraged to pursue professionals, public, etc. about the value of special areas
certification by the Board of Pharmacy Specialists (BPS) in the of pharmacy practice and how they would benefit from
USA if pursuing specialisation. its implementation;
8. Establishment of pharmacy special area of practice and
• In 2014, the Canadian Pharmacists Association and the specialisation certification system.
blueprint for pharmacy outsourced a needs assessment of
specialisation in pharmacy in Canada. These Action Ideas are being followed up by the blueprint for
pharmacy Steering Committee.
• Ensuring all pharmacists and key stakeholders (regulators,
academia, employers, other healthcare professionals, patients
etc.) have a straight forward definition for pharmacist Alignment with national strategies for
specialisation is crucial before additional work can occur in healthcare services and delivery
Canada.
The blueprint for pharmacy is a long-term initiative designed
to catalyse, coordinate and facilitate the changes required
Tools, frameworks and support mechanisms to align pharmacy practice with the health care needs of
Canadians. The Vision for Pharmacy is: “Optimal drug therapy
The blueprint for pharmacy is a collaborative initiative outcomes for Canadians through patient-centred care”
between all the major pharmacy associations in Canada. It is (http://blueprintforpharmacy.ca/about).
led by the Canadian Pharmacists Association (CPhA) and aims
to catalyse, coordinate and facilitate the changes required
to align pharmacy practice with the healthcare needs of Supporting regulation
Canadians.
There are limited regulations in place for specialist or
A blueprint for pharmacy Steering Committee helped to advanced practice pharmacists in Canada. Two Canadian
develop an implementation plan to support the achievement provinces have regulations in place for “advanced practice”
of the Vision for Pharmacy in Canada: Optimal drug therapy pharmacists.
outcomes for Canadians through patient-centred care.
There is one for extended practice pharmacists in the
Canadian Province of Alberta, where pharmacists can apply
to the provincial pharmacy regulatory body for “additional
prescribing authorisation”.

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The process is tightly regulated and pharmacists must meet Lessons learned
strict criteria to receive this extended practice designation
(e.g. at least one year of experience working in a collaborative • Recognition for pharmacy specialisation has been largely
clinical team, additional clinical training, etc.). The additional driven by pharmacists themselves.
prescribing authorisation allows the pharmacist to prescribe
almost any medication, except for narcotics and controlled • The drive for pharmacist specialisation needs to be based
substances. on improvements to patient care and/improved efficiencies
within the health system.
In Manitoba, pharmacists may obtain “extended practice
authorisation”. Extended practice pharmacists are required • The term ‘pharmacist specialisation’ is used in a wide variety
to practice in a specialty area and provide satisfactory of contexts and no single definition is agreed upon in Canada.
evidence of specialisation through qualifications listed in the Ensuring all pharmacists and key stakeholders (doctors, nurses,
regulations. patients and administrators) have a straight forward definition
is crucial before additional work can occur in Canada.
Further details on the extended scope of practice pharmacists
can do in Canada can be found here: • There needs to exist a distinction between pharmacist
http://www.pharmacists.ca/index.cfm/pharmacy-in-canada/ specialisation and advanced practice.
scope-of-practice-canada/
http://www.cmaj.ca/site/press/cmaj.121990.pdf • Although many pharmacists support the development of
a Canadian-specific accreditation program for pharmacist
specialisation, given the size of Canada’s pharmacist
Professional recognition population, it may be more viable to use international
certification bodies instead of creating a Canadian-specific
Upon completion of a residency, the resident may use the one.
title designation of ACPR (Accredited Canadian Pharmacy
Resident). All residency programs are accredited by a national
accrediting agency. Key stakeholders
Some clinical pharmacist jobs are now expecting the Blueprint for pharmacy (http://blueprintforpharmacy.ca/).
candidate to have completed a residency (financial incentives),
but this is a minority of workplaces. Professional organisations: Canadian Pharmacists Association
(CPhA), Canadian Council on Continuing Education in Pharmacy
(CCCEP), Pharmacy Examining Board of Canada (PEBC),
Ongoing progress Canadian Society of Hospital Pharmacists (CSHP), Provincial
Pharmacy Regulatory Authorities, National Association of
The on-going work is being performed under the auspice of the Pharmacy Regulatory Authorities (NAPRA).
blueprint for pharmacy

• In 2010, the CPD/CE Policy Summit project identified a

main action idea was to conduct a needs assessment for
certification of specialities in Canada.

• In 2012, a Task Group on Specialisation in Pharmacy in Canada

was established.

• In 2014, The CPhA called for a request for proposal for a needs
assessment of specialisation in pharmacy in Canada.

Since then, a mixture of interviews and surveys has since

been conducted for this needs assessment of specialisation in
pharmacy in Canada.

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China: Clinical pharmacy recognised Requirements for CPD/CE

and supported by standardised training
Pharmacists are encouraged to undertake CPD and are
required to get a certain number of credits each year. These
Author can be gained in a variety of ways including attending
conferences, seminars or training courses. These activities are
Zhu Zhu, Associate Director, Chinese Pharmaceutical not linked to university yet.
Association, zhuzhu666777888@hotmail.com.
Ongoing progress
Summary There is a need for the following key factors to be present to
support development of professional recognition:
• After introducing the concepts of clinical pharmacy
in the1970’s and pharmaceutical care in 2000 in China, • Clear standards to describe and evaluate specialisation
pharmacists are expected to provide patients with competencies;
professional instruction on proper administration and caution • A clear evaluation and accreditation system;
for medications, and to provide advice to physicians with • An authorised accreditation institution;
therapeutic drug monitoring and necessary adjustment on • Qualified evaluators who have the requisite education
dosage regimens, especially for those patients with impaired background and practical experience;
renal function or hepatic function. • A demonstrated need from patients and physicians;
• A series of exams and reviewing books;
• After prolonged effort, the concepts of clinical pharmacy • Textbooks and guidelines need to be translated into
and clinical pharmacists were officially recognised in 2002 Chinese so it becomes more accessible for pharmacists
(Provisional Rules of Pharmaceutical Affairs Management to read and implement best practice.
of Medical Institutions) and 2010 (Pharmaceutical Affairs
Management of Medical Institutions).

• More recently pharmacists have been encouraged to practice Lessons learned

in several specialisations including Total Parenteral Nutrition
(TPN), anti-coagulation, Intensive Care Units (ICU), oncology, Some of the lessons learned during this process are that
and pneumology. hospital pharmacists already provide pharmaceutical care.
The curricula in pharmacy schools and universities are out
• In order to maintain standardised training of clinical of date so that the capacities of graduates cannot meet the
pharmacists, the Ministry of Health issued a guideline on contemporary needs of hospital pharmacy.
training and accredited nearly 100 qualified training sites
nationally.
Key stakeholders

Alignment with national strategies for Professional organisations are the major force driving
development of more advanced practice through professional
healthcare services and delivery conferences, seminars and training courses.
The Chinese government promotes rational use of
medications, especially antibiotics. Pharmacists were found
to play active roles against irrational use of medications,
e.g. higher dose or longer duration, improper medication
or intervals, etc. Therefore, pharmacists are encouraged to
review prescriptions and medical orders in order to prevent
improper use of medications since 2012.

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Great Britain (UK): Professional recognition Tools, frameworks and support mechanisms
programme of advanced practice
The RPS has developed its own resources building on work of
the Competency Development and Evaluation Group (http://
Authors www.codeg.org/). These now extend to handbooks, guidance,
support tools and standards.
Chris John, Workforce Development Lead, Royal
Pharmaceutical Society, christopher.john@rpharms.com; The RPS Faculty provides the professional recognition
Hannah Wilton, Head of Faculty, Royal Pharmaceutical Society, programme of advanced practice across Great Britain and
hannah.wilton@rpharms.com; Catherine Duggan, Director of (starting in) Northern Ireland. The RPS Faculty provides
Professional Development and Support, Royal Pharmaceutical pharmacists with support networks, access to experts
and mentors across all sectors, and at all stages of their
Society, catherine.duggan@rpharms.com.
professional careers, alongside opportunities to develop
professionally, to build a portfolio of transferable knowledge
and skills that is widely recognised. Available to RPS members
Summary who have completed their first two to three years of practice
post registration, the Faculty supports them throughout the
• RPS members have access to a range of resources and whole of their career as a more advanced practitioner.
services that support their professional development and
help them meet the behavioural competencies outlined in the RPS members have access to a range of resources and services
Advanced Pharmacy Framework (APF). that support their professional development and help them
meet the competencies outlined in the APF, including:
• Stepping up to the challenge of meeting changing patients’
needs requires support and opportunities to develop and • a suite of Faculty resources to support professional
provide evidence of excellence. This is the role of the Royal development and advancement within the Faculty;
College in partnership with the profession itself. • professional curricula spanning clinical, specialist, generalist
and science, and generic areas such as management,
leadership, mentoring and support and, research and
evaluation;
• a portfolio to enable recording of professional development,
which is then submitted as part of a portfolio review.

Once a pharmacist’s development has been assessed and

recognised, they receive post-nominals that align to their
stage of practice (see Table 1). This provides a means of
demonstrating their professional experience and expertise to
their patients, the public and their employer.

Table 1: Faculty stages, descriptions and post-nominals.

Faculty Stage Description Post-nominals

Stage I Faculty member

Advanced Stage I  You are established in a role, performing well, and advanced beyond your foundation
"Established, practice years MFRPSI
Experienced" Practice OR
Are at a stage of specialisation and advancement beyond your early years of practice.

Stage II Faculty member

Advanced Stage II  You are an expert in an area of practice and are experienced. You routinely manage
"Excellent" Practice complex situations and are a recognised leader locally/regionally. MFRPSII

Faculty Fellow
You are a nationally recognised leader in an area of expertise (often internationally),
Mastery with a breadth of experience and expertise. You are recognised as a leader in FFRPS
"Exceptional" Practice community pharmacy; have a business/corporate leadership role; or are a
business/strategic leader in community. 

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Alignment with national strategies for Supporting regulation

health care services and delivery
The only post registration annotation to the professional
In 2010, the RPS started a process of long-term strategic register in Great Britain is for independent pharmacist
planning for a workforce wide professional recognition prescribers; these regulations came into effect in 2006.
process and scheme. The RPS is in a unique position to provide
leadership for workforce development that is independent of A pharmacist independent prescriber may prescribe
provider organisations, government policy changes and other autonomously for any condition within their clinical
vested interests. competence. This currently excludes three controlled drugs
for the treatment of addiction.
Maintaining professional standards of workforce development
and providing access to useful quality assured development In order to qualify as an independent prescriber, pharmacists
processes are a key function for professional leadership must complete a GPhC-accredited programme. On successful
bodies. More recently the Report by Robert Francis1, completion of the programme, pharmacists receive a practice
considers the responsibility of professions, the professionals certificate in independent prescribing, making them eligible to
and the wider workforce. Don Berwick2 followed this by apply for annotation on the register.
recommending:

“Mastery of quality and patient safety sciences and practices Professional recognition
should be part of initial preparation and lifelong education
of all health care professionals, including managers and Post-nominals are available to Faculty members as recognition
executives” of their stage of advancement (http://www.rpharms.com/
faculty/faculty-membership.asp). Details are in Table 1
Acknowledging the professional privilege to practice, and on page 29.
associated responsibilities, are key when developing tools
to support and empower the profession to play a key clinical
leadership role in optimising medicines for the best care of Ongoing progress
patients. Stepping up to the challenge of meeting changing
patients’ needs requires support and opportunities to develop The following six strategic imperatives for the RPS Faculty and
and provide evidence of excellence. This is the role of the Royal Foundation Programmes have been identified as essential to
College in partnership with the profession itself. deliver the potential of the RPS Faculty by 2020.

Strategic Imperative I: Every member will be supported at

every stage of their career, through the RPS Foundation and
Requirements for CPD/CE Faculty programmes, across all stages and areas of practice.
Strategic Imperative II: Every member will have opportunities
On looking back at the development of continuing
to develop and advance, and will have support from RPS
professional training for health professionals during the past
Mentors and Tutors.
25 years, it is of interest to note the long-term impact of the
Kennedy report3 on all health care practice. The requirement
Strategic Imperative III: Every member will have access
of pharmacists, doctors, and all other health professionals,
to a roadmap of quality assured education, training and
to demonstrate an active engagement with professional
development opportunities, mapped to the RPS career stages,
development is now required practice. It is salutary to note
from Foundation to Faculty, through our accredited provider
that “professional regulation” as a process usually results after
models.
a failure in patient care.
Strategic Imperative IV: Every member will have access to
The General Pharmaceutical Council (GPhC) is the regulator for
support for building their portfolio and gathering evidence
pharmacists in Great Britain. Its CPD framework is mandatory
ready for a quality assured assessment process.
for all pharmacists who are expected to maintain their
professional capability throughout their career by keeping
CPD records. These requirements are the same whether you
are a member of the RPS’s Faculty or not. There is a potential
for Faculty membership to be linked to CPD/Continuing Fitness
to Practice (CFtP) in future, especially as the GPhC moves from
a set number of CPD records towards a continuous cycle of
professional development. It is the ambition of the RPS Faculty
that membership and on-going development within the
Portfolio will provide the GPhC with the evidence required for
CFtP. One system for the profession.

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Strategic Imperative V: The quality of support, development

and assessment processes will be highly regarded:

• as a model to support continuing professional

development by GPhC (accredited as the gold standard
for revalidation / Continuing Fitness to Practice);
• by employers as a requirement for advanced roles
across sectors;
• by education providers as a route for career support;
• by other Royal Colleges, professions, regulators,
commissioners and by patients and the public,
as a consistent and reliable means of assuring the quality
of services provided by Faculty Members and Fellows.

Strategic Imperative VI: The RPS Faculty and foundation

programmes will be financially viable within the next five
years, through delivery of quality assured, recognised
processes of support, development and assessment.

Lessons learned
Submissions to the Faculty are currently based on defined
deadlines across the year. To improve engagement with
members of the profession, RPS members will be allowed
to submit their portfolio at any time throughout the year.

Development and implementation of the strategic

initiatives (described above) underpins the Faculty’s five
year strategic approach.

The RPS Faculty and Foundation Programmes support the

RPS in its wider role in the public health arena through
campaigning for change, advising government, and taking part
in national debates on pharmacy, clinical and public
health issues.

Key stakeholders
The Royal Pharmaceutical Society in partnership with
pharmacy specialty groups and members of the profession
across GB.

References
1. House of Commons (HC). Report of the Mid Staffordshire NHS Foundation
Trust Public Inquiry. London: The Stationery Office; 2013.

2. Berwick D. A promise to learn – a commitment to act; Improving the Safety

of Patient in England. Department of Healt; 2013.

3. Kennedy I. Learning from Bristol: the report of the public inquiry into
children’s heart surgery at the Bristol Royal Infirmary 1984 -1995. London:
The Stationery Office; 2001.

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India: Advance pharmacy practice via Alignment with national strategies for
development of regulations healthcare services and delivery
The Indian National Health Policy recognises the significant
Author role played by pharmacists, the pharmaceutical industry and
pharmacy professionals.
Suresh Bhojraj, President Pharmacy Council of India,
sureshbhojraj@gmail.com. The PCI ensures there are a sufficient number of skilled and
competent pharmacists. Minimum national standards have
been set, for example:

Summary • The availability of clinically trained pharmacists (after six

years of PharmD study) has had a positive impact on more than
• A Pharm.D course was introduced in 2008 with an emphasis 60,000 patients who visit more than 200 hospitals associated
on clinical practice, professionalism and training in essential with a PharmD programme. An improvement in the responsible
professional and generic skills.1 use of medicines is of benefit to patients and hospital
management.
• Pharmacy Practice Regulations, introduced in 2015
emphasise patient counselling, pharmaceutical care, • There has been strengthening of the government
pharmacy ethics and defining duties and responsibilities pharmacovigilence programme and there is now a database of
of pharmacist to the public and profession thus making adverse drug events being reported. The Pharmacy Council of
pharmacists accountable to society.2 India has been successfully producing well trained competent
pharmacists to meet the different needs of the country in this
• Continuing education is a mandatory requirement for sector.
renewal of registration.2
It is proposed to utilise additional funding for continuing
• Diploma in pharmacy is the minimum qualification for education of pharmacists and to strengthen and upgrade
registration to practice in India. Since 2014 there has been pharmacy institutions. Proposals include establishing a
an opportunity for diploma pharmacists to upgrade their National School of Pharmacy with the objective of producing
qualification to Bachelor of Pharmacy (Practice).3 clinically trained pharmacists who will play a significant role in
pharmacovigilance in the country.
• There are Minimum Qualification for Teachers in Pharmacy
Institutions defining the number, qualification, experience etc.
for pharmacy teachers.4 Requirements for CPD/CE
There is a requirement for continuing education.
Tools, frameworks, support mechanisms
The Pharmacy Council of India (PCI) is aiming to advance Supporting regulation
pharmacy practice via development of regulations to define
aspects of practice such as code of pharmacy ethics; patience, 1. Pharmacy Practice Regulations, 2015.
delicacy and secrecy; the role of the pharmacist for promotion 2. Minimum Qualification for Teachers in Pharmacy
of rational drug use; and pharmacist’s conduct during Institutions Regulations, 2014.
counselling. 3. Pharm.D. Regulations, 2008.
4. Education Regulations, 1991.
These regulations are designed to ensure good pharmacy 5. The Bachelor of Pharmacy (B.Pharm) Course Regulations,
practice, emphasise highest quality assurance in patient 2014.
care, and define their statutory duties and responsibilities of 6. The Master of Pharmacy (M.Pharm) Course Regulations,
pharmacists thus making them accountable. The ultimate aim 2014.
is to ensure that patients are not neglected by describing the 7. Bachelor of Pharmacy (Practice) Regulations, 2014.
obligations of the pharmacist to patients.

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Ongoing progress Challenges

The vision and mission of the PCI is to continuously evolve 1. Indian pharmacy qualifications are designed to meet the
pharmacy course curriculum towards meeting present and varying needs of the country as well as other regions. Hence
future societal needs so as to prepare a pharmacist workforce some of the qualifications may be different from those that are
with required competencies. There is a focus on continuing globally, and may not meet the needs of such countries and
education of in-service pharmacists and pharmacy faculty. regions.

Establishment of National Task Force for Quality Assurance in 2. There is a shortage of pharmacy faculty, in the areas
Pharmacy Education to motivate the pharmacy institutions to of pharmacy practice to provide PharmD students with
provide more than minimum prescribed standards. the advanced experiential training. One of the strategies
with which this can be overcome is by collaboration with
National School of Pharmacy as a centre of excellence. international universities, to hire their faculty members as
visiting professors will help in exchange of resources that will
On-going work includes periodically reviewing the Pharmacy support the development of the PharmD program in the right
Act and regulations to ensure they are contemporary with direction.
latest developments in the field of pharmacy education and
practice. 3. Community and hospital pharmacists predominantly hold
a diploma in pharmacy qualification and are now seen to
Working on a common platform with other stakeholders be under qualified. The introduction of a bridging course
for exchange, mentoring and learning with a focus on will provide an opportunity to pharmacists holding diploma
development of leadership skills. qualification to upgrade their qualification to Bachelor of
Pharmacy (Practice). Similarly, the first cohort of PharmD
graduates (2014) are now employed in hospitals and this is
expected to address the requirements of clinical pharmacy
Lessons learned practice.
1. Successful implementation of the PharmD course has
advanced practice by enabling more patient centred care.
Key stakeholders
2. Maintenance of the prescribed standards by the pharmacy
institutions has ensured the quality of the pharmacist The work is done by the regulator, based on the input received
workforce. from various professional associations and other stakeholders
(e.g. pharmacy institutions, general public).
3. Mandatory continuing education for pharmacists and
teaching faculty has helped in enhancing the competencies,
knowledge and skills that has benefit all stakeholders
References
1. Pharmacy Council of India (PCI). Pharm.D, Regulations 2008. The Gazette
4. Introduction of new regulations has ensured that of India, No.19, PART III, section 4. Ministry of Health and Family Welfare
compliance to erstwhile guidelines and policies now become (Pharmacy Council of India). 2008;1–97. Available from: http://pci.nic.in/PDF-
mandatory by law. This will help in ensuring and uplifting Files/PharmD-Revised-A.pdf
the standards of pharmacy education and profession.
2. Pharmacy Council of India (PCI). The Gazette of India: Extraordinary, No.17,
PART III, section 4. Ministry of Health and Family Welfare (Pharmacy Council
of India). Updated 2015;27–52. Available from: www.pci.nic.in/Circulars/
Pharmacy%20Practice%20Regulations.pdf

3. Pharmacy Council of India (PCI). The Gazette of India: Extraordinary,

No.372, PART III, section 4. Ministry of Health and Family Welfare (Pharmacy
Council of India). Updated 2014;29–57. Available from: www.pci.nic.in/
Circulars/Bridge_Course_Regulations.pdf

4. Pharmacy Council of India (PCI). The Gazette of India: Extraordinary,

No.325, PART III, section 4. Ministry of Health and Family Welfare (Pharmacy
Council of India). Updated 2014;4–7. Available from: www.pci.nic.in/Circulars/
Teachers%20Education%20Regulation.pdf

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Ireland: Nationally approved model of The Irish Institute of Pharmacy (IIOP, www.iiop.ie) has been
established to enable pharmacists to engage with the model of
continuing professional development CPD approved by the PSI. The Institute will deliver an increasing
range of accredited programmes and will introduce the Quality
Assurance system component of the CPD model. As the learning
Authors needs change the IIOP will support the development and
recognition of advancing practice and specialisation.
Catriona Bradley, Executive Director, Irish Institute of
Pharmacy, catrionabradley@iiop.ie; Joan Peppard, Hospital
Pharmacists Association of Ireland, joan.peppard@hse.ie.
Alignment with national strategies for
healthcare services and delivery
Summary The IIOP will work with the PSI (Regulator) the Department
of Health and the Health Service Executive (delivery body
• A CPD system is currently being developed by the Irish for Health) to identify the skills required by pharmacists to
Institute of Pharmacy, which will require pharmacists, to support national healthcare strategies. An annual work plan
demonstrate generalist competency requirements. In time, it is for pharmacy CPD programmes will be agreed and signed off
anticipated that this system will evolve to facilitate specialist to ensure that the development of advanced practice and
and advanced competency. specialisation is aligned with national strategies for healthcare
services and delivery. Similarly, future advanced frameworks
• For the provision of advanced services, such as will be reflective of the requirements of the Irish healthcare
administration of seasonal influenza vaccination, pharmacists system.
must undertake additional training, which has been accredited
by the Regulator. The hospital structure is currently undergoing re-organisation.
There will be seven hospital groups to provide services for
• The Hospital Pharmacists Association of Ireland is engaged specific regions. It is considered that these groups will provide
with the Health Service Executive to recognise specialism for all the health needs of the population in the region. The
within hospital pharmacy. The post of specialist pharmacist Report on the Reform of Hospital Pharmacy is currently being
was first recognised with the appointment of pharmacists for aligned to the new structures with a view to implementation
hospital based hepatitis C services. (http://www.hpai.ie/uploads/Review2012.pdf).

Tools, frameworks, support mechanisms Requirements for CPD/CE

The development of advancing practice and specialisation has This is not yet defined, as advanced practice has not yet
largely been a ‘bottom up’ approach with pharmacists seeking been recognised in job descriptions. In practice pharmacists
out postgraduate courses to undertake. The one exception undertake appropriate CPD to support their practice.
to this has been the taught Masters in Hospital Pharmacy
in Trinity College for which there are six paid positions in The CPD for Ireland is an outcomes-focused model, which
university teaching hospitals each year. This course has been involves ePortfolio reviews and practice assessments. The focus
available since the 1990’s. is on reflective practice, and pharmacists are encouraged to
undertake CPD activities that are relevant to their practice in
The representative body for hospital pharmacists has also a way that is appropriate for them. There is no requirement to
engaged with the employer (largely a state run health system) demonstrate completion of hours or courses of training or to
to achieve recognition in job descriptions and posts for accumulate points. Instead, completion of an ePortfolio, which
advanced practice. Agreement was reached in November 2011 supports reflective practice, is a central component
but the agreed structure has not been implemented to date. of the system.

The Pharmaceutical Society of Ireland (PSI) is looking at ePortfolio reviews: Pharmacists are required to use the IIOP
hospital pharmacy practice as a priority for 2015. It plans to ePortfolio to maintain a contemporaneous record of their CPD.
carry out a review to explore and enhance the contribution of Pharmacists will be selected at random once in every five year
pharmacy, both community and hospital, to the health system, cycle and required to provide an extract from their ePortfolio to
and the safe and effective care of patients, supporting good demonstrate that they have been engaging with CPD.
practice in expanded pharmacy services.
This extract will need to demonstrate that the pharmacist has
It will engage with stakeholders to progress development completed regular self-assessment (using the core competency
of hospital pharmacy practice (http://www.thepsi.ie/tns/ framework) and that they have included a range of CPD records
publications/CorePublications/publications_2015.aspx). which will allow them to meet requirements.

34
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These requirements will be set each year by a group of The publication of the European statements on hospital
peers and it is anticipated that they will evolve over time. pharmacy has been a welcome development as it sets the
Requirements will be communicated clearly on an on-going broad scope of the role of the profession allowing each
basis to pharmacists. Reviews are carried out by trained peers. country to progress from a different starting point and can
Reviewers will seek evidence that pharmacists are engaging in be used to elaborate on the potential of hospital pharmacy
CPD, in a way that is relevant to their role and which will result (http://www.eahp.eu/practice-and-policy/european-
in enhanced patient care, and which meets the requirements statements-hospital-pharmacy).
that have been set.
Hospital pharmacists avail of on-going academic courses to a
Practice reviews: Each year a percentage of pharmacists very significant degree and this attitude has helped to drive
who are in patient-facing roles will be randomly selected practice and standards in the interest of patient care and
and required to participate in a practice assessment. This is patient safety – this has enabled the “bottom-up” approach to
similar to the process which is in place in the Ontario College the development of advanced practice with hospital pharmacy
of Pharmacists. Pharmacists will be required to undertake a – albeit as yet not formally recognised.
clinical knowledge assessment and to participate in a number
of simulated scenarios. The developments in the UK and Northern Ireland have also
been of assistance – both in terms of practice development
Secondary legislation is currently being drafted which will and educational courses e.g. http://www.qub.ac.uk/schools/
give legal effect to the CPD system (http://www.thepsi.ie/ SchoolofPharmacy/ProspectiveStudents/PostgraduateTaught/
consultations.aspx) which is based on a core competency PrescribingforPharmacists/
framework (http://www.thepsi.ie/Libraries/Publications/
PSI_Core_Competency_Framework_for_Pharmacists.sflb.ashx).
However, as more advanced frameworks are developed and as Key stakeholders
specialisation and credentialing evolves, the CPD requirements
can be expected to evolve to reflect this. The development of advancing practice, up until now has
been driven by a range of bodies including the Regulator,
representative bodies and pharmacy chains.
Supporting regulation
In future, the recently established Irish Institute of Pharmacy
The Pharmacy Act 2007 (Section 7(1)(d)) (http://www.thepsi. will be responsible for supporting the development of
ie/Libraries/Legislation/Pharmacy_Act_2007.sflb.ashx) states pharmacy practice, which will include development and
that the PSI has responsibility for ensuring that “pharmacists recognition of advancing practice and specialisation.
undertake appropriate continuing professional development,
including the acquisition of specialisation”. Under secondary
legislation, which is currently in the process of public
consultation (http://www.thepsi.ie/consultations.aspx), the
IIoP is the management body that is responsible for the
establishment and management of an appropriate CPD system
to support the development of pharmacy practice.

Ongoing progress
Although Ireland has not yet developed a formal programme
of specific professional development to assist pharmacists
in evolving their advanced and specialised practice, the
PSI has established the IIoP to oversee the development
and management of the CPD system for the pharmacy
profession in Ireland. The PSI will work with the IIoP in any
future development of the accreditation and recognition of
specialisation in the pharmacy profession.

Lessons learned
In the absence of a national instruction such as happened in
the UK, the pharmacy profession will have difficulty as a small
profession in being heard at the national level.

35
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Japan: Lifelong learning support system provides some internship programmes to become a specialist
pharmacist, while the other awarding bodies provide textbooks
includes a clinical ladder with 10 steps and lectures, seminars or workshops.
of skills development
The Japanese Pharmaceutical Association (JPA) developed and
launched ‘JPA life-long learning support system (JPALS)’ in April
Authors 2012 to support continuing professional development (CPD).
This system currently supports CPD at a foundation level and
Shigeo Yamamura, Josai International University, a support system for advancing practice is underway.2
s_yama@jiu.ac.jp; Rieko Takehira, Assistant Professor, Josai
International University, ricotake@jiu.ac.jp; Naoko Arakawa,
FIP Collaborating Centre, UCL School of Pharmacy, naoko.
arakawa.11@ucl.ac.uk.
Alignment with national strategies for
healthcare services and delivery
There is little discussion about pharmacist specialisation
Summary in national (or regional) strategies for healthcare services
and delivery. However, due to the advancement of
In Japan, there are some systems for pharmacists’ credentials: pharmacotherapeutics and medical sciences, it is natural that
pharmacy practices will also advance. In order to maintain the
• Certificated pharmacists through continuing education quality of advancing practice by pharmacists, a support and
programme. recognition system for pharmacist specialists is essential.3

• Certifying pharmacists through related societies such as The government is planning to establish an ‘Integrated
Japanese Society of Pharmaceutical Health Care and Sciences, Community Care System’ by 2015 to provide life-long healthcare
Japanese Society of Clinical Pharmacology and Therapeutics, for the elderly in the community.4 In this system, pharmacists
Japanese Society for Emergency Medicine, Japanese Society are expected to play an important role to provide effective
of Chemotherapy, etc. Other certifying pharmacist is “Sports care to the elderly. It will be necessary for pharmacists to
pharmacist” who has a role in promoting prevention of doping have advancing skills and expand their professional role to be
in athletes. involved in this initiative.

• Specialist pharmacists are certified by the Japanese Society

of Hospital Pharmacists in the fields of cancer, infection
control, psychiatric, HIV infection, pregnancy or lactation etc. Requirements for CPD/CE
There is no mandated requirement for CPD/CE of pharmacists
Tools, frameworks, support mechanisms in Japan. However, to be recognised and remain a pharmacist
specialist, often CPD/CE is mandated by the credentialing
To support the development of advancing practice and organisation.5
specialisation, the Council on Pharmacists Credentials
(CPC - an independent agency) evaluates and accredits There is also no specific requirement relating to university-
Continuing Education Credentialing Programmes, Special linked postgraduate education to be a pharmacist specialist,
Training Programmes, and Pharmacy Specialties Credentialing although some universities provide life-long learning education
Programmes in order to increase pharmacists’ competence and for pharmacists.
professional role.1
JPALS developed a ‘clinical ladder’ to classify pharmacists into
Although CPC accredits the pharmacy educational level 1 to 10 by their skills. Currently support for levels 1 to 5
programmes, the recognition itself is granted by the relevant (foundation level) pharmacists is provided, and support for
organisations, including pharmacy-related professions, levels 6 to 10 (advanced level) pharmacists is in development
academic fields, and educational bodies in Japan.1 linking to areas of specialisations.6

The process and standards vary in each specialty area, and

these are developed by the awarding organisations.1 For Professional recognition
example, the Japanese Society of Hospital Pharmacists (JSHP)
Only the Japanese Society of Pharmaceutical Health Care
and Sciences certified ‘Oncology Pharmacist’ is a nationally
recognisable title for pharmacy specialisation.7 Pharmacists
can also become a board certified pharmacy specialist in a
particular field.

36
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Ongoing progress References

The Japanese government is going to establish an “Integrated 1. Council on Pharmacists’ Credentials (CPC). Council on Pharmacists’
Credentials. Tokyo; 2014. Available from: http://www.cpc-j.org/english/index.
Community Care System” by 2015 to provide life-long care for
html
elderly people in the community.8 It is expecting pharmacists
to play an important role to provide appropriate care to elderly 2. Japan Pharmaceutical Association (JPALS). JPALS Summary (in Japanese).
people in community. There is encouragement for health Tokyo; 2014. Available from: https://www.jpals.jp/summary.php
professionals, including pharmacists, to establish “Integrated
3. Science Council of Japan (SCJ). Report on the needs of pharmacist specialist
Community Care Systems” in each community. This may be an and further development in the future: to support the improvement of the
opportunity to progress the development and professional quality of healthcare (in Japanese). Tokyo; 2008. Available from: http://www.
recognition of pharmacists. scj.go.jp/ja/info/kohyo/pdf/kohyo-20-t62-12.pdf

Further, JPALS for advanced level pharmacists is underway.6 4. Ministry of Health, Labour and Welfare (MHLW). Health and Welfare Bureau
for the Elderly. Tokyo; 2013. Available from: http://www.mhlw.go.jp/english/
policy/care-welfare/care-welfare-elderly/dl/health_and_welfare_bureau.pdf

5. Science Council of Japan (SCJ). Report on the needs of pharmacist specialist

Lessons learned and further development in the future: to support the improvement of the
quality of healthcare (in Japanese). Tokyo; 2008. Available from:
Japanese pharmacists may not be well recognised as http://www.scj.go.jp/ja/info/kohyo/pdf/kohyo-20-t62-12.pdf
healthcare professionals in the healthcare system. Some
6. Japan Pharmaceutical Association (JPALS). JPALS Summary (in Japanese).
do not understand that the separation of prescribing and Tokyo; 2015. Available from: https://www.jpals.jp/summary.php
dispensing is necessary for responsible use of medicines
(in 2012 the rate of separation was approximately 66%). It is 7. Ministry of Health, Labour and Welfare (MHLW). Advertisable titles for
advocated that the role of pharmacists is one of the keys to healthcare specialisation of healthcare professionals (in Japanese). Tokyo;
maintaining the health of community people. 2011. Available from: http://www.mhlw.go.jp/topics/2007/06/tp0627-1.html

8. Ministry of Health, Labour and Welfare (MHLW). Health and Welfare Bureau
Further, there is no standardised pathway for the professional for the Elderly. Tokyo; 2013. Available from: http://www.mhlw.go.jp/english/
recognition of pharmacist specialists at the moment, although policy/care-welfare/care-welfare-elderly/dl/health_and_welfare_bureau.pdf
the areas of advancing practice are growing. To maintain
and further improve the quality of the established and
future advancing practice, clear standards for professional
recognition for pharmacist specialists would be needed.

Key stakeholders
There are three main professional organisations of
pharmacists: Japanese Pharmaceutical Association (http://
www.nichiyaku.or.jp/e/default.html), Japanese Society of
Hospital Pharmacists (http://www.jshp.or.jp/ - no English page)
and Japanese Society of Pharmaceutical Health Care and
Sciences (http://www.jsphcs.jp/ - no English site).

They are mainly driving the development and recognition of

advancing practice and specialisation of pharmacists.

37
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Malaysia: MAP to support provision, • At present, various MTACs have been created and regularly
follow up the patients. These include: MTACs in diabetes,
credentialing and accreditation of respiratory, psychiatry, nephrology, neurology, heart failure,
specialists and advanced level practitioners retroviral disease, haemophilia, psoriasis, rheumatology,
geriatric and anticoagulant (warfarin). Pharmacists need to
undergo training before starting to provide these services.
Authors (http://www.pharmacy.gov.my/v2/ms/entri/perkhidmatan-
medication-therapy-adherance-clinic-mtac.html).
Benny Efendie, Lecturer, Monash University Malaysia, benny.
efendie@monash.edu; Abida Haq Syed M Haq, Director of
Pharmacy Practice and Development, Pharmaceutical Services
Division, Ministry of Health Malaysia, abida_haq@moh.gov.my;
Tools, frameworks, support mechanisms
Noraini Mohamad, Senior Principal Assistant Director, Clinical
Pharmacists who provide clinical services have to go through
and Technical Branch, Pharmaceutical Services Division,
training with structured modules developed by the Clinical
Ministry of Health Malaysia, norainimohd@moh.gov.my;
Pharmacy working committee of the Pharmaceutical Services
Mohamad Haniki Nik Mohamed, Associate Professor, Principal,
Division, MOH. In addition they have to undergo observation
Academy of Pharmacy, Malaysia, haniki@iium.edu.my; Jaya
and hands-on training in appointed training institutions
Muneswarao, Clinical Pharmacist, Kulim Hospital, Ministry of
(hospitals). The duration of these trainings are normally 2-3
Health Malaysia, rahulraoraorao@gmail.com.
weeks. Protocols and guidelines have been published to guide
these pharmacists (http://www.pharmacy.gov.my/v2/ms/entri/
perkhidmatan-medication-therapy-adherance-clinic-mtac.html).
Summary Trainees who complete and pass the assessment are provided
with a certificate.
• In Malaysia clinical pharmacy has been introduced in public
hospitals since the 1990’s. The first Masters program in clinical As part of professional development, pharmacists working
pharmacy was offered by the Universiti Sains Malaysia (USM) in the public sector are given opportunity to undertake
in 1992. The graduates take leading roles in developing basic postgraduate study up to Masters and PhD levels. As part
and advanced clinical pharmacy practice in the country. of international partnerships and collaboration, selected
pharmacists are sent overseas every year for short course
• Although no formal specialisation training and recognition training in specialised areas such as oncology, palliative care,
has been established, clinical pharmacists have developed rheumatology, paediatric and anti-coagulant management etc.
practice in certain areas such as paediatrics, psychiatry,
cardiology, endocrinology, oncology, respiratory, ICU, etc.
Alignment with national strategies for
• In 2003 the Certified Smoking Cessation Service Provider
(CSCSP) programme was introduced by the Malaysian
healthcare services and delivery
Pharmaceutical Society (MPS) and Malaysian Academy of
The expected outcomes of the Country Health Policy (10th
Pharmacy (MAP) with the support of the Ministry of Health
Malaysian Plan) are to ensure provision of, and increase
(MOH) Malaysia. Up to 2015, more than a thousand pharmacists
accessibility to quality healthcare, and public recreational
have gone through this training and become certified smoking
and sports facilities to support active healthy lifestyle. Human
cessation providers in community pharmacies and hospitals.
capital development is one of the strategies outlined to achieve
An online CSCSP module was launched in 2009 (http://www.
these outcomes (http://www.moh.gov.my/images/gallery/
acadpharm.org.my/index.cfm?&menuid=2).
Report/Country_health.pdf).
• Since 2004 pharmacist-managed clinics, known as
The Pharmaceutical Services Division has the task to provide
“Medication Therapy and Adherence Clinic (MTAC)” have been
more pharmacist experts in specialised areas, such as geriatrics,
introduced. The aims of the clinic are to optimise the patient’s
paediatrics, nephrology, oncology, cardiology, etc. This is also
drug therapy, to increase the patient’s knowledge on diseases
in line with the human development and strategies in the
and the medicines, and to increase the patient’s adherence to
National Medicine Policy 2012 (http://www.pharmacy.gov.my/
their medications. The MTACs increase collaboration between
v2/sites/default/files/document-upload/buku-dunas.pdf).
pharmacists and medical doctors.

38
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Requirements for CPD/CE Ongoing progress

The Malaysian Academy of Pharmacy (MAP http://www. At present, the Pharmaceutical Services Division with
acadpharm.org.my/) is the professional body dedicated to cooperation from universities and MAP are in the process of
advancing the potential of pharmacists through education, preparing proposals and guidelines for pharmacy specialisation
advocacy, research and service towards the betterment of as well as modules for residency programs. The two-year
society and the nation at large. This is in tandem with the residency program is designed to produce clinical pharmacists
mission statements: who are competent in providing pharmaceutical care in
the selected specialised areas. At the start of this process, a
1. To provide continuing professional development (CPD) small number of pharmacists with a PhD in clinical pharmacy
opportunities in support of lifelong learning among will be selected to undertake special modules and later will
pharmacists. be appointed as preceptors to this programme. The target
2. To provide a platform for effective sharing of knowledge, timeframe for implementation of the residency program is
skills and experience among pharmacy educators, 2017, with the first pharmacists accredited as specialists in
researchers and practitioners as well as policy makers. 2019.
3. To advocate and facilitate provision, credentialing and
accreditation of specialists and advanced level The Pharmacy Specialist Accreditation Board (PSAB) will be
practitioners in pharmacy practice. responsible for certifying the successful candidates [the
4. To promote innovations in pharmacy practice, research residency program will have the duration of 2 years. The first
and education. 6 months there will be a written exam. Subsequently the
assessment will be from case reports, case presentations,
Currently, there is no specific requirement related to research projects and portfolio (log book)], who will be
postgraduate education but MAP is preparing to offer tutorials rewarded special additional allowances in their monthly
for pharmacists planning to sit for the coming American BCPS revenue.
(Board Certified Pharmacotherapy Specialists).
On the other hand, for credentialing and privileging, the
Pharmaceutical Service Division has set the criteria for
application. These may include a duration of practice in a
Supporting regulation specific area and prior training attended in the specialty area.
The National Credential Committee (NCC) will be responsible for
Specialisation for pharmacy has not being formalised although
vetting their credentials.
it has been recognised to be the future plan for the careers of
pharmacists in Malaysia, especially those working in public
sectors.
Lessons learned
At present the development and recognition of advanced
practice and specialisation is being regulated by circulars from In Malaysia, the 1980’s saw a shift from product-oriented
the Pharmaceutical Services Division, Ministry of Health(MOH) services to patient-focused care. Since 2000, clinical pharmacy
Malaysia. has expanded into specialised services that now include
medication therapy adherence clinics (MTACs), critical care,
cardiology and many more. The transformation is inevitable
Professional recognition for pharmacy services in Malaysia to be in line with the current
developments worldwide.
The Pharmaceutical Services Division, MOH is currently
in the process of developing proposals and guidelines for The Pharmaceutical Services Division, MOH ensures that
professional recognition in two categories: the pharmacy services offered are of good quality and are
achieving the required standards. Among the measures taken
i) Pharmacy Specialisation include standardisation of practice and expertise development
programme. Expertise development programmes, which
ii) Credentialing & Privileging are training given to the pharmacists, such as the residency
programme and the special training for pharmacist-run clinics,
which are called: Medication Therapy and Adherence
Clinic (MTAC).

39
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Two main challenges:

1. Preparedness of the pharmacists (regarding their

competence, skills, knowledge and making the change to
become more patient focus).

2. Recognition and collaboration from the medical doctors and

other health professionals.

Key stakeholders
In Malaysia, advanced pharmacy practice is mostly carried out
in public hospitals and health clinics. It is mainly driven by:

1. The Pharmaceutical Services Division of the Ministry

of Health, by endorsing the practice and providing jobs
(vacancies) in the practice area and training to
pharmacists.
2. The Schools of Pharmacy, by providing the postgraduate
training in clinical pharmacy and pharmacy practice
research.
3. The Malaysian Pharmaceutical Society and The Pharmacy
Academy, by providing CPD
4. The institutions (hospitals and public health clinics).

40
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New Zealand: Government policy supports Tools, frameworks, support mechanisms

pathway for advanced practice,
and credentialed services NZ has mainly developed their own resources:

• Pharmacist Services Framework 20141 - This framework

comprehensively defines pharmacist services that are
Authors available for primary care and/or secondary care sector
use. New service areas in the framework are in addition to
Elizabeth Johnstone, Manager, Professional Development
base mandatory pharmacy services and designed to provide
Programme, Pharmaceutical Society of New Zealand,
national consistency for users of pharmacist extended services.
e.johnstone@psnz.org.nz; Bob Buckham, Chief Pharmacist
Health practitioner competence requirements dictate that all
Advisor, Pharmaceutical Society of New Zealand, b.buckham@
pharmacist services must be provided in line with appropriate
psnz.org.nz. standards as defined by the Pharmacy Council of New Zealand.

• Advanced Trainee Fellowship (ATF) Scheme2 - Financial

Summary assistance to help health professionals undertake advanced
training, a specialist qualification or study overseas in a priority
There has been intentional advocacy by the Pharmaceutical specialty area (Ministry of Health).
Society of New Zealand (NZ) since 2004 to create a funded
pathway for advanced practice in NZ. This began by creating • NZ Hospital Pharmacists’ Association (http://www.nzhpa.org.nz)
and implementing the Ten Year Vision (2004–2014) and - established a Workforce Development Working Group to
advocacy with government to create policy that supported develop a career progression pathway including suggested
these roles. qualifications, knowledge, skills and behaviours that are
expected at each level of practice. Competency frameworks
Documents supporting this include: have been proposed drawing on the General Level Framework
(CoDEG, UK); shpaclinCAT (SHPA, Australia).
• Development of NZ National Pharmacist Services Framework
2014 – involved consultation with all major pharmacy and
medical organisations and District Health Boards as funders of Alignment with national strategies for
pharmacy service. healthcare services and delivery
• Vision 2020 – Pharmacists and Doctors Working Together: The current government policy includes an intentional move
Vision statement to offer a strategic direction for the by government funding agencies away from funding medicine
pharmacy and medical professions to work together in an supply to funding cognitive, collaborative and advanced
integrated and collaborative health practice environment to pharmacist services. This has initially involved implementation
significantly improve patient care and health outcomes. of the Long Term Conditions Service, which is designed to
support patients with identified medicine adherence issues to
• NZ government policy: Policy direction to optimise the use of become self-managing through the provision of a pharmacist
medicines and the specific role of pharmacists in this. medicines management service.

• Medicines NZ Strategy supported by Actioning Medicines This provides the pathway outlined by the NZ National
New Zealand Policy documents. Pharmacist Services Framework 2014 to implement the
government’s Medicines NZ Strategy outlined in ‘Actioning
• Confidence & Supply Agreement with United Future Party Medicines NZ 2010’ (currently being updated through the
– the implementation of the National Medicines Strategy ‘Implementing Medicines NZ 2015-2020’ Policy3), in providing
will continue, including the enhanced role of pharmacists funding and support for pharmacist’s role in opportunistic and
in medicines management and primary care (Opening of scheduled monitoring and screening, pharmacist prescribing
Parliament 2014 - Speech from the Throne which laid out the and the delivery of Comprehensive Medicine Management
key objectives for the new government term.) Services. This includes pharmacists managing optimal medicine
use, medicine therapy assessment and providing health and
medicine education.

41
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The 2020 Vision Statement developed by the Pharmaceutical Supporting regulation

Society of NZ and the NZ Medical Association offers strategic
direction for six vision areas underpinned by five-year Pharmacist Prescribing — Medicines Act and Misuse of Drugs
objectives from each profession. The six vision areas are: Act amended to allow this activity.

1. The Patient’s Healthcare Journey Reclassification of medicines by the Medicines Classification

2. Health Professional Roles Committee of Medsafe (NZ Medicines and Medical Devices
3. A Shared Working Environment Safety Authority) from ‘Prescription Only’ to a defined
4. Services exemption from prescription status or Pharmacist-Only
5. Professional Competence and Ethics Medicine status to enable vaccination and pharmacist supply
6. Payment Arrangements for Services of medicines that require an accreditation or credentialing
process to supply without prescription e.g. emergency
The NZ Maori Health Strategy for the pharmacy profession hormonal contraception, trimethoprim, sildenafil.
provides a pathway for pharmacists to provide high quality,
innovative services to improve Maori well-being, by enhancing Medicines NZ — Government Policy to ensure progression of
patient care and public health. Pharmacist Services away from solely supply services.

Requirements for CPD/CE Professional recognition

There are no specific annual CPD requirements set as part
Any professional recognition for advanced practice or
of the on-going accreditation for Medicines Use Review
specialisation usually relates to titles e.g. ‘Palliative Care
(MUR), Medicines Therapy Assessment (MTA) and prescribing
Pharmacist’ or ‘Pharmacist Vaccinator’. This may or may not
pharmacists.
attract enhanced remuneration – depending on the employer.
Credentialed services that are recognised in NZ include:
The specific requirements for CPD/CE for pharmacists offering
Medicines Management Services (MUR, MTA) changed with
• Vaccination that requires recertification every two years
the introduction of the revised Competence Standards for the
[the vaccination accreditation training and two yearly
Pharmacy Profession4 in January 2015. The new Standards have
reaccreditation is managed by IMAC (Immune Advisory Centre)
a focus on professional integrity and quality improvement, and
http://www.immune.org.nz/education-and-training].
therefore carry the expectation that the pharmacist will:
• Pharmacist Prescribers and MTA pharmacists who have a
• proactively review their own performance; and
pre-requisite for a specific PG qualification, but no further PG
• actively participate in personal professional development in
qualifications are required after accreditation.
the context of their own practice as well as ensuring that the
Medicines Management Service being offered will also
• Community Pharmacy Anticoagulation Services (CPAMS)
undergo a continuous quality improvement process.
pharmacists who are required to be reaccredited every two
years.
Prescribing Pharmacists
• Supply of emergency contraception, trimethoprim and
The Standards and Guidelines for Pharmacist Prescribers
sildenafil without prescription following specified training and
require pharmacist prescribers to “actively participate in the
accreditation.
review and development of their prescribing practice, and in
the critical appraisal of information to improve patient care”.5
Pharmacists are funded for some specialised services e.g. MTA
In particular to:
but there is no financial incentive to carry out these roles.
• Participate in CPD to maintain quality of prescribing practice.
• Participate in quality improvement activities to develop and
improve prescribing practice. Ongoing progress
• Access, evaluate and apply information to improve
prescribing practice. This has been an intentional on-going activity since 2004, with
the publication of the Ten Year Vision for Pharmacists (2004–14),
supported by government policy in Medicines NZ (2007) and
Actioning Medicines NZ (2010). This has been reviewed and
extended in Implementing Medicines NZ (2015-2020).

42
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The Pharmaceutical Society of NZ is managing the Any advanced services need to be tied to financial benefits
implementation of the NZ National Framework of Pharmacist for the provider and this is not currently happening in NZ.
Services, designed to support initiatives to realise the potential The challenge is knowing that there is future proofed funding
of the pharmacist workforce and address the barriers to the available for delivering these services and ensuring that the
delivery of innovative pharmacy and pharmacist services. services remain viable. This will facilitate and encourage
change management within pharmacy.
The provision of Community Pharmacy Anticoagulation
Services has funded pharmacists for the provision of an
advanced service and the success of this initiative is opening Key stakeholders
further opportunities for additional services.
Professional organisations — Pharmaceutical Society of NZ
The Pharmaceutical Society, on behalf of Health Workforce and the NZ Hospital Pharmacist Association — have been the
NZ, is undertaking a project to investigate the viability of two main driving forces for development and recognition of
introducing pharmacy accuracy checking technicians into the advanced practice. These two organisations have developed
NZ pharmacy workforce. This project (PACT Project) is to provide frameworks and worked to lobby government organisations
evidence to determine whether the presence of an accuracy for changes to enable the necessary policy and regulatory
checking technician will enable a pharmacist to free up time changes required for advanced practice and service delivery.
to engage in, or expand on, the provision of patient-centred The NZ Pharmacy Council (the regulatory authority for
services without compromising public safety, or the accurate pharmacy in NZ) developed the competence and registration
dispensing of medicines. requirements for the Pharmacist Prescriber Scope of Practice,
which required legislative change.

Lessons learned Health Workforce NZ (a division of the Ministry of Health) is

charged with developing the health workforce. It collaborates
Pharmacists are willing to undergo training for advanced with educational bodies and employers to ensure that
and extended roles but much less willing to step out of their workforce planning and postgraduate training aligns with the
comfort zone. They find it difficult to manage a culture change, needs of current and future service delivery.
and many are still stuck in the ‘dispense and supply’ mode.
Health Workforce also provides government funding for
This was demonstrated with the initial provision of Medicine innovation through demonstration projects and pilots e.g.
Use Review Services (in 2006) when hundreds of pharmacists CPAMS.
were trained (often at their own expense) but did not
follow through to take up contracts and deliver the service.
This resulted in many contracts being withdrawn. As a References
generalisation, pharmacist are uncomfortable with marketing
1. Pharmaceutical Society of New Zealand Inc (PSNZ). New Zealand
themselves, and there is also a significant barrier with doctors National Pharmacist Services Framework 2014. Wellington; 2014.
being concerned about pharmacists’ ‘taking over’ some of Available from: http://www.psnz.org.nz/public/home/documents/
their previously exclusive roles. PSNZPharmacistServicesFramework2014FINAL.pdf

2. Ministry of Health (MoH). Advanced Trainee Fellowship (ATF) Scheme.

Pharmacists also find it difficult to produce and put proposals Wellington: Ministry of Health; 2015. Available from: http://www.health.govt.
to funders and managers. nz/our-work/health-workforce/education-and-training/advanced-trainee-
fellowship-atf-scheme
This is gradually changing and there has been a marked
increase in the uptake of pharmacists becoming accredited to 3. Ministry of Health (MoH). Implementing Medicines New Zealand 2015 to
2020. Wellington: Ministry of Health; 2015.
supply trimethoprim, sildenafil, vaccinations and Community
Pharmacy Anticoagulant Services (CPAMS). 4. Pharmacy Council of New Zealand (PCNZ). Safe Effective Pharmacy
Practice, Competence Standards For The Pharmacy Profession. Wellington:
CPAMS has been a real success story with pharmacists Pharmacy Council of New Zealand; 2011. Available from:
http://www.pharmacycouncil.org.nz/cms_show_download.php?id=201
consistently producing improved results for patients and this
has led to a building of confidence and a willingness to provide 5. Pharmacy Council of New Zealand (PCNZ). Safe Effective Pharmacy
further advanced services by pharmacists and a willingness to Practice, Standards and Guidance for Pharmacists Prescribers. Wellington:
accept them by doctors. This service is a much admired model Pharmacy Council of New Zealand; 2011. Available from:
of integrated primary care. http://www.pharmacycouncil.org.nz/cms_show_download.php?id=397

43
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Philippines: Enhancement of professional The PPhA has been very much involved in issues concerning the
pharmacy profession. It has established local and international
competence, supported by mandatory CPD partners and linkages with various government and
non-government organisations as well as other professional
associations.
Authors
Nelly Nonette Ouano, Chairman, University of San Carlos
Dept. of Pharmacy, ettenon@hotmail.com; Anthony Aldrin Alignment with national strategies for
C. Santiago, Chairman Professional Regulatory Board of healthcare services and delivery
Pharmacy Professional Regulation Commission of the
Philippines, aacsantiago@gmail.com; Imelda Peña, President Pharmacy education in the Philippines is guided by the
Philippine Association of Colleges of Pharmacy (PACOP), Commission on Higher Education (CHED) Memorandum Order
melds_pena@yahoo.com; Olivia M. Limuaco, President, CMO 3 (http://www.ched.gov.ph/wp-content/uploads/2013/07/
Philippine Pharmacists Association (PPhA), limuacoolivia@ CMO-No.03-s2006.pdf).
yahoo.com.
The CMO ensures that pharmacy education in the country
Acknowledgement: Yolanda Deliman, Dean, University of San meets the health needs of the people through quality health
Carlos School of Health Care Professions, yolandadeliman@ services and keeping relevant with the demands of global
yahoo.com; Marilyn Young Tiu, Pharmacy Curriculum competitiveness.
Development Coordinator, University of San Carlos,
Department of Pharmacy, malyntiu@yahoo.com.
Requirements for CPD/CE
Summary The Philippine Senate recently approved a bill that aims to
regulate the practice of pharmacy, integrate the pharmacy
• The Philippine Senate recently approved a bill, aimed to profession, and enhance professional competence
regulate the practice, integrate the profession, and enhance through mandatory continuing development and research
professional competence through mandatory continuing (information available at: http://www.senate.gov.ph/lis/bill_res.
development and research. aspx?congress=16&q=SBN-2436 | http://www.congress.gov.ph/
download/journals_16/J58_2RSS.pdf
• Currently the Philippines Professional Regulation
Commission (PRC) Board of Pharmacy is responsible for The current law requires all registered pharmacists to attend 10
registration and licensing of pharmacists but is not yet Continuing Professional Development (CPD) units every year.
involved in the ‘licensing’ of pharmacy specialists.

• The Philippines has no advanced Pharmacy Practice Supporting regulation

Framework is currently revising from another country and
adapting it according to the country’s needs. The Philippine Commission on Higher Education (CHED) is
responsible for an on-going paradigm shift to competency
• The Philippine Pharmacists Association (PPhA), in conjunction based learning standards
with the American College of Clinical Pharmacy, is currently
offering a series of pharmacotherapeutic workshops to The Philippine Professional Regulations Commission (PRC)
pharmacists who wish to pursue Board of Pharmaceutical ensures the implementation of the Philippine Qualifications
Specialties certification in the USA. Framework (PQF), which is the basic framework used for
all regulated professions under PRC. The PQF is one of four
convergent programs designed to address jobs and skills
Tools, frameworks, support mechanisms mismatch.

The Philippines has no advanced Pharmacy Practice Framework

but is developing one by revising a currently available
framework from another country and adapting it according to
the country’s needs.

44
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Ongoing progress Key stakeholders

The following are initiatives to ensure development The Philippines PRC (Professional Regulation Commission)
and professional recognition of advanced practice and Board of Pharmacy does registration and licensing of
specialisation: pharmacists who has finished their Baccalaureate (BS
Pharmacy and its equivalent) degree.
1. PDI: The Pharmacy DOTS Initiative (PDI) aims to enhance the
capability of Filipino pharmacists in the control of tuberculosis. The Philippine Pharmacists Association, Inc. (PPhA) is the only
Professional Regulation Commission (PRC) — accredited,
2. Clinical Pharmacy summit: The PPhA Clinical Pharmacy integrated national organisation of licensed Filipino
Program is in partnership with the American College of pharmacists. PPhA has been very much involved in issues
Clinical Pharmacy. The program is a series of learning modules concerning the pharmacy profession. It has established
to develop the clinical competency of Filipino pharmacy local and international partners and linkages with various
practitioners in the country towards obtaining an international government and non-government organisations as well as
specialty board certification in pharmacotherapeutics. other professional associations.

3. PhilPSP: Philippine Practice Standards for Pharmacists PACOP (Philippine Association of Colleges of Pharmacy) is
(PhilPSP) aims to build capacity among pharmacists and composed of institutional members or colleges or universities
support workforce that will enable Filipino pharmacists to all over the country that offer graduate educational
align with global standards and upgrade the level of practice. programmes with specialisations in areas of practice, such
as hospital pharmacy, pharmaceutical sciences, industrial
4. TESDA Pharmacy Services National Certificate (NC III): In pharmacy, and community practice.
view of the need to strengthen the program of Pharmacy
Services National Certificate (NC) II established last 2008, this
was revised and justified to be elevated to NC III in 2014. This
initiative was in partnership with Technical Education and
Skills Development Authority (TESDA) and the PPhA.

5. Philippine Pharmacy Act of 2014: The State recognises

the vital role of pharmacists in the delivery of quality health
care services through the provision of safe, effective, and
quality pharmaceutical products, pharmaceutical care, drug
information, patient medication counselling, and health
promotion. The pharmacists’ professional services shall,
therefore, be promoted as an indispensable component of the
total healthcare system to ensure the physical well-being of
Filipinos.

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Portugal: Four recognised specialties For Clinical Analysis Specialisation candidates:

• Candidates should choose a laboratory or laboratories able

to provide them with the practice according to the internship
Authors programme/syllabus (handbook). The council of the Clinical
Analysis Board (chosen and appointed by the PPS) will validate
Helena Vilaça, Professional Affairs Lead, Ordem dos
the proposal according to the suitability of the laboratory(ies)
Farmacêuticos (Portuguese Pharmaceutical Society -
chosen for internship.
PPS), helena.vilaca@ordemfarmaceuticos.pt; Luís Baião,
• Provision of bibliographic references to help candidates to
International Affairs Lead, Ordem dos Farmacêuticos
prepare themselves for the exams (tools).
(Portuguese Pharmaceutical Society - PPS), luis.baiao@
ordemfarmaceuticos.pt; Andreia Bruno, Professional
For Hospital Pharmacy Specialisation candidates:
Development Lead, Ordem dos Farmacêuticos (Portuguese
Pharmaceutical Society - PPS), andreia.bruno@
• Provision of bibliographic references to help candidates to
ordemfarmaceuticos.pt.
prepare themselves for the exam (tools).

Under development there is a Competency based model

Summary with a framework that will fit the existing requisites of the
specialisation.
• The Portuguese Pharmaceutical Society (PPS), the regulator of
the profession has four titles of specialised pharmacists:
• Pharmacist specialised in Clinical Analysis;
• Pharmacist specialised in Pharmaceutical Industry;
Alignment with national strategies for
• Pharmacist specialised in Hospital Pharmacy; healthcare services and delivery
• Pharmacist specialised in Regulatory Affairs.
Strategy for the future of the health workforce is still under
• In order to recognise the specialisations, the PPS has one development. Portugal is one of the countries in the Joint
evaluation period per year in each area of specialisation. The Action for Health Workforce Planning and Forecasting through
evaluation period consists of exams, and/or internships and/or the Central Administration for the Health System.
presentation of a work related thesis.
Particularly regarding pharmacists specialised in hospital
• The PPS is developing a competency-based model to pharmacy there is under development the alignment of the
recognise these four areas. specialisation awarded by the PPS title and the public sector
career in hospital pharmacy.
• A pharmacist can only be a candidate for the evaluation
period after having at least five years of experience in the
subject/area/field. Requirements for CPD/CE
• In 2014, 86% of pharmacists in practice in Portugal were non- It is not compulsory for specialist pharmacists to continue
specialists. Of the 14% who were specialists: their professional development and education related to their
• 793 were Specialists in Clinical Analysis; specialty area. There are no specific requirements relating to
• 247 were Specialists in Pharmaceutical Industry; postgraduate education.
• 617 were Specialists in Hospital Pharmacy;
• 118 were Specialists in Regulatory Affairs. The completion of the Specialisation Programme grants the
pharmacist 10 CPD credit points (out of the 15 needing to be
completed in each five year CPD cycle).
Tools, frameworks, support mechanisms
The Portuguese Pharmaceutical Society gives general support
and help to candidates. The PPS is also available for contact and
to answer any doubts or information requests by candidates
throughout the year.

More specifically the PPS also promotes support on the

following:

46
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Supporting regulation • Certification of competencies on vaccination and medicines

administration:
The Specialty Boards of the PPS have regulations
for the titles of: In 2007 new Portuguese legislation was passed allowing
pharmacists to expand their services into a number of areas,
• Clinical Analysis Specialist such as immunization and medicines administration included
• Pharmaceutical Industry Specialist coverage of vaccines outside National Vaccination Scheme.
• Hospital Pharmacy Specialist A major training drive was launched in 2008 leading to the
• Regulatory Affairs Specialist first nationwide pharmacy-based flu immunisation campaign
during the 2008/2009 flu season.

In 2013 the PPS published guidelines on Immunization Services

Professional recognition certification:
• Guidelines establishing the minimum requirements
The specialist title is written on the PPS professional card and
for accreditation of initial training and also for
detailed on the PPS pharmacists’ database.
recertification training.
• Certification to provide the service include:
Examples of professional recognition include:
• Complete initial training;
• Complete recertification training every 5 years;
• Pharmacist specialised in Clinical Analysis – comply with
• Evidence of continued activity.
legal proceedings that grant them access to the function of
Technical Director of Medical Biology laboratories.
The National Association of Pharmacies training model was
one of the first to be implemented across Portugal with 1,914
• Pharmacist specialised in Pharmaceutical Industry – comply
pharmacists and 1,273 pharmacies completed the training
with legal proceedings that grant them access to be Technical
(48% of Portuguese pharmacies) in 2014, resulting in a 98%
Director of a pharmaceutical industry with market introduction
patient satisfaction.
authorisation for medicines and to be a Qualified Person.

• “Area of Expert professional practice – Phase II Diabetes

disease management service”: Ongoing progress
Between April 2008 and June 2010 the 3rd Agreement on A competence-based model is under development for the
Diabetes Programme was in place between the Ministry specialisations that already exist in the PPS. The framework in
of Health, PPS, National Association of Pharmacies, and development will need to fit the specific needs of the existing
Association of Pharmacies from Portugal. This Disease-State (practicing) professionals.
Management service was directed to patients who were
medicated for diabetes and who were not meeting the Further proceedings are planned as follows:
established therapeutic objectives.
• Develop a competency framework, template and handbook
It consisted of the follow-up of diabetic patients in for each specialisation;
programmed visits to the pharmacy (SOAP methodology), • Pilot the framework in one of the Specialisation Programmes;
between doctors’ appointments, with the aim to detect, • Extend the experience to other Specialisations.
prevent and resolve Drug Related Problems (DRPs) through
an intervention at the patient level (information, adherence,
healthy lifestyle advice) and/or doctor referral, followed by a
follow-up of the intervention’s results.

It was delivered only by certified pharmacists who had

completed compulsory courses on DRPs and pharmaceutical
intervention, patient and doctor communication,
merchandising and marketing of services, health checks and
diabetes. Certified pharmacists were paid 15 €/patient/month,
75% of which was reimbursed by the National Health System,
and 25% paid by the patient directly.

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Lessons learned Key stakeholders

The main challenges faced so far by the Specialisation model: The National Board of PPS is the competent authority for the
pharmaceutical specialisations.
• Human resources are allocated exclusively to the general
management of the Specialisations – one pharmacist and The National Board provides education and training
one administrative assistant; through the Councils of each Specialist Board, who organise
congresses, symposia and meetings targeting specialists, and
• There is only one exam period per year/per specialisation; through the National Council for Quality, with training events
on particular quality practices in each professional setting.
• Exam jurors are nominated by the National Board of the
PPS after recommendation by specialists assigned by each The Councils of each Specialist Board also produce handbooks
Specialisation Board Council. The jurors work pro bono. and guides for good practice.

Special challenges of the Specialisation in Hospital Pharmacy • Hospital Pharmacy — Handbook on Cytotoxic Handling;
and Clinical Analysis under work in a hospital setting of the Handbook on Wound Management Material; Handbook for
public sector (under the Ministry of Health): Medicinal Gases; Guide on Good Hospital Pharmacy Practices
(in production).
• At the moment PPS is facing the challenge of having a unique
national hospital pharmacist career, together with the • Clinical Analysis — Norms for the Medical Biology
Health Ministry and the PPS. Laboratory (updated 2015).

• Specialisations of pharmaceutical professions that work in a • Pharmaceutical Industry — Adaptation and dissemination of
hospital setting can be of hospital pharmacy (if based in the the European GMP and GDP.
hospital pharmacy) and of clinical analysis (if based in the
hospital medical biology laboratory). • Regulatory Affairs — Good Regulatory Practices.
The Regional Branches of the PPS also provide general
• Careers in the public sector unfortunately do not follow a education and training opportunities to pharmacists.
progression compatible with the PPS specialisation.
Currently, career progression for pharmacists within the The Regional Branches of the PPS also provide general
hospital sector follows a general system for public servants education and training opportunities to pharmacists.
in the health sector.

• Working towards an alignment between both of these

specialisations in the PPS and also career progression that is
particular to pharmacists.

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Singapore: Accreditation and registration Summary

of specialist pharmacists available
A review of the pharmacy career structure in the public
healthcare sector (see figure 1) was conducted with a new
career pathway framework being introduced in 2009. Under the
Authors new career framework, pharmacists in the public healthcare
sector can develop their career in either the professional,
Lita Chew, Assistant Professor, Registrar, Singapore Pharmacy
clinical or research tracks, and progress to become advance
Council, Chair, Pharmacy Specialists Accreditation Board,
practitioners in each of these tracks. Advanced practitioners
Lita_Chew@moh.gov.sg; Wu Tuck Seng, President, Singapore
in the clinical track may seek accreditation and registration as
Pharmacy Council, tuck_seng_wu@nuhs.edu.sg; Camilla Wong,
specialists.
Secretary, Pharmacy Specialists Accreditation Board, camilla.
wong.m.l@sgh.com.sg; Lim Hui Leng, Senior Manager and
Pharmacist, Manpower Standards & Development Division,
Ministry of Health, Lim_Hui_Leng@moh.gov.sg; Felicia Ling,
Executive Secretary and Pharmacist, Singapore Pharmacy
Council, Felicia_Ling@spc.gov.sg.

Figure 1: Pharmacy career structure in the public healthcare sector.

Years of Admin / General Specialisation Clinical Research

experience

Head / deputy head of department

Pharmacy
Pharmacy clinician
Consultant
practice manager investigator
(clinical)
8 - 10 yrs

Advanced /
managerial

Associate Snr principal Associate

Snr principal consultant clinical pharmacy
pharmacist (clinical) pharmacist clinician scientist

6 - 8 yrs

Principal
Principal Snr pharmacist
clinical
pharmacist researcher
4 - 6 yrs pharmacist
Senior
Snr Snr clinical Pharmacist
pharmacist pharmacist researcher
2 - 4 yrs

Clinical Pharmacist
Pharmacist pharmacist

1 - 2 yrs
Junior

Pharmacist
entry-level

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The Pharmacists Registration Act 2007 made provisions for Tools, frameworks and support mechanisms
the accreditation and registration of specialist pharmacists.
These include the establishment of the (Pharmacy) Specialists Development of specialist training framework: The American
Accreditation Board (PSAB) whose functions are to define the Society of Health-System Pharmacy (ASHP) Required and
specialties in the pharmacy practice, and to certify those who Elective Educational Outcomes, Goals, Objectives, and
have met the requisites of both qualifications and experience Instructional Objectives for Postgraduate Year One (PGY1/2)
for registration as specialists. Pharmacy Residency Programs have been adapted and serve as
reference standards for the curriculum of the National PGY1/2
The Ministry of Health has set aside funding to encourage Pharmacy Residency programmes. The ASHP PGY1/2 Residency
more pharmacists to pursue specialist training. From 2008 Accreditation Standards have been adapted to serve as
to 2012, funding was provided for 35 scholarships in specialist reference standards for the Pharmacy Specialist Accreditation
residency training and to support another 43 pharmacists Board (PSAB) to accredit the local residency programmes.
in Doctorate and Masters programmes. Most of the returned
residency scholars have been accredited and registered Recognition of specialisation: The local pharmacy specialist
as specialist pharmacists and have helped to establish accreditation framework was developed with reference to the
the local PGY1 and PGY2 residency programmes. existing medical and dental specialisation framework.
Besides completion of the National PGY1/2 Pharmacy
Residency programmes, the US Board of Pharmacy Specialists,
Specialty Board Certification or Added Qualification is also a
pre-requisite for accreditation. The figure 2 below depicts the
current specialist training framework.

Figure 2: Current specialist training framework.

Nº of years
post-graduation 1 2 3 4 5 6 7 8 9

PGY1 PGY2
Work residency residency Post-residency Specialist
experience training in training specialist accreditation &
Pre-reg in patient Postgraduate broad-based in specialty practice registration if all
Programme training care area education pharmacotherapy area experience criteria are met

PSAB
specialists
accreditation
SPC SPC specialist
Qualification/ practising US BCPS US specialty practising
Pharm D
Certification certificate certification certification certificate

(SPC: Singapore Pharmacy Council)

50
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Other than the PSAB, various other committees were formed to Requirements for CPD/CE
provide governance of the Pharmacy Specialist framework.
Specialist pharmacists will need to meet continuing
• Residency Policy and Oversight Committee (RPOC): development requirements by fulfilling the training hours
required for specialty-specific CE programmes.
• Chaired by the Ministry Of Health (MOH) Chief Pharmacist
with membership comprising all six Residency Programme
Directors (RPDs), the Office of Residency Training (ORT) They must fulfil at least 15 of the total of 50 continuing
Faculty Advisor and an MOH ex-officio. professional education points in their specialty areas within
the qualifying period of two years to be eligible for renewal of
• Roles are to guide RPDs in the development, their practicing certificates.
implementation and refinement of the programmes,
including the application process and selection criteria With the exception of the grandfathered specialists, all
of residents, and to monitor and review the outcomes applicants for specialist accreditation will have to be a holder
and deliverables of the respective programmes. of the following degree, or its equivalent: Master in Clinical
Pharmacy or Doctor of Pharmacy from institutions of higher
• Pharmacy Residency Accreditation Committee (PRAC): learning that offers such a degree that is recognised
by the SPC.
• Comprised of senior pharmacy practitioners well-versed
in pharmacy practice, education and training from
the public healthcare institutions;
Supporting regulation
• Role to accredit the local residency training programmes.
The Pharmacists Registration Act 2007 provides for the
setting up of a separate register for specialist pharmacists
• Pharmacy Residency Selection Committee (PRSC):
and the registration of such specialists. The Act also makes
provision for the establishment of a Pharmacy Specialists
• Comprised of senior members of the pharmacy
Accreditation Board (PSAB) to define the pharmacy specialties
and medical community in the public sector institutions
and to determine the requirements for specialist registration.
Oncology, cardiology, infectious disease, psychiatry and
• Roles are to evaluate applications from the various
geriatrics are the SPC recognised pharmacy specialties
healthcare clusters, interview applicants and submit
its recommendations to MOH for approval.
The Register of Specialists is the record of pharmacists who
are recognised as specialists by virtue of their qualifications,
• Office of Residency Training ORT:
specialised knowledge and experience. Accredited specialists
must have met the necessary criteria stipulated by the PSAB.
• Role to provide administrative, secretariat and technical
support to RPOC, PRSC, and residency faculty members.
Professional recognition
Alignment with national strategies for A specialist certificate, in respect of that specialised branch of
healthcare services and delivery pharmacy, would be issued by the SPC. The title of a ‘specialist
pharmacist’ would also be conferred. Only pharmacists who
Building Capacity and Capability – The Ministry of Health are registered as specialists in the Register of Specialists are
recognised the need for more specialist pharmacists to allowed to use the title ‘Specialist’.
provide specialised care for complex cases in tertiary hospitals.
The development and implementation of government-funded Specialist Pharmacists serve as an important member of the
National Pharmacy Residency Programmes will help produce multidisciplinary care team and provide specialty-specific
sufficient number of specialist pharmacists to meet the future inpatient and or ambulatory care services to contribute to
needs of Singaporeans and the health care system. improved patient outcomes by optimising pharmaceutical care.

Ongoing progress
The PSAB is constantly reviewing the need to recognise
other new specialties in tandem with the healthcare needs
of Singaporean patients, and to set up the related specialist
training and accreditation framework in the new specialties.

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Lessons learned
Focused and continued stakeholders engagement and
communication, leadership support and sustainable resources
are needed to transform the pharmacy workforce and to
integrate basic, advanced and pharmacy specialist practice
as an essential part of the model of care for Singapore .

What went well:

• Professional engagement and support from pharmacy

leadership;

• Ministry of Health’s funding and continued support;

• Support and encouragement from public hospital doctors.

Challenges:

• Shifting practice landscape leading to changing model

of care continues to challenge us to better define the scope
of specialist practice;

• Forging closer collaboration with physicians in delivering

patient-centred pharmaceutical care as a cohesive team.

Key stakeholders
Ministry of Health (regulator); Pharmacy department heads
of public hospitals; and Doctors in public hospitals.

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South Africa: Development of scopes Frameworks used:

of practice and required qualifications 1. Council on Higher Education (CHE) - National
for specialist pharmacists Qualifications Framework (NQF) – Masters level
and pharmacist prescribers qualification (NQF9) and Postgraduate Diploma (NQF8).

2. Legislation – Education, Health and Pharmacy Acts.

Authors
3. Other specific regulations mentioned in case study.
Hazel Bradley, Senior Lecturer, School of Public Health,
University of the Western Cape, hbradley@uwc.ac.za; Lorraine
Osman, Head Public Affairs, Pharmaceutical Society of South
Africa, lorraine@pharmail.co.za; Vincent Tlala, Chief Operating These Action Ideas are being followed up by the blueprint for
Officer, South African Pharmacy Council, Vincent.Tlala@sapc. pharmacy Steering Committee.
za.org; Hlone Masiza, Senior Manager, Professional Affairs,
South African Pharmacy Council, Hlone.Masiza@sapc.za.org.
Alignment with national strategies for
healthcare services and delivery
Summary
South African national strategies include roll out of universal
• The statutory Pharmacy Council has developed draft scopes health care through the implementation of National Health
of practice and qualifications for four categories of specialist Insurance (NHI), focus on the primary health care level through
pharmacists (Radiopharmacist, Pharmacokineticist, Clinical the Re-Engineering Primary Health Care (PHC) Strategy and the
Pharmacist and Public Health Pharmacy & Management). National Development Plan (NDP) 2013.
Finalisation and publication as regulations is anticipated by
the end 2015. Primary Care Drug Therapy Pharmacists and Authorised
Pharmacist Prescribers are aligned to Re-Engineering PHC
• The National Department of Health instituted an approach and improvements in access to health care services.
Occupational Specific Dispensation for scarce healthcare Clinical Pharmacy and Public Health Pharmacy & Management
skills. This provides recognition and remuneration for Pharmacists align to new posts recently created (Clinical
specialisation as well as a number of career paths for pharmacist and Policy pharmacist, respectively) in public
pharmacists in the public sector. sector (government services) through benchmarking processes
resulting in Occupational Specific Dispensation (OSD) intended
• Community pharmacists may obtain a supplementary to improve quality of pharmaceutical services in public sector.
qualification in Primary Care Drug Therapy. Authorised
Pharmacist Prescriber regulations, which will permit
pharmacists to diagnose and treat conditions in compliance Requirements for CPD/CE
with the Primary Health Care Essential Medicines List and
Standard Treatment Guidelines, are awaiting approval and will CPD is required for all pharmacists in South Africa and CPD
support government strategies to improve health care across relevant to advanced practice and specialisation would be
the country. required for pharmacists registered as advanced practitioners
and specialists. Although postgraduate education in these
fields is largely in the interests of professional development,
Tools, frameworks and support mechanisms and can therefore be used to meet CPD requirements, the
only specific requirements are those dictated by the gazetted
The development of scopes of practice and qualifications for qualification. These are required for registration as a specialist/
specialist pharmacists and pharmacist prescribers have been advanced practitioner but not for CPD.
developed through consultation processes and benchmarked
with similar internationally recognised scopes of practice and
qualifications.

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Supporting regulation Pharmacist prescribers (Primary Care Drug Therapy

pharmacists and Authorised Prescribers)
Pharmacists (additional services)
Pharmacists can charge fees for services.
Rules relating to the services for which a pharmacist may
levy a fee and guidelines for levying such a fee or fees. Other services provided by pharmacists (screening,
Board Notice 33 of 2012. Pretoria: Government Gazette immunisations, emergency contraception etc.)
No. 35095, 2 March 2012. URL: http://www.mm3admin.
co.za/documents/docmanager/0C43CA52-121E-4F58-B8F6- Pharmacists can charge fees for services.
81F656F2FD17/00025238.pdf

Primary Care Drug Therapy Pharmacist Ongoing progress

Draft Regulations relating to supplementary training or Advanced Practice:
refresher courses to be undergone or taken by persons
who are registered in terms of the Pharmacy Act, 1974, and Authorised Pharmacist Prescribers: Regulations are awaiting
the provisions and control over such training or courses. signature by Minister of Health.
Government Notice No. R.1138, 4 August 1995. URL: http://www.
mm3admin.co.za/documents/docmanager/0C43CA52-121E- Specialisations:
4F58-B8F6-81F656F2FD17/00010798.pdf
Scopes of Practice and qualifications for Radiopharmacist and
Authorised pharmacist prescribers Pharmacokineticist (existing specialist pharmacists categories)
and Clinical Pharmacist and Public Health Pharmacy
Draft Scope of practice and qualification for authorised & Management (new categories) expected to be approved
Pharmacist prescriber. Board Notice 122 of 2011. Pretoria: by end 2015.
Government Gazette No. 34428, 1 July 2011. URL:
http://www.gov.za/sites/www.gov.za/files/34428_bn122.pdf Providers of new Masters qualifications, which are
a requirement for registration as a specialist pharmacist,
Specialist Pharmacists are expected to be accredited in 2016.

Draft Regulations relating to the registration of the specialities

of Pharmacists. Government Notice No. R.2342. Pretoria: Lessons learned
Government Gazette No. 15658, 29 April 1994. URL: http://www.
mm3admin.co.za/documents/docmanager/0C43CA52-121E- Good support from Minister of Health (government)
4F58-B8F6-81F656F2FD17/00011755.pdf and private health sector for advanced practice and
specialisations.
Draft Scopes of practice and qualifications for specialist
pharmacists. Board Notice 152 of 2014. Pretoria: Government Challenges: Some concerns regarding scope of advanced
Gazette 38327, 12 December 2014. URL: practice, and areas of specialisation have been expressed
www.gov.za/sites/www.gov.za/files/38327_bn152.pdf by some professional boards e.g. Health Professions Council
of South Africa (includes doctors) and South African Nursing
Council. However, the South African Pharmacy Council (SAPC)
Professional recognition has developed good relationships between boards and
memorandum of understanding (MOU) is in place to facilitate
Specialisations engagement between boards on matters of mutual concern.

• In public sector (government): through creation of some Lessons: Providers of new qualifications will only be accredited
new posts for clinical pharmacists and policy pharmacists, by SAPC after the new regulations for the qualification are
at a fairly senior level. published.

• In private hospitals: through creation of some clinical

pharmacist posts, some of which may be remunerated
at an increased salary scale. Pharmacists receive a financial
recognition for their advanced practice/specialisation.

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Key stakeholders
Several role players are promoting the establishment of
advanced practice and specialisation including: South African
Pharmacy Council (SAPC) (regulator) with support of the
Department of Health, Pharmaceutical Society of South Africa
and its sectors (the Academy of Pharmaceutical Science,
SA Association of Hospital and Institutional Pharmacists,
SA Association of Pharmacists in Industry, and SA Association
of Community Pharmacists), South African Society of Clinical
Pharmacy (SASOCP), Independent Community Pharmacy
Association (professional organisations) Schools of Pharmacy
& Public Health (academic institutions), and individual
practitioners.

The SAPC as the regulator, plays a pivotal role in ensuring

that the qualification and scopes of practice of the advanced
practice and specialisations are approved by the Minister of
Health.

Bibliography
• Minister of Health (MoH). Regulation relating to the practice of pharmacy.
Government Notice No, R.1158, November; 2000. Available from:
http://www.mm3admin.co.za/documents/docmanager/0C43CA52-121E-4F58-
B8F6-81F656F2FD17/00010804.pdf

• Minister of Health (MoH). Regulations relating to supplementary training

or refresher courses to be undergone or taken by persons who are registered
in terms of the Pharmacy Act, 1974, and the provisions and control over such
training or courses. Government Notice No. R.1138, August; 1995. Available
from: http://www.mm3admin.co.za/documents/docmanager/0C43CA52-
121E-4F58-B8F6-81F656F2FD17/00010798.pdf

• Minister of National Health and Population Development (MNHPD).

Regulations relating to the registration of the specialities of Pharmacists.
Government Notice No. R.2342. Pretoria: Government Gazette No. 15658,
April; 1994. Available from: http://www.mm3admin.co.za/documents/
docmanager/0C43CA52-121E-4F58-B8F6-81F656F2FD17/00011755.pdf

• Registrar, South African Pharmacy Council (SAPC). Rules relating to the

services for which a pharmacist may levy a fee and guidelines for levying
such a fee or fees. Board Notice 33 of 2012. Pretoria: Government Gazette
No. 35095, March; 2012.

• Registrar, South African Pharmacy Council (SAPC). Scope of practice and

qualification for authorised Pharmacist prescriber. Board Notice 122 of 2011.
Pretoria: Government Gazette No. 34428, July; 2011. Available from: http://
www.gov.za/sites/www.gov.za/files/34428_bn122.pdf

• Registrar, South African Pharmacy Council (SAPC). Scopes of practice and

qualifications for specialist pharmacists. Board Notice 152 of 2014. Pretoria:
Government Gazette 38327, December; 2014. Available from:
http://www.gov.za/sites/www.gov.za/files/38327_bn152.pdf

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Spain: Specialisation is largely Requirements for CPD/CE

governed by regulations covering
all healthcare professionals In the specific case of the pharmaceutical profession, there
are no CPD/CE requirements, though practicing professionals
constantly renew, recycle and obtain new knowledge so as to
ensure that their professional practice is updated to existing
Author needs.
President, General Pharmaceutical Council of Spain (Consejo
General de Colegios Oficiales de Farmacéuticos de España),
congral@redfarma.org. Supporting regulation
As mentioned earlier, primarily:
• Law 44/2003 of 21 November, which defines the healthcare
Summary professions [2003].
• The specialised training of healthcare professionals is
• Royal Decree 1393/2007 of 29 October, which defines
intended to provide them with the knowledge, techniques,
the official university degrees [2007].
skills and aptitudes required for a given specialty. At the same
time during this training, the professional gradually assumes
• Royal Decree 183/2008 of 8 February, which determines
the responsibilities associated with the practice of said
and classifies specialties in the Health Sciences and expounds
specialty.
on certain aspects of the system for specialised healthcare
training [2008].
• The regulation of healthcare professions provides Spain’s
health system with the legal framework containing those
• Royal Decree 639/2014 of 25 July, which regulates course
instruments and resources making it possible to integrate
subjects, re-specialisation and areas of specific practice,
healthcare professionals into healthcare services, facilitating
lays out the regulations applicable to the annual tests for
the joint responsibility needed to achieve common goals, and
admission into training programs and other aspects of the
improve the quality of the assistance given. This also ensures
healthcare training system specialising in Health Sciences,
that all professionals have the skill levels needed to ensure
and creates and modifies certain specialist titles [2014].
citizens’ right to proper healthcare.

Tools, frameworks, support mechanisms Professional recognition

The specialist title earned (official diploma and denomination)
Primarily the development of the legislation that is applicable is used. In the case of a Doctorate or Masters, the title of
in each case. Doctor in (…) and Master in (…) may be used, as applicable.

Alignment with national strategies for Lessons learned

healthcare services and delivery
A considerable amount of work has been carried out in this
It is the Spanish government, at the request of the Ministries area, and the applicable regulations have been completed and
of Education and Health, and subsequent to a report from the improved over time. One aspect that needs further work is CPD,
National Healthcare System Human Resources Commission of both for specialised and non-specialised professions.
the National Council on Health Sciences Specialties, and from
the relevant professional organisation, that defines, deletes
or changes the names of the titles for Specialists in Health Key stakeholders
Sciences.
Legislation with support from professional organisations.
The National Healthcare System Human Resources
Commission, together with requests made by the regional
governments, the healthcare system’s need for specialists,
and the available budget, sets the number of places to be filled
through the annual entrance exams.
This number is determined subsequent to a report from the
National Council on Health Sciences Specialties and from the
Ministry of Education.

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Switzerland: pharmaSuisse responsible Requirements for CPD/CE

for programmes and titles of recognition
and maintenance of federal titles Postgraduate education in Switzerland is not university linked.
Some or all of the required postgraduate courses can be
taught at university but only the professional association is
responsible for delivering postgraduate titles and certificates.
Authors Postgraduate education has to be further education based
on the university education. University, postgraduate and
Astrid Czock, Head Dept. Science, Education, Quality, Member
continuous education is defined in the federal Law for the
of the Operational Board of Directors, pharmaSuisse, a.czock@
Medical professions (c.f. art. 3: https://www.admin.ch/opc/fr/
bluewin.ch. Dominique Jordan, Immediate Past President,
classified-compilation/20040265/index.html).
pharmaSuisse, dominique.jordan@pharmasuisse.org.
Every healthcare professional is required to further their
education by the above law (art. 40).
Summary
Furthermore, every pharmacist holding a postgraduate
• Two federal postgraduate titles (community pharmacy and title is required by the postgraduate education regulations
hospital pharmacy). to further their education by annually visiting four days of
controlled continuous education, as well as a further six
• Postgraduate certificates for specialised competencies. days of non-controlled professional reading. These four days
of continuous education are controlled by the professional
• Federal accreditation of the postgraduate education of all society, pharmaSuisse, using a specially developed educational
medical professions, including pharmacy. platform.

• Revision of the Law for the Medical professions in favour of

pharmacists and their evolving role providing new services Supporting regulation
according to the needs of the healthcare system and society.
Postgraduate programs in community pharmacy and hospital
• The professional association (pharmaSuisse) is responsible pharmacy are accredited by federal law every seven years. In
for all postgraduate education in pharmacy. addition to the accreditation of the programs, the responsible
institution (pharmaSuisse) will be accredited in 2016 for the
first time.
Tools, frameworks and support mechanisms
With the accreditation of the programmes in 2013, the
pharmaSuisse developed their own programmes, created federal government gave recommendations and compulsory
the necessary infrastructure (external education providers amendments that needed to be done within a certain period
and internal education providers) to make the necessary of time (i.e. until the end of 2014 or 2015). The required
postgraduate and continuous education possible and then amendments are controlled by the federal government.
submitted the programs to get acknowledged by the federal
government.
Professional recognition
The federal Law was adapted after the postgraduate titles
were acknowledged. With the newly revised Law of the Medical Professions it
will be compulsory also for a pharmacist-in-charge to have a
postgraduate title in either community or hospital pharmacy
Alignment with national strategies – this is in accordance with medical doctors, dentists and
for healthcare services and delivery chiropractors. The law applies to all pharmacists exercising
their professional activity in a community or a hospital
pharmaSuisse developed the courses and the postgraduate pharmacy.
certificates, as well as the postgraduate titles, in accordance
to the needs of society and the health care system.

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Ongoing progress
As mentioned above, the newly revised Law for the medical
professions was revised in favour of pharmacists and their
changing role as healthcare professionals providing services
as required by the evolving healthcare system and the needs
of society.

Lessons learned
In 1994-1999 the postgraduate specialisation in community
pharmacy consisted of two four-week courses over two years,
organised by pharmaSuisse. In 2000, pharmaSuisse wanted to
let the pharmacists organise their own schedules according
to a set curriculum. Now, more than ten years later, and in
preparation for the first federal accreditation, a set curriculum
with an organised schedule is back in practice – a mix
of three single course weeks and single variable courses.
The curriculum has to be passed within two-five years.

The federal re-accreditation of the postgraduate curricula

(2018-2020) and the accreditation of pharmaSuisse as the
responsible organisation for the postgraduate titles in
pharmacy (2016) will be a large workload but manageable as
our accreditation in 2011-13 is a model for the re-accreditation
of the medical professions. In 2016 pharmaSuisse will
be accredited parallel to the professional societies of
medical doctors, chiropractors and vets, so that the federal
government has a comparison among the medical professions.

Key stakeholders
The professional organisation and the federal government.

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USA | California: States differ There are no requirements for university-linked education.
State boards of pharmacies will accept continuing education
in the recognition of specialty accredited by the Accreditation Council for Pharmacy
and advanced pharmacy practice Education (ACPE), and some state boards will accept
continuing education accredited by other bodies. For example,
California will accept accredited Continuing Medical Education
Author (education that would be accepted by the state medical board)
and also California Accreditation for Pharmacy Education.
Sarah McBane, Associate Clinical Professor, University of
California San Diego, Skaggs School of Pharmacy
and Pharmaceutical Sciences, smcbane@ucsd.edu. Supporting regulation
State regulations are cited above, but there is no similar
Summary regulation in place at a national level.
National organisations have published perspectives on
• The diversity of regulatory agencies (e.g. – state boards of the need for advanced training and certification, and offer
pharmacy) makes comparison of practices difficult. educational programmes for their members.

• Advanced practice recognition is limited to certain states. American College of Clinical Pharmacy - publication:
Qualifications of Pharmacists Who Provide Direct Patient Care:
• Specialisation is primarily through the Board Perspectives on the Need for Residency Training and Board
of Pharmaceutical Specialties. Certification. Pharmacotherapy 2013; 33(8): 888–891. Available
at: http://www.accp.com/docs/positions/commentaries/
• The concept of reimbursement for advanced practice services Commntry_BOR_DPC_phar1285.pdf
remains a challenge.
American Society of Health System Pharmacists - policy 0701:
To support the position that by the year 2020, the completion
of an ASHP-accredited postgraduate-year-one residency should
Alignment with national strategies be a requirement for all new college of pharmacy graduates
for healthcare services and delivery who will be providing direct patient care. Available at:
http://www.ashp.org/DocLibrary/BestPractices/
In California, it is envisioned that advanced practice EducationPositions.aspx
pharmacists will be able to supplement the primary
care workforce. Currently, about two-thirds of the counties
in California lack sufficient primary care physicians. Professional recognition
While it is not expected that advanced practice pharmacists
will replace physicians, they may be able to provide care for Each state has its own laws and regulations regarding
some patients thus alleviating the burden on primary care pharmacy practice. However, many states that have some
physicians. For example, pharmacists might be able to manage recognition of advanced pharmacy practice recognise the
medication-intensive conditions such as diabetes, freeing certifications from the Board of Pharmaceutical Specialties
physicians to focus their energies on other medical needs. (BPS).

Requirements for CPD/CE Ongoing progress

In general, pharmacists with advanced practice designations In California – as with all states in the United States –
have additional requirements for continuing education. pharmacists and the practice of pharmacy is regulated by
In North Carolina, pharmacists (without any special our state regulatory body, the state Board of Pharmacy. The
designation) are required to accrue 15 hours of continuing mission of the Board of Pharmacy is to protect and promote
education annually. Clinical pharmacist practitioners are the health and safety of California residents by regulating
required to accrue 35 hours of practice-specific continuing pharmacists and pharmacy practice (http://www.pharmacy.
education annually. In California, pharmacists (without ca.gov/about/mission_statement.shtml).
any special designation) are required to accrue 30 hours of
continuing education every two years.

Advanced practice pharmacists are required to accrue an

additional 10 hours of practice-specific continuing education
every two years.

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The board has convened a taskforce to evaluate the

implementation of advanced practice pharmacists. The
taskforce has met several times, starting in June 2014
and continuing through the present time. The time frame
for implementation of advanced practice pharmacists is
estimated to be in the latter half of 2015.

Lessons learned
In California, the legislation that created advanced practice
pharmacists was introduced in 2013. The legislation served as a
unifying voice for pharmacists throughout the state, especially
members of the two state pharmacy organisations: ‘California
Pharmacists Association’ and ‘California Society
of Health System’.

Current challenges include education of all pharmacists in

the state – those who are not members of the state pharmacy
organisations are less likely to be aware of the opportunity –
and the pace of implementation as regulated by the California
Board of Pharmacy. An additional challenge is the question
of reimbursement. Although pharmacists in California are
recognised as healthcare providers, there is no legislation,
policy, or regulation that mandates any sort of compensation
for advanced practice.

There are efforts at a national level to garner provider status

for pharmacists – there are currently companion bills in the
United States Senate and House of Representatives. These
bills call for recognition and compensation of pharmacists
for services not linked to a product (i.e. – dispensing). There
is no mention of advanced practice pharmacy in these
bills, however it is implied because the national legislation,
if passed, would simply authorise and recognise what
pharmacists do on a state-by-state basis (http://www.
pharmacistsprovidecare.com/facts).

Key stakeholders

In California, the regulator is the current driver. The state

pharmacy organisations – the California Pharmacists
Association primarily and to some extent the California Society
of Health System Pharmacists – are supporting the Board in its
efforts.

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USA | North Carolina: States differ Certification in defined areas of pharmacy practice has also
pushed the case for recognition of pharmacists as providers.
in the recognition of specialty The Board of Pharmacy Specialties (BPS) is the organisation
and advanced pharmacy practice that certifies pharmacists in the areas of pharmacotherapy,
ambulatory care, critical care, nuclear, oncology, paediatrics,
nutrition support, and psychiatry. Over the past decade there
Authors has been significant growth in the number of board certified
pharmacists and the number of specialties pharmacists can be
David Steeb, Clinical Assistant Professor and Director of Global certified in.
Engagement, UNC Eshelman School of Pharmacy, david_
steeb@unc.edu; Stephen Eckel, Clinical Associate Professor To assist with federal recognition, more than 25 national
and Associate Director of UNC Hospitals, UNC Eshelman School pharmacy organisations, companies, and key stakeholders
of Pharmacy, seckel@unc.edu; Macary Marciniak, Clinical united to establish the Patient Access to Pharmacists’ Care
Associate Professor, UNC Eshelman School of Pharmacy, Coalition (PAPCC) (http://pharmacistscare.org/) which aims
macary_marciniak@unc.edu. to expand patient access to pharmacist services in medically
underserved communities across the country.

A national grassroots advocacy campaign, Pharmacists

Summary Provide Care, has also been established which includes an
informative website with several educational resources about
• In the United Stated (US), the profession of pharmacy
provider status (www.pharmacistsprovidecare.com). On this
is pushing for the federal recognition of pharmacists as
website there is a user-friendly tool that allows supporters to
healthcare providers, which would enable payment for
identify and communicate with his or her elected official to
cognitive and clinical services, such as medication therapy
urge them to support legislation that recognises pharmacists
management, in medically underserved communities.
as providers. Supporters can also fill out a provider status
commitment card to reaffirm their support for being an active
• Most states allow pharmacists to initiate, modify, and
participant in the campaign for provider status. As of this
continue medication regimens through collaborative drug
publication, the campaign has nearly 20,000 supporters.
therapy management (CDTM) protocols.1

• In North Carolina, pharmacists with advanced training can

become credentialed as a clinical pharmacist practitioner (CPP) Alignment with national strategies
allowing for an expanded level of care including prescriptive for healthcare services and delivery
authority.
The Patient Protection and Affordable Care Act (ACA) was
• As the scope of pharmacy practice evolves, more pharmacists signed into law by President Barack Obama in 2010 with
are pursuing advanced training and board certification the primary goals of improving quality, reducing costs, and
in a growing number of specialties expanding access to healthcare. As one of the most accessible
and trusted healthcare professions, pharmacists have the
opportunity to fulfil the goals of the ACA by providing patient
care services to a larger population of people, especially
Tools, frameworks and support mechanisms those living in medically underserved or health professional
shortage areas.
While pharmacists continue to strive for national recognition
as healthcare providers, some states have passed legislation
As chronic care, access to care, and the provider workforce
that has expanded the scope of practice for pharmacists
become more important focus areas under the ACA,
within that state through collaborative drug therapy
pharmacists are primed to fulfil a variety of needed roles
management (CDTM) protocols and have recognised
as healthcare professionals that provide preventative and
pharmacists as healthcare providers.
primary care patient services.2 To help fulfil this role, certified
pharmacy technicians can allow pharmacists to expand
As states continue to develop innovative advanced practice
patient care services. The federal recognition of pharmacists
models, such as that of the clinical pharmacist practitioner
as healthcare providers would further strengthen the goals of
(CPP) model in North Carolina, it is the hope of the profession
the ACA of providing high quality, cost-effective patient care
that these state frameworks continue to provide support for
services that improve patient and health system outcomes.
federal recognition of pharmacists as healthcare providers
along with other recognised professions such as nurse
practitioners, dentists, optometrists, and psychologists
among others.

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The Community Care of North Carolina (CCNC) is widely In 2013, California passed a bill recognising pharmacists as
recognised for its innovative state-wide medical home and providers and established the advanced practice pharmacist
care management system3. Through a variety of community (APP) designation for pharmacists who meet the additional
networks, pharmacists in collaboration with other healthcare training and certification criteria. Besides advanced practice
providers are able to manage medication related needs and models, pharmacists can be board certified in defined areas
improve health outcomes, thereby strengthening the goals of such as pharmacotherapy which allows them to place board
the ACA. Most networks employ at least one pharmacist with certification credentials after their name (i.e. BCPS for Board
advanced training as part of a collaborative care model. Certified Pharmacotherapy Specialist). Both board certification
and advanced practice credentials could lead to career
advancement and professional growth.
Requirements for CPD/CE
While some pharmacists have these advanced designations,
Advanced practice models in certain states such as the CPP there is still the challenge for federal government insurers
model in North Carolina require additional practice relevant and other stakeholders to recognise these titles from a
continuing education (CE) hours (35 hours/year) compared to reimbursement perspective for the patient care services
that which is required for traditional pharmacists (15 hours/ pharmacists provide.1
year). The state of North Carolina allows for the submission
of a continuing professional development (CPD) portfolio to
count for licensure and recertification. This is the only state to Ongoing progress
date that allows it.
The main push for provider status recognition is through
There is not a specific requirement that CE be associated with the Pharmacists Provide Care Campaign and the Patient
a university or part of an additional postgraduate training Access to Pharmacists’ Care Coalition. The priority behind
programme. However, there are a number of pathways one can these endeavours is to gain legislative support for and pass
pursue to obtain the CPP credentials or other specialisations, the Pharmacy and Medically Underserved Areas Enhancement
which could include postgraduate training (i.e. residency Act, which will enable Medicare beneficiaries to access
training) associated with a university. pharmacists’ services through the amendment of the United
States Social Security Act.

Supporting regulation
Lessons learned
The scope of pharmacy practice is regulated at the state level
by state boards of pharmacy. Most state boards of pharmacy What has worked well is that states have recognised the value
have language recognising CDTM, which allows pharmacists to and importance of having pharmacists provide patient care
initiate, modify and continue drug therapy under a protocol in services with 48 states having some form of collaborative
collaboration with other providers for a specific patient practice between pharmacists and providers.4 Additionally,
or patient population. Although the scope of CDTM 37 states have recognised pharmacists as providers, which
and other patient care services such as immunisations has further pushed the cause for federal recognition of
differ from state to state, these regulations allow pharmacists as providers.5 However, despite this progress
pharmacists to further engage with other providers and and success, much has to be done regarding the regulatory
patients in an advanced manner. framework to support provider status on both the state
and federal level including reimbursement and payment
models for pharmacist services.6 The recognition by states
Professional recognition of pharmacists as providers reduces statutory barriers for
payment for pharmacist patient care services, but it does not
Certain states in the US have designated titles for advanced necessarily correlate with reimbursement for these services.7
practice pharmacists with prescriptive authority that have
met additional training criteria to work alongside physicians Regarding advanced practice models such as the CPP in North
through collaborative drug therapy management agreements. Carolina, a survey1 in 2011 indicated that the main challenges
In New Mexico, these pharmacists are called Pharmacist to implementing an advanced collaborative practice model
clinicians while in Montana and North Carolina they included lack of acceptance by other providers and the
are deemed clinical pharmacist practitioners. clinical inability to receive adequate reimbursement for patient
pharmacist practitioners will have “CPP” placed after their care services. An additional challenge is there is a lack of
name as part of their credentials and similarly pharmacist standardisation regarding CDTM agreements and the scope
clinicians will have “PhC”. of pharmacy practice they cover since these agreements
are governed separately by each state.

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Key stakeholders
In the US, professional pharmacy organisations are a driving
force behind advancing the practice of pharmacy and the
recognition of pharmacists in advanced roles and as providers.
Numerous national pharmacy organisations have come
together to push for recognition of pharmacists as healthcare
providers under federal law in order to recognise the value
of and reimburse for the services pharmacists provide
to patients. In addition, the Patient Access to Pharmacists’ Care
Coalition has been established which is a multi-stakeholder,
interdisciplinary initiative to expand patient access
to pharmacist services in medically underserved areas
of the country (http://pharmacistscare.org/).

State Boards of Pharmacy and State Pharmacy Associations

are also a driving force in developing and supporting advanced
practice models for pharmacists within a particular state.

References
1. Murawski M, Villa KR, Dole EJ, Ives TJ, et al. Advanced-practice pharmacists:
practice characteristics and reimbursement of pharmacists certified for
collaborative clinical practice in New Mexico and North Carolina.
Am J Health Syst Pharm. 2011;15; 68(24): 2341-50.

2. Giberson S, Yoder S, Lee MP Improving patient and health system

outcomes through advanced pharmacy practice. A report to the U.S. surgeon
general. Office of the Chief Pharmacist. U.S. Public Health Service; 2011.

3. A history of CCNC. Community Care of North Carolina; 2011. Available from:

http://www.communitycarenc.com/about-us/history-ccnc-rev/

4. Pharmacist provider status gains traction. Drug Topics; 2015. Available

from: http://drugtopics.modernmedicine.com/drug-topics/news/
pharmacist-provider-status-gains-traction?page=full

5. Provider status success: a look back at 2014. American Pharmacists

Association; 2014. Available from: https://www.pharmacist.com/provider-
status-successes-look-back-2014

6. Marotta R. Regional pharmacy trends: the state of provider status.

Pharmacy Times; 2015. Available from: http://www.pharmacytimes.com/
publications/career/2015/PharmacyCareers_February2015/Regional-
Pharmacy-Trends-The-State-of-Provider-Status

7. Weaver K. NASPA finds state-level provider status is widespread, but

not necessarily linked to payment. American Pharmacists Association;
2015. Available from: http://www.pharmacist.com/naspa-finds-state-level-
provider-status-widespread-not-necessarily-linked-payment

63
 PART 5
OVERVIEW OF TERMINOLOGY
AND NOMENCLATURE
.................................................................................. ..................................................................................

Global agreement on terminology and definitions is an

important early step necessary for shared understanding
of issues around advancing practice and specialisation.
As a key component of data gathering for this report, FIP
member organisations, country level contacts from regulatory,
professional and government agencies and universities, were
approached to contribute a case study database describing
aspects of advanced practice and specialisation.

A template was developed in collaboration with the FIP

Collaborating Centre, University College London School
of Pharmacy, Faculty of Pharmacy and Pharmaceutical
Sciences at Monash University, and FIP Education Initiative.
The template was validated by an expert working group,
drawn from a cross-section of FIP sections and special-interest
groups. Data was collected between January 2015
and May 2015.

Cases were edited and returned to original authors for

approval. Details of individual cases are in Part 4 of this report.

The data collection template and report are available

for download from www.fip.org/educationreports.

Collation of input from 18 case studies (covering 17 countries)

indicates significant differences in our understanding and
usage of common terms. For this report no attempt has been
made to harmonise these definitions, or to suggest global
definitions; however FIPEd will continue to investigate
how to contribute to improved common understanding of
terminology in this area, and work towards a transnational
understanding of specialisation and advanced practice.

Presented in the tables are the responses received when

contributors were asked to share their definitions of the
following common terms.

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WHO regional Examples of definitions of “Specialisation”

country examples

EUROPE Pharmacists are considered qualified for a specialisation if, after concluding their university diploma, have undergone the
PPS Specialists’ Programme on one of the areas of specialisation and achieve the title of ‘specialist’.

EUROPE Specialist – someone fulfilling the role and with specialist knowledge as defined by Expert Practice Curricula produced
by specialist groups in pharmacy.

WESTERN PACIFIC A recognised branch of a profession in which one specialises.

SOUTH-EAST ASIA The specialisation in pharmacy education is at postgraduate level. At present ‘The Master of Pharmacy (M.Pharm) Course
Regulations, 2014’ is in vogue prescribing the following specialisations (e.g.): 1. Pharmaceutics ; 2. Industrial Pharmacy ;
3. Pharmaceutical Technology ; 4. Pharmaceutical Chemistry ; 5. Pharmaceutical Analysis.

The speciality practice is governed by specialisation held by the pharmacist. For example the M.Pharm of following
specialisations predominantly practice in research, manufacturing, analysis, quality control, etc. - a. Pharmaceutics,
b. Industrial Pharmacy, c. Pharmaceutical Technology, d. Pharmaceutical Chemistry, e. Pharmaceutical Analysis,
f. Pharmaceutical Quality Assurance, g. Pharmaceutical Biotechnology. 2.Similarly holders of M.Pharm. regulatory affairs
practice in the government sector (drug regulatory departments, departments regulating education like PCI, State Pharmacy
Councils etc.). 3.Holders of M.Pharm. pharmacy practice basically practice in community pharmacy and hospital pharmacy.

WESTERN PACIFIC There are two meanings: hospital pharmacist or community pharmacist; pharmacists who have specialised skills in more
specific area.

WESTERN PACIFIC Term used mainly in hospital practice to recognise advanced skills and knowledge in a specified specialised area of practice
e.g. renal pharmacist, medicines information.

WESTERN PACIFIC Refers to advanced practice in a particular clinical area/discipline. The PSAB recognises the following pharmacy specialties
for a start: 1. Advanced Pharmacotherapy which includes: cardiology pharmacy, geriatric pharmacy, infectious diseases
pharmacy and psychiatric pharmacy; 2. Oncology Pharmacy.

EUROPE Specialised training in the Health Sciences is an official, structured program whose purpose is to provide professionals with
the knowledge, techniques, skills and aptitudes needed for the relevant specialty, while at the same time having the
candidate gradually take over the responsibilities inherent to the practice of the specialty.

AMERICAS An identifiable and distinct field of practice that calls for special knowledge and skills acquired by education and training
and/or experience beyond the basic pharmaceutical education and training. Specialisation may focus on a certain
therapeutic area (e.g. – oncology) or an area of practice, e.g. health system administration.

AMERICAS “An identifiable field of pharmacy practice that requires specialised functioning and is distinct from other BPS-recognised
pharmacy specialties” .

Specialisation often refers to pharmacists who are board certified in the areas of ambulatory care, critical care, nutrition
support, nuclear, oncology, paediatric, pharmacotherapy, and psychiatry. Specialisation can also refer to the concept of
pharmacists pursuing postgraduate training or experience within a defined pharmacy practice area such as cardiology,
oncology, infectious disease, solid organ transplant, critical care, paediatrics, etc. which often precedes formal board
certification. See article “Growing trend of specialisation, board certification”

AMERICAS For the purpose of the needs assessment of pharmacist specialisation, the following definitions were used: Pharmacist
Specialists: maintain an active clinical practice that is limited to a particular type of patients (e.g. geriatrics, ambulatory
care). Specialties can be either broad (e.g. Pharmacotherapy specialists) or focused (e.g. oncology or cardiology specialists).
Pharmacy specialisation requires an advanced body of knowledge distinct of the general practitioner and a specialised or
enhanced depth of competency including knowledge, skills, attitudes and accountabilities based on the physical, social,
and health sciences, sufficient to manage the most complex of cases and provide clinical leadership in the field. Generally,
specialty competencies attained through formal learning /education programs and practice in the field are recognised
through a certification process.

AMERICAS Specialty practice (specialism) is the training on a specific topic as part of a profession or field of application for various
professions, such capacitation gets through by an intensive theoretical and practical training

PHARMINE Specialisation has a syntax meaning of becoming an expert in one particular skill or area. It is not universally accepted
as a term to denote ‘sector of practice’. (…) “means an advanced understanding of a specific sector (hospital pharmacy)
while “specialist practice” means specific competence in a defined field of practice (for example, oncology pharmacy
or radiopharmacy).”

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WHO regional Examples of definitions of “Advanced Practice”

country examples

WESTERN PACIFIC Practice that is so significantly different from that achieved at initial registration that it warrants recognition by
professional peers and the public of the expertise of the practitioner and the education, training and experience from which
that capability was derived.

WESTERN PACIFIC Practice necessary of advanced clinical and pharmaceutical knowledge, skills, and experiences.

AMERICAS Advanced Practice Pharmacists are recognised in California’s state law as pharmacists who may practice pharmacy
at an advanced scope.

EUROPE ‘Advanced Training’: Masters programs are designed to give students advanced training of a specialised or multi-disciplinary
nature, geared toward an academic or professional specialisation, or to initiate them in research activities.

AMERICAS Advanced practice often refers to innovative practice models such as the Clinical Pharmacist Practitioner (CPP) model
in North Carolina and the Pharmacist Clinician (PhC) model in New Mexico. Advanced practice settings, pharmacists are
involved with provision of more expanded direct patient care through comprehensive disease management, CDTM,
medication management, health promotion/disease prevention, care coordination and follow‐up patient care. Many
of these services are similar in scope and complexity to other primary care services delivered in our healthcare system.

AMERICAS Defining an Advanced Practice Pharmacist: graduation from an accredited experiential pharmacy training program such
as a residency, clinical Masters program, or Doctor of Pharmacy program; ability to collaborate with the healthcare team in
their clinical practice; ability to access and interpret comprehensive health information relevant to the patient’s care; ability
to assess and monitor a patient’s signs, symptoms, and response to therapy; expectation to practice within the person’s
scope of expertise; recognition of duty to incorporate evidence-based decisions and the patient’s goals and preferences into
the care plan; recognition of duty to communicate interventions and plans to the rest of the care team; ability to monitor
the outcomes of interventions; accountability to ensure appropriate follow-up; and responsibility for the patient’s care.

EUROPE Pharmacy professionals who are experienced practitioners; who are developing complex skills; or who are recognised at
NHS Consultant or higher levels of practice. For example, registered practitioners are very often involved in work relating to
patients, customers and other staff and are the ones who are experiencing how day-to-day healthcare works in action. They
often undertake more education, training and professional development opportunities to further consolidate and develop
their skills and knowledge in everyday practice. They are uniquely placed to develop experience across all six clusters.

This experience will, of course vary from sector to sector, but these experiences can be mapped to very generic
competencies with some additional support and guidance. Essentially the framework is very useful for capturing a
practitioner’s experience and development as evidence of advancement. More experienced practitioners hold more complex
roles and have greater responsibility for outcomes and deliverables. They develop their abilities though delivery of services,
higher levels of responsibility and accountability, by working with colleagues in other settings and projects and by working
across boundaries, disciplines and sectors. Familiarity with a specific focus of practice will enable them to improve
healthcare for patients, to innovate, educate and research their practice, whatever their sector. As established members of
staff, area teams, company or Trust directors or as pharmacy owners and partners, they are able to develop their leadership
abilities by actively contributing to the running of the organisation and to the way care is provided in complex systems.

WHO regional Examples of definitions of “Defined area of practice”

country examples

WESTERN PACIFIC The pharmacist’s area of responsibility and accountability in professional practice. As defined in the Advanced Pharmacy
Practice Framework (APPF). Preferred terms are Area of expert professional practice; Scope of practice.

EUROPE The specific area of responsibility in a role, which may be a specialist or general area of practice but would be covered in
depth beyond that of a core area as is the focus of that role. Knowledge and skills are defined in the generic and specialist
‘Professional curricula’.

SOUTH-EAST ASIA Various areas of expert professional practice are defined as under – ‘Community Pharmacist’ means an individual currently
registered and who works according to legal and ethical guidelines to ensure the correct and safe supply of medical
products to the general public. They are involved in maintaining and improving people's health by providing advice and
information as well as supplying prescription medicines. ‘Hospital Pharmacist’ means an individual currently registered and
who works in a hospital pharmacy service, primarily within the public/private sector. They are responsible for ensuring the
safe, appropriate and cost-effective use of medicines. Hospital pharmacists use their specialist knowledge to dispense drugs
and advise patients about the medicines, which have been prescribed. They work collaboratively with other healthcare
professionals to devise the most appropriate drug treatment for patients.

Some pharmacists are also involved in manufacturing required drug treatments. ‘Drug Information Pharmacist’ means
an individual currently registered who works in a community pharmacy/hospital pharmacy/teaching hospital/ other
healthcare settings and provides information and advice regarding drug interactions, side effects, dosage and proper
medication storage to patients/physicians/dentists/other health care professionals. ‘Clinical Pharmacist’ means an
individual currently registered and who provides patient care that optimises the use of medication and promotes health,
wellness and disease prevention. Clinical pharmacists care for patients in all health care settings. Clinical pharmacists often
collaborate with physicians and other healthcare professionals.

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WHO regional Examples of definitions of “Scope of Practice”

country examples

EUROPE Defined as Core Areas of Practice: Core areas cover the common areas that any practitioner would be expected to be familiar
with in a similar role at an advanced level.

The core areas of pharmacy practice include leadership, management, education, training and development, and research
and evaluation.

Core clinical areas are defined in the generic and specialist, professional curricula.

WESTERN PACIFIC The boundaries within which a health professional may practice.

WESTERN PACIFIC A time sensitive, dynamic aspect of practice, which indicates those professional activities that a pharmacist is educated,
competent and authorised to perform and for which they are accountable.

AMERICAS Describes the procedures, actions, and processes that a healthcare practitioner is permitted to undertake in keeping with
the terms of their professional license.

AMERICAS Types of service the practitioner is trained and permitted to do within their own organisation/province. Scope of practice
varies.

AMERICAS “The boundaries within which a health professional may practice. For pharmacists, the scope of practice is generally
established by the board or agency that regulates the profession in a given state or organisation.” The article “Scope of
contemporary pharmacy practice: Roles, responsibilities and functions of pharmacists and pharmacy technicians” provides
an overview of the current context and scope of pharmacy practice and has a great appendix with a terminology glossary.
Please also note that ‘scope of practice’ is governed at the state level by state boards of pharmacy.

WESTERN PACIFIC The scopes of practice describe the health services that form part of the profession of pharmacy. There are three scopes of
practice - intern pharmacist, pharmacist, and pharmacist prescriber. All advanced services fall within the Pharmacist Scope
of Practice except prescribing which has its own scope.

WHO regional Examples of definitions of “Expert professional practice”

country examples

WESTERN PACIFIC A particular field or subject in, which an individual has acquired the knowledge, skills and experiences for them to be
accepted as an expert.

EUROPE The specific area of responsibility in a role, which may be a specialist or general area of practice but would be covered in
depth beyond that of a core area as is the focus of that role. Knowledge and skills are defined in the generic and specialist
‘Professional curricula’.

A defined area may be: an area of clinical practices e.g. cardiology, paediatrics a specific role e.g. Area Manager,
Superintendant Pharmacist a service area e.g. manufacturing of cytotoxics, medicines information.

WHO regional Examples of definitions of “Privileging”

country examples

AMERICAS The process that healthcare organisations employ to authorise practitioners to provide specific services to their patients.
Also sometimes termed “credentialing”, this is a quality assured process, which recognises a practitioner’s attainment of the
required knowledge and skills at a particular level of practice. Crucially, this is a process conducted through professional
peer review, and is not connected with a regulatory function. It exists for the purposes of validation of practice by peers, and
demonstrates a recognition of practice that has value and merit for the general public and other members of the profession
or professional colleagues.

WESTERN PACIFIC The process by which a healthcare organisation, having reviewed an individual healthcare provider’s credentials and
performance and found them satisfactory, authorises that person to perform a specific scope of patient care services within
that organisation.

WESTERN PACIFIC The process that healthcare organisations employ to authorise practitioners to provide specific services to their patients.

WESTERN PACIFIC Permission grated by a facility or institute to the individual to allow them to undertake specific procedures or services.
Not specialised in pharmacy.

SOUTH-EAST ASIA The healthcare organisations like hospitals, dispensaries or community pharmacies and other appointing authorities after
being satisfied of the credentials and performance of pharmacist, allow the pharmacist to perform his/her duties.

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WHO regional Examples of definitions of “Extended Practice”

country examples

WESTERN PACIFIC An extension of existing scope of practice, requiring additional education and training and demonstration of competence.

SOUTH-EAST ASIA Bachelor of Pharmacy (B.Pharm.) is a four years course in which there is a provision for lateral entry for pharmacist holding
diploma in pharmacy qualification for admission to direct 2nd year B.Pharm. course. Similarly there is a provision of lateral
entry in Pharm.D. course for pharmacist holding B.Pharm. qualification to take direct admission in IVth year Pharm.D. course
which is six years duration. Since above provisions are available in the statutory regulations, it motivates the pharmacist to
go for extended practice requiring additional education and training for which the scope is available in the Pharmacy
Practice Regulations, 2015.

AMERICAS Pharmacist Extended Practice Regulations made under Section 83 of the Pharmacy Act - “extended practice” means any of
the following practices: (i) directly administering drug therapy to a patient, including drug therapy by injection, (ii) testing.

Pharmacist and Pharmacy Technician Profession Regulations made under the Regulated Health Professions Act 2014 -
extended practice by a pharmacist includes any of the following activities: (a) administering a vaccine or drug therapy
to a patient (i) by intradermal, subcutaneous or intramuscular injection, (ii) orally, including sublingual and buccal
administration, (iii) topically, including ophthalmic, otic and intranasal administration, and (iv) by inhalation; (b) on and after
1st April, 2016, dispensing methadone and suboxone; (c) prescribing drugs for minor ailments as authorised in the Practice
of Pharmacist and Pharmacy Technicians Regulations.

Pharmaceutical Regulation made under The Pharmaceutical Act - "extended practice pharmacist" means a member whose
name is entered on the register of extended practice pharmacists under Part 12. To be an applicant for extended practice
pharmacist: 95(1) An applicant for registration as an extended practice pharmacist must (a) be a member who is qualified
as a specialist in an area described in section 96; (b) submit an application to the board in the form approved by the council;
(c) practice or undertake to practice in a collaborative practice that meets the requirements of clause(5) (c); and (d) pay the
fee provided for in the by-laws. Section 96 - A member is qualified as a specialist in an area upon providing evidence
satisfactory to the registrar that he or she has one or more of the following qualifications: (a) board certification from
the American Board of Pharmacy Specialties in one of the following specialties, is currently practising, and has practised
for at least 1000 hours in the two years before applying for registration, in a healthcare setting in one of the following
specialty areas: (i) ambulatory care pharmacy, (ii) nuclear pharmacy, (iii) nutrition support pharmacy.

EUROPE Pharmacists must undertake accredited training in order to provide flu vaccination service. This is not officially referred
to as extended practice, but is provided for by legislation (http://www.irishstatutebook.ie/2011/en/si/0525.html).

WHO regional Examples of definitions of “Professional Recognition”

country examples

EUROPE Professional recognition comes as a title awarded by the PPS that might be relevant for the pursuit of specialised
pharmaceutical acts. Title awarded by the PPS can come from special academic education (MSc, PhD, etc.), other relevant
education or specialisation programmes of the PPS. These are specially detailed in the PPS database and come written on
the pharmacists’ professional card. Some professional acts are reserved for specialisation titles awarded by the PPS.

SOUTH-EAST ASIA The term used for professional recognition is “Registered Pharmacist”, as an acknowledgement of a pharmacist’s
professional status and right to practice the pharmacy profession in accordance with prescribed professional standards.

EUROPE Public, express and individual recognition of the level attained by a healthcare professional in terms of knowledge,
experience in service, teaching and research activities, as well as of complying with the service or research-oriented goals
of the organisation where they provide their services. Access to the professional development system is voluntary and
open to any professional who provides services within Spain.

WESTERN PACIFIC The recognition is divided into four levels. Obtaining the first level and accessing subsequent levels requires a favourable
evaluation of the applicant’s knowledge, skill, accredited continuing training, and teaching and research activity.
Also considered will be the results of hospital care services, their quality, and compliance with assessment indicators.
Anyone with five years of accredited professional practice is eligible for the first level.

Advanced and Extended Pharmacy Practice - an environmental snapshot discusses professional recognition for advanced
practice for pharmacy and other professions. There is no generally defined term used in practice to describe aspects of
advancing practice and specialisation. The professional recognition of advanced practice will be via the awarding of the
Credential of Advanced Practice Pharmacist.

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WHO regional Examples of definitions of “Credential” or “Credentialing”

country examples

WESTERN PACIFIC Credential: Documented evidence of professional qualifications. Credentialing: Process by which an authorised
organisation/body reviews and verifies a practitioner’s qualifications, skills, experience and competencies against defined
standards, applying for advanced practice recognition by submitting a practice portfolio for evaluation against the APPF
and the standards/policies and procedures.

AMERICAS The CSHP permits its fellows to use the credential FCSHP and for those that complete a residency program may use ACPR.

EUROPE A process of acts as a workforce incentive to develop a broad scope of advanced competencies necessary for service
delivery and patient care. This forms part of professional recognition, a key element of which is a system for awarding
credentials following quality assured assessments for practice beyond day one.

WESTERN PACIFIC Authorising a defined practice activity. Just starting to use this term, as it is used widely internationally and better reflects
the situation rather than the current common term of ‘accreditation’.

SOUTH-EAST ASIA “Credentialing” is a process that identifies when a defined set of knowledge, skills and experiences has been met at a
defined standard of practice, and where an individual is able to demonstrate this against a consistent method of
assessment.

AMERICAS “A credential is a documented evidence of professional qualifications”. “Credentialing” refers to one of two processes: the
first is the process of granting a credential (such as granting a practitioner a license to practice or granting board
certification); the second is the process by which an organisation or institution obtains, verifies, and assesses an individuals’
qualifications to provide patient care services.

AMERICAS “Credentialing” (1) the process of granting a credential (a designation that indicates qualifications in a subject or an area);
and (2) the process by which an organisation or institution obtains, verifies, and assesses an individual’s qualifications to
provide patient care services. “Credential”: documented evidence of professional qualifications. Academic degrees, state
licensure, residency certificates, and certification are all examples of credentials. Credentialing is frequently done at an
institutional level (e.g. – a health system will credential its own staff).

AMERICAS “Tuition” is the credential that certifies that the holder is a registered professional by the correspondent authority.

WESTERN PACIFIC Credentialing is required for specialist pharmacists. The credential is offered by PSAB/SPC.

WESTERN PACIFIC Credential is usually given to individuals (for programmes, accreditation is often granted).; a document presenting
the evidence of successful results of certain training.

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 PART 6
SUMMARY AND CONCLUSIONS
.................................................................................. ..................................................................................

The data presented in this report represents the first time

that specialisation and advanced practice, as defined scopes
of practice, have been codified and examined. FIP Education
Initiative will continue to move forward in this area with the
aim of providing a foundation for workforce development
in a transnational context. It should be noted that the
foundations of practice, and early career development are
considered by FIPEd to be of equal, if not greater, importance
with regards to workforce development, but we also recognise
that many in the pharmacy workforce are at a practice level
beyond that of foundation.

What is clear from this first collection of global data

is that professional advancement and the professional
recognition of advancement in practice is a developing trend
worldwide. This can be attributed to a number of reasons,
such as the increasingly complex role of pharmacists, the
enhancement of more patient facing roles and greater extent
of clinical pharmacy with the associated risk this entails
and a consequent need to be able to endorse professional
capabilities. Comparisons and parallels with medical practice
and the advancement of physicians, for example, are notable.

As pharmacists continue to become more clinically-oriented

health professionals, with enhanced responsibilities
and accountabilities for pharmaceutical care in clinical
environments, then clear pathways for workforce
development, coupled with professional recognition and
credentialing of practitioners, is an important consideration.
In addition, this represents a clear opportunity for
transnational collaboration and further opportunities
for transnational recognition of advanced capabilities
for the pharmacy workforce.

The public and our patients should expect the highest

possible pharmaceutical care from professional practitioners
worldwide, without exception. A clear demonstration and
assurance of competence and capability that is commensurate
with advanced and expert practice is a clear message to civil
society that pharmacists possess this expertise; professional
recognition, credentialing and quality assured specialisation
are part of this demonstration of competence and capability.
It is in the interest of patients, health systems and our
profession that we develop a common and shared
understanding of what we mean by “specialisation”
and by “advanced practice”. This is a key driver for future
workforce development.

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Annex 1. Acknowledgements

Argentina – Marcela Rousseau, Viviana Bernabei, Silvia Japan – Japan Pharmaceutical Association; Shigeo Yamamura,
Campos, Alicia Avila, Argentine Association of Hospital Rieko Takehira, Josai International University.
Pharmacists.
Jordan – Lina Bader, University of Nottingham.
Australia – Andrew Matthews, Bronwyn Clark, Kylie Woolcock,
Australian Pharmacy Council (APC); Helen Dowling, The Society Korea (Rep. of) – Bong-Kyu Yoo, College of Pharmacy.
of Hospital Pharmacists of Australia.
Lebanon – Marwan Akel, Lebanese International University,
Belgium – Jan Saevels, APB, Association of community Order of Lebanese Pharmacists; Rony Zeenny, Lebanese
pharmacists in Belgium. American University, School of Pharmacy.

Belize – Lydia Thurton, University of Belize. Macedonia (Rep. of) – Jasminka Patcheva, Pharmaceutical
Chamber of Macedonia.
Canada – Janet Cooper, Canadian Pharmacists Association;
Jennifer Smith, Intergage; Derek Jorgenson, University of Malaysia – Benny Efendie, Monash University Malaysia;
Saskatchewan. Abida Haq Syed M Haq, Noraini Mohamad, Jaya Muneswarao,
Ministry of Health of Malaysia; Mohamad Haniki Nik Mohamed,
China – Zhu Zhu, Chinese Pharmaceutical Association. Academy of Pharmacy, Malaysia.

Costa Rica – Lidiette Fonseca González, Facultad de Farmacia, Malta – Lilian M Azzopardi, University of Malta.
Universidad de Costa Rica.
Namibia – Timothy Rennie, University of Namibia.
Denmark – Iben Treebak, Pharmadanmark.
Nepal – Panna Thapa, Kathmandu University.
Egypt – Adel Sakr, Future University, Egypt.
Netherlands – Marnix Westein, KNMP: Royal Dutch
El Salvador – Anabel de Lourdes Ayala de Soriano, Universidade Pharmacists Association; Wilma Göttgens-Jansen, Apotheek
de El Salvador. Blanckenburgh/Radboudumc.

Finland – Sanna Passi, The Finnish Pharmacists’ Association. New Zealand – Elizabeth Johnstone, Bob Buckham,
Pharmaceutical Society of New Zealand.
Germany – Roberto Frontini, Universitätsklinikum Leipzig;
Daniela Bussick, ABDA: Federal Union of German Associations Nigeria – Wilson Erhun, West African Postgraduate College of
of Pharmacists. Pharmacists.

Ghana – Philip Anum, Ghana College of Pharmacists. Norway – Tove Ytterbø, The Norwegian Association of
Pharmacists.
Grenada – Anthony Cyrus, Grenada Pharmacy Council.
Hungary – Georgina Gal, Hungarian Society for Pharmaceutical Peru – Iván André Torres Marquina, Universidad Privada
Sciences, Industrial Section. Antonio Guillermo Urrelo.

Iceland – Lóa María Magnúsdóttir, The Pharmaceutical Society Philippines – Hazel Faye Docuyanan, Philippine Society of
of Iceland. Hospital Pharmacists (PSHP); Nelly Nonette Ouano, Marilyn
Young Tiu, University of San Carlos; Yolanda Deliman,
India – Suresh Bhojraj, Pharmacy Council of India; Ramjan University of San Carlos School of Health Care Professions.
Shaik, Al-ameen College of Pharmacy; Thirumaleswara Goud,
Creative Educational Societies College of Pharmacy. Portugal – Luis Baião, Helena Vilaça and Bruno Macedo, Ordem
dos Farmacêuticos (Portuguese Pharmaceutical Society, PPS).
Ireland – Pamela Logan, Irish Pharmacy Union; Conor O’Leary,
The Pharmaceutical Society of Ireland, The Pharmacy Romania – Dana Coltofeanu, Federatia Farmacia.
Regulator; Catriona Bradley, Irish Institute of Pharmacy; Joan
Peppard, Hospital Pharmacists Association of Ireland. Saudi Arabia – Ahmed Aljedai, King Faisal Specialist Hospital
and Research Centre, Riyadh.
Israel – Howard Rice, Pharmaceutical Association of Israel.

Italy – Annarosa Rocca, Federfarma.

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 Singapore – Lita Chew, Ministry of Health Singapore, Singapore FIP – Luc Besançon, Joana Carrasqueira, FIP Staff; Bill Charman,
Pharmacy Council; Wu Tuck Seng, Felicia Ling, Singapore Henri Manasse, Jennifer Marriott, Ross McKinnon, FIP
Pharmacy Countil; Camila Wong Pharmacy Specialists Education Initiative Steering Committee.
Accreditation Board; Lim Hui Leng, Ministry of Health.
FIP Collaborating Centre – Ian Bates, Andreia Bruno, Naoko
Slovenia – Andreja Cufar, University medical centre Ljubljana. Arakawa, University College London, School of Pharmacy;
Kaitlyn Craddock, Sara Twillmann, rotation students from
South Africa – Hazel Bradley, School of Public Health, St Louis College of Pharmacy.
University of the Western Cape; Lorraine Osman,
Pharmaceutical Society of South Africa.

Spain – Carmen Peña, Consejo General de Colegios Oficiales This report was supported by the FIPEd Corporate Roundtable
de Farmacéuticos de España. on Education members: GlaxoSmithKline, Pfizer, McCann
Health, the Federation of Pharmaceutical Manufacturers’
Sweden – Clary Holtendal, Swedish pharmaceutical Associations of Japan and the Nagai Foundation.
Association.

Switzerland – Dominique Jordan, Astrid Czock, pharmaSuisse.

Taiwan China – Mary Wang, Taiwan Society of Health-care

System Pharmacist (TSHP).

Turkey – Rida Himmet, Turkish Pharmacists’ Association (TPA).

Uganda – Richard Adome, Makerere University.

United Kingdom – Christopher John, Catherine Duggan,

Hannah Wilton, Royal Pharmaceutical Society (RPS).

United States of America – Sarah McBane, University of

California, San Diego; Brian Lawson, Board of Pharmacy
Specialties; Jonathan Penm, Neil MacKinnon University of
Cincinnati; David Steeb, Stephen Eckel, Macary Marciniak, UNC
Eshelman School of Pharmacy.

Uruguay – Nora Gerpe Martinez, Asociación de Quimica y

Farmacia del Uruguay (AQFU).

Zimbabwe – Tsitsi Grace Monera-Penduka, School of Pharmacy,

Univeristy of Zimbabwe College of Health Sciences.

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Fédération
Internationale
Pharmaceutique
...................................
International
Pharmaceutical
Federation

Andries Bickerweg 5
2517JP The Hague
The Netherlands
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T +31 70 302 19 70
fip@fip.org
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www.fip.org | Advanced practice specialisation 10/2015
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