Fergus Nugent, Chief Pharmacist at the Mater Private Hospital Cork, speaks to Niamh Cahill about his education, career, and the future of Irish hospital pharmacy
As a self-proclaimed ‘chemistry nerd’, it was perhaps no accident that Fergus Nugent chose to pursue a career in pharmacy. Coming from a family with two GPs (father and sister) and a physiotherapist (sister), you could say that medicine was in the genes.
“I was quite a chemistry nerd as a kid. Physics, chemistry, and maths were really my strong suits,” he recalled. “Unfortunately, my Gaeilge and English were not my strong points. I wasn’t going to get the points here and pharmacy places were limited in Ireland in 1995, so I went through the UK system. I headed over and did my degree at the University of Brighton.”
The move was a fortunate one, as it provided the Tipperary native with a great breadth of pharmacy experience and education. The pharmacology department at his university had established links with local hospitals, which enabled his enthusiasm for hospital pharmacy to flourish. “During our undergrad, we were able to go into hospitals and go to consultant clinics. It was very hands-on. That drew my attention to the hospital side of things.”
After completing his pre-registration year in hospital pharmacy, Mr Nugent moved to Guy’s and St Thomas’ NHS Foundation Trust in London to complete a residency. He fondly recalled how he was among 16 newly-qualified pharmacists who worked on-call late at night there. “Effectively it was
mirroring what the junior doctors were doing. We had a senior pharmacist we could call if we got into trouble in the middle of the night. There was a good support structure there and I enjoyed that, not necessarily the calls at 3 o’clock in the morning, but it was a very good education and gave me a really good grounding.”
After about 18 months in London, he decided to move to New Zealand “for a bit of a round-the-world trip” and worked at a hospital in Auckland before returning to London. But it wasn’t long before home beckoned and he moved back to Ireland. “It was time to head back and see what was happening,” he explained. “At that time, it was 2001 or 2002 and we were riding the Celtic Tiger wave, so the country was really prospering and it was an exciting place to come back to.”
Despite the booming economic environment, however, the opportunities in hospital pharmacy were limited. Mr Nugent moved into community pharmacy, where he spent many years before an opportunity came up 11 years ago at the Mater
Private in Cork. He served there as pharmacy manager before becoming Chief Pharmacist five years ago.
“Because I had a hospital background, I was able to get work here. Then once the hospital got to a level where they needed a pharmacy team, they asked me to set it up. Five years later, here we are. I find it quite fulfilling in hospital. It is a bit more on the acute side as opposed to in the community, where it’s more long-term, primary-care focused.”
As head of the hospital’s Pharmacy Department, Mr Nugent manages a team comprising 12 people.
He is Secretary of the Drugs and Therapeutics committee and a member of the QUEST committee of Mater Private Cork. He also holds the position of adjunct lecturer at University College Cork School of Pharmacy.
His hospital role is multifaceted. It is both patient facing and non-patient facing. It involves setting policies and procedures and ensuring standards are maintained. Important aspects of his work include oversight of medication use within the hospital, and working to ensure patient safety.
“Pharmacists by their nature are very careful,” Mr Nugent said. “They are conscientious and they really do want patients to have the best treatment plan possible. I see that day-in, day- out. The main goal is the same, and it is to optimise patient care. The team here are all very hard-working and I find it really easy to manage them.
“It’s a lovely team. We get great support from the management team within the hospital and as a result, it allows us to use our skills to the best of our ability, to give the best care to patients. The role here for the clinical pharmacy department is to make sure that what is prescribed to inpatients is correct. We advise on administration, be it intravenous drugs or what not, and make sure that discharge prescriptions are correct.
“We also ensure the patient has the information they need to take their medication, and we ensure there is a concordance between the patient and the prescriber and other healthcare professionals on the best course of action.”
The Mater Private Cork has a fully electronic hospital prescribing system, which provides pharmacists with the ability to see in real time when prescriptions are issued. This allows Mr Nugent and his team to “ensure the prescription is correct and appropriate for the patient and optimise safe patient care, that’s the key role from a clinical pharmacy point of view.
“Ultimately, we track medication errors and we have open disclosure and a ‘no blame’ culture within the hospital for any medication error that might occur. For anyone to know the correct doses and get it right all the time is very difficult, but certainly the electronic system helps.”
Medicine shortages
The most challenging aspect of his work, “without doubt”, are medicine shortages. In fact, he believes it is the biggest challenge facing the industry at present. “It’s a huge burden on hospital and community pharmacy. It consumes huge amounts of time,” he said. “Most of it is outside our control but, unfortunately, we’re at the forefront and be it a doctor or a patient, or whoever, it can be very difficult to explain the issues around why something has gone short. The challenge is to try to find solutions
to that, be it either by using different products or finding a different supply route. It’s not getting any better.
“When you’re facing these challenges, it’s really serious and it’s time consuming. It’s not what we want to spend our time doing. Pre-Covid and pre-Brexit, the supply chain was relatively straightforward. There were lots of options. But since Covid and the boom in biologic monoclonal antibodies, the interest and focus on smaller drug molecules has waned. This has been detrimental to patients… the vast majority of medications are consumed by older people who do worry and get anxious about any change to anything in their lives, including medications.”
He maintains that the European Union (EU) needs to take greater action to address the problem.
“It’s not just within Ireland, this is a Europe-wide and worldwide phenomena and really, the EU needs to step up… I think the EU needs to step up and put in a good supply chain mechanism and bring some manufacturing back to Europe to help ensure we have continuity of medicine supply,” he stated.
“We are five years in now and this is not getting any better. It is a huge waste of time for everybody when we could be doing other things and optimising patient care. It’s grinding people down and leading
to conflict with colleagues, and also with patients. That leads to huge amounts of stress for community and hospital pharmacists and technicians and really, if this was a short-lived type problem we could grin and bear it, but the pressure is incessant now and there’s no light at the end of the tunnel for people on this.”
Education and career progression
Challenges for pharmacists are not limited to medication shortages, unfortunately. While the number of colleges offering pharmacy degrees in Ireland has thankfully increased since the mid-1990s, Mr Nugent believes that more student places need to be provided in Ireland.
The structure of pharmacy has changed here in recent years, with more opportunities available for career progression with the introduction of the advanced specialist pharmacist grade.
But, Mr Nugent argued, more training placements in hospitals for pharmacy students are required to enable undergraduates to gain hospital experience. Ireland, he maintained,
is lagging behind the UK and other countries on the development of pharmacy departments and pharmacy career progression within hospitals.
“When I was doing my undergraduate degree and went into hospital subsequently, there was actually quite a lot of opportunities to get into hospital pharmacy departments in the UK; pharmacy departments were much more established and much bigger and were 24/7, and maybe that’s where we need to go to eventually in Ireland. We are the medicine experts, so it is something that will in time need to happen,” he said.
“Some 25 years ago in the UK, specialist posts in areas such as chemotherapy and aseptic compounding, for example, were already there in spades. We’re always floating about 15 or 20 years behind the UK, in my experience.”
Having clinical pharmacy training programmes in place in hospitals “is a good thing” as it gives students the chance to undertake placements, he said. “We take three interns here on rotation and we’re very lucky to get the support of the management team to do that. That has helped us to train and educate young pharmacists and bring them into the hospital and give them that experience.
“A number of them have come back to work within our department after qualifying. I think the common complaint for a lot of hospital pharmacies in Ireland will be that they find it difficult to recruit qualified staff who have hospital experience. I think we have to do a bit better in terms of training staff.
“We really have to get management teams in hospitals to see the benefit of having training programmes. The APPEL system is there, it really is a case of just applying it and you will get people who want to do it. We get 40 candidates, roughly, every single time we go out to the fourth- and fifth-year students, so they want to come — the barrier for them is that there aren’t enough training places.
“Within the actual degrees and masters in Ireland, when students get to third, fourth, and fifth year, the number of opportunities for hospital experiences is limited.”
Another issue for young pharmacists is pay. According to Mr Nugent, hospital pharmacist salaries are significantly smaller than salaries in community pharmacy. “One of the barriers does come down to pay. When you graduate, your community salary versus your hospital salary has quite a large gap.
“That’s a tough choice for someone to make, where you’ve spent five years in college and maybe you’ve got college debt. A huge proportion, probably 70 per cent of pharmacy students, go into community pharmacy when they qualify.
“When you look at your pals in community pharmacy and they’re earning an extra €15,000 or €20,000 a year, then that can be a difficult decision to make. It does level-up as the years go by, but in the initial phase, the salary is a barrier.”
Mr Nugent advised undergraduate and young pharmacists to gain some experience in hospital. This would, he said, help ensure that any possible future move from community to hospital pharmacy is easier to undertake. “It is an easier transition if you’ve had some hospital experience in your career. It’s easy to go back to hospital. If you only go down the community route, it’s quite a difficult transition to hospital,” he explained.
“It’s a slightly harder transition. It’s not insurmountable and we’ve quite a few who have come here from the community… People shouldn’t be daunted by it, they can transition, but it is just that bit more difficult. For young pharmacists, if they can get some experience within hospitals, it will help them later on.”
Despite the difficulties, however, he believes the future of pharmacy in Ireland is bright and that studying pharmacy offers a rewarding career. Hospital pharmacy departments are only going to expand and get bigger in the future, he said.
“I don’t think there is any hospital department in the country that has got smaller in the last five years. They are only going one way.”
