16th July 2018

Insight from Femeeda Padhani

Time in general practice

7+ years (2 years as part of GPPTP)

Location

Bacon Lane Surgery

Qualifications

MPharm, Diploma in community pharmacy (Keele University), Independent prescribing (Kings University)

Current Role

Respiratory pharmacist, minor illness clinics, medicines management

My life before becoming a pharmacist in GP Practice

My background has been in community pharmacy where I have worked in different settings (multiples/independents) over the past 25 plus years.

Before joining the GP practice as a GPPTP pharmacist, I worked in an independent pharmacy close to the GP practice for about 13 years. As a senior member of the community pharmacy team, I was constantly looking for new ways of working to improve our systems to provide better patient care and improving and enhancing collaborative working with other multi-disciplinary teams in our local GP practices. I had already developed good relations with the GP practice during this time, and I had completed my IP in COPD with this surgery. After completing my IP, I then continued to work 1 session per week in the surgery conducting respiratory clinics to help meet the respiratory and COPD QOF targets, for 5 years prior to joining the GPPTP pilot scheme.

I have been with Barnet Community Education Provider Network (CEPN) since October 2014 as pharmacy lead.  Part of my role is to engage with Barnet pharmacists regarding multidisciplinary education and training, by motivating them to attend meetings and workshops run by the CEPN.  In this regard I am involved in planning the topics for these meetings and act as a facilitator for regular multi-professional collaborative lunchtime meetings (MCLG’s) held locally.

I have also organised a series of evening meetings based on clinical topics which have been attended by local healthcare professionals (GP, Nurses, community pharmacist and practice-based pharmacist)

The role within the CEPN has enabled me to develop working relationships with health, social and community care professionals in Barnet. This role has enabled me to understand the challenges faced by these individuals and their respective organisations and to recognise the barriers to collaborative working. My role involves working with the CEPN and CCG to address some of these challenges and barriers where possible.

GP Practice experience

Becoming a GP practice pharmacist was a natural progression as explained in the previous section, and in particular I wanted to be able to use my qualification as an independent prescriber in asthma and COPD to be able to run patient facing respiratory clinics.

  • Role 1: Running and leading on respiratory care within the practice
  • Role 2: Medicines optimisation lead within the practice – working with GGG team to meet med opt targets and cost-effective prescribing
  • Repeat prescription implementation of protocols for safer prescribing – improving process for more efficient service and management of urgent prescription requests
  • Clinical support – telephone appointments and medicine related queries from staff, patients and admin
  • Increasing access for electronic prescription and patient access to request their meds
  • Allocation of repeat prescriptions – query scripts
  • Patients facing clinics: respiratory, minor illness, travel clinic, polypharmacy clinic & medication reviews
  • Risk management – developing protocols for safer prescribing and improving monitoring of high risk drugs
  • Significant events – discussing and taking part in meetings
  • Education & training – nurses, HCA, med students, GPs – any staff members
  • Identifying learning needs of the other pharmacists in the Soar Beyond team to help to develop the service and highlighting service gaps – provided shadowing for our pharmacists for individual support and mentoring,
  • Leadership – supporting practice with CQC targets
  • Interpreting blood results (with GP support once a week for 20-30mins)
  • Conducting searches and audits as part of LIS work
  • Action MHRA alerts

Key examples of personal challenges of practice pharmacy – what were they and how did you overcome them? (including skills, knowledge and training)

Challenge #1

Minor illness clinics – inappropriate patients being booked in to the minor illness clinic (MIC) by the triage doctors which were beyond my scope of competency.

Solution

Discussions with nurse practitioner (also doing MIC) and a GP about illnesses not suitable for the minor illness clinic being run by the pharmacist and nurse practitioner. This involved looking through some examples of inappropriate bookings and creating a list of conditions to include and those not to include. This was then used to educate Drs to triage appropriately and asking all appropriate questions before booking. It is an ongoing process to refine this.

Challenge #2

Getting a lot of inappropriate tasks which was very time consuming e.g. GPs off-loading work inappropriately leading to a great number of med review tasks sent by a GP which should/could have been done by GP’s e.g. updating med review dates post a med rev done by GP.

Solution

Discussed with lead GP and in meetings so that all are aware of limitations – communicate workload to all staff so they are aware of what is involved in the work flow of your day to avoid being overloaded with work.

Key Messages
  • Communication with the GPs is key when it comes to areas you are feel comfortable and competent in dealing with.
  • Being aware of your competencies and being open and honest in communication about this and your manageable workload to the GP is crucial

What are your current priorities / key areas of focus?

  • Continue developing my role in seeing patients with minor illness
  • Starting to do contraceptive pill checks – wants to develop women’s health clinics in general including family planning, menopause etc.

How have you demonstrated impact and value in your practice?

My working week is a 4-day week working full days on a Tuesday and a Friday and half a day on a Wednesday and Thursday. In these hours I contribute the following to the practice:

  • I conduct 20-25 telephone calls in my clinics each week (over 3 days)
  • I see around 30 patients in my clinics across the week (over 3 days)
  • I save the GP around 1 – 2 hours per day on the repeat prescription queries every day, and it takes me around 2.5hours to work through between 10-20 queries
  • I save a lot of patients going through the GP triage system to deal with medication queries directly from patients and staff members in between my clinics in admin time saving around 20-30minutes of GP triage time
  • As the Respiratory lead at the practice, I deal with all respiratory patients so most don’t need to go to see their GPs regarding their long term respiratory needs
  • I participate in extended hours service at the practice by working until 7:30pm on some of my days in the week which generates practice income. This not only increases patient access, but it also works with the surgery room availability which can be a struggle to allocate at times.

What development do I need / am I undertaking at this point in my journey?

In addition to my respiratory skills, I am currently sourcing a formal accredited spirometry course via the CCG to enable me to interpret spirometry within my practice.

I am also looking at setting up family planning & women’s health clinics in my practice as it has been identified that this is an area of need. I have been on a couple of courses and done CPPE training, with a view to develop this service in my practice and upskill myself by attending an accredited course.

What skills or competencies do you feel are important to have in your role as a practice pharmacist?

  • Being personable – it is important to get on with everyone.
  • Being available and accessible – not working in silo but working in an open office with the admin team, and offering flexible working hours to meet the needs of the practice
  • Working collaboratively with other HCPs and services – to increase the integration between all sectors to provide seamless care to patients
  • Learn to work outside comfort zone – know how to upskill yourself safely whilst being open to new challenges

What has been your perception of the i2i Network?

I have attended the frailty workshop so far, and eager to attend the workshops in all therapy areas. I have found that the i2i training is better than most other training currently available to practice pharmacists. It is relevant, practical and gives tools and resources to enable to implement in practice. i2i does what it says on the tin – it gives you insight to implementation and it is very well executed.

I wish someone had told me………

That you can’t run before you walk, it takes time to establish into your role, it’s a process and you will only continue to improve. Setting high standards is great but you can’t do everything immediately and you must allow yourself time to grow and evolve in the role and you will achieve great things.

Lastly, coming from a community pharmacy background, I found that my patient facing skills and people skills were invaluable for this role. Do not underestimate those skills. It is a challenging environment but we as pharmacists have a lot of skills to offer.

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