15th November 2018

Insight from Helen Garrood

Time in general practice

4 Years

Location

GP Practice, Surrey. Not part of NHS Pilot

Qualifications

BPharm (hons) King’s College London. Clinical Diploma in Clinical Pharmacy Practice, University of Keele.  Independent Prescriber, University of Brighton.

Current Role

I have four current roles:

  • GP practice pharmacist
  • CCG medicines Optimisation Pharmacist
  • Community Pharmacist Boots Chemists.
  • CPPE Clinical Mentor to GP Pharmacists enrolled in the NHS pathway.

My life before becoming a pharmacist in GP Practice

After finishing my degree, I decided that hospital life was for me. I started my Pre-reg at Guy’s hospital London and Maidstone hospital Kent. I loved it and wanted to continue as a basic grade. Unfortunately, appointments were few and far between in the early 90’s if you weren’t prepared to travel miles out of the South.

I wasn’t prepared to make that sacrifice. I had just entered a new relationship and I suppose I put him first by moving to Reading where he was a PhD student at the University.

We were two broke graduates, so reluctantly I started working for Moss Chemists.  It was a backstop as the plan was to return to hospital or start a Masters in organic chemistry at the university.

Neither happened and I remained in Community Pharmacy for 26 years. It was a blessing in disguise. I learnt to talk to people properly and manage teams effectively.

Without my years as a CP I would never have had the guts to do what I’m doing now.

I moved into GP practice completely by accident. My mother had died and left me with a huge hole in my life. I was devastated. Within a couple of weeks, a GP friend contacted me asking if I knew of any pharmacists that would fancy working at the practice supporting the Prescribing lead. I took the plunge and put myself forward.

I was kept so busy learning my new craft that it entirely filled the void and helped me come out the other side.

GP Practice experience

My role has evolved enormously over the last 4 years, partially out of necessity and partially out of my stubborn determinedness not to fail in my new career.

I started off doing prescription queries and requests then moved onto hospital discharges and clinic updates. The latter was a really bug-bear to the GP’s as it took so much of their time, so they were over the moon to give me the job. It turned into a double edge sword for them because I queried many more prescribing decisions then they had ever done. I liked to think that I was trying to get people to think in a different way and put Medicine Optimisation at the heart of prescribing.

As time went on, I realised that my role was limited, and we were missing out on opportunities to expand it further through greater patient contact. The Practice were generous enough to support me through my Independent prescribing and I was rewarded by weekly clinics. Initially I started with hypertension but now I have progressed to lipid management, Respiratory and medication reviews.

Frail elderly and complex needs are areas I am looking to explore in 2019.

When I first started my clinics I still had the nagging doubt that my clinical knowledge wasn’t up to scratch. I needed to see the patient holistically and not just their blood pressure!

Once again good fortune came my way and I took the opportunity to study for my clinical diploma whilst always trying to push the boundaries of my Practice work. Soon I was involved with QOF and QIPP work, learning to run searches, review patients and writing protocols and procedures. I’ve also kept a close eye on our local community pharmacies too by engendering collaboration and keeping open channels of communication.

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

Challenge #1

I had the usual challenges of being the new girl, trying not to make a fool of myself in a new job. It was difficult at first because my clinical knowledge was limited so every question that was asked of me I had to tell them that I would get back to them. I know I made some mistakes along the way when I replied immediately without doing my homework first, ignorant to the fact that I wasn’t in possession of all the facts!

Solution

My solution was to work and work and work. I read everything that came my way and went to every study event hosted. I exhausted CPPE’s back catalogue and used the pharmaceutical industry shamefully for my own ends. It was my pursuit of knowledge that led me to i2i’s launch day in Diabetes which I found invaluable not just for the clinical theory but in its practical application. It was i2i who helped me set up my clinics and persuade the key stakeholders to give me a chance. That sort of knowledge you will never find in books.

Although I learnt an incredible amount whist studying for my IP, it is the clinical diploma that has given me the confidence to talk to my peers without hesitation. I would urge anyone who can to complete their Clinical diploma. I won’t deny it is hard work and you will probably lose your friends, family and sanity along the way. They soon forgive you and your sanity returns along with a head full of useful information.

Challenge #2

I suppose for me the biggest challenges in life come from people and managing relationships. People can be very resistant to change because they fear the negative impact on themselves that change may bring. I found that at the Practice. An individual who misguidedly thought I was going to tread on her toes and take her job away from her. I had no intention of doing that and in fact needed her input to help me in my new role. Looking back, I think the trouble began because the boundaries of my role were not defined well enough or maybe I felt that I should be tackling all the medicine related problems and not realising that they had coped very well without me before I came along. I think the truth lies more in the latter.

Solution

Time is a great healer as they say. Over time I kept asking questions of the individual partly because she was brilliant at her job but more importantly I really did not have a clue what was going on! I tried to get to know them as human being, gain their trust and respect. I also moved my role away from being clerical to clinical. This was a natural way of not crossing into their territory. I developed my role to work more closely with the GPs and a good working relationship has blossomed. I feel that the GP’s respect my medical opinion and this has had a positive influence on the people around me.

Key Messages

My challenges have taught me that any new role demands learning and lots of it. Keep building your clinical knowledge whilst building positive relationships with your colleagues because it is like inheriting a new family. Resilience is key, but a touch of humility goes a long way.

What are your current priorities / key areas of focus?

I would like to continue my university studies beyond the clinical diploma most probably in Cardiology but I’m not sure right now in what form they will take.

I have started a leadership course which I think will help me to deliver projects more effectively and allow me to further develop my people skills.

I’ve started a new job with the CCG so learning about commissioning and how this has a positive impact on medicine optimisation is a key priority of mine. Once again, it is through learning I will feel that I am a better Pharmacist.

How have you demonstrated impact and value in your practice?

This is a hard one because of the sometime subjective nature of a patient facing role. I’ve had lots of feedback from patients telling me how they value my service in clinic. I’ve also tried to show improvement in blood pressure profiles and reductions in polypharmacy. My impact with QIPP and QOF is easy to quantify as the practice has come in underbudget with all initiatives completed. I would never say it was all my own work, but I am proud to say that I was part of a team that delivered.

A GP once told me that she could instantly recognise when it was me who had made the changes to a patient’s medication because of the precise wording of the dosages and completion of the follow up.

For me, I could not have a better demonstration of value than gaining the respect of my peers.

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

Apart from the Leadership and change management course that I am in the middle of, I’d like to do some more work around mentoring because I think it is important to give back into the NHS after years of taking.

Writing this blog has reminded me of my early days where I leaned heavily on my more learned friends and colleagues.

I’m grateful for their help and I hope through mentoring I can help others starting their journey.

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

Where do I start with this one?

Hard work, resilience, humility, a sponge like attitude to learning and positivity.

Aim to collaborate but stick to your guns when you know you are right.

Always keep in the back of your mind that the sole reason for your existence in the organisation lies in the safe and effective treatment of the patient.

What has been your perception of the i2i Network?

i2i were the first people to give me the learning I needed as well as the pathways to implement it effectively. They helped me deliver.

Networking and sharing best practice is so important to raise the profile and competency of the profession in GP practice. The i2i network have made it easy for me to incorporate this into my everyday work.

I wish someone had told me………

Do your clinical diploma BEFORE your IP course. Personally, this makes a lot more sense to me and would have made the IP less of a torturous exercise.

Above all, I wish someone had told me that it was ok not to know it all. It would have saved me years of anxiety and a head full of white hair.

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