15th May 2018

Insight from Karmini Marvadi

Time in general practice

3 months

Location

The Northwick Surgery, Harrow, London

Qualifications

B.Pharm (India), OSPAP (University of Brighton), Post Graduate Certificate in Clinical pharmacy (The Queen’s University of Belfast), Independent Prescriber (University of Hertfordshire)

Current Role

Working as General Practice Clinical Pharmacist as part of the NHSE pilot (Phase 1), 3 days a week

My life before becoming a pharmacist in GP Practice

Being an overseas pharmacist from India brought about many challenges on my journey to becoming a registered pharmacist in UK. From 2003 to 2008 I worked as a pharmacy assistant/technician in both community and hospital settings in the UK, which motivated me to be a pharmacist. I finally qualified as pharmacist in 2010. Since then I have been inspired to further progress in my career with a strong desire to be an Independent Prescriber.

I had worked as locum pharmacist in the community for super chains and independent stores. Then I got my first hospital pharmacy position in 2012 at Bedford Hospital.  After that, I worked for four years at NHS Essex Partnership University Trust in Bedford as a Band 7 clinical pharmacist on the care of the elderly rehabilitation ward. Being a ward based pharmacist involved undertaking medicine management (as well as training nursing staff and updating SOPs on medicine management), carrying out medicines reconciliation on admission, counselling patients, attending ward rounds with doctors, MDT meetings and managing discharge summaries. I then got the opportunity to do the Independent Prescribing course at the University of Hertfordshire and qualified as IP in August 2017. I started to look for a role in General Practice as soon as I had qualified as an IP and joined The Northwick Surgery in Harrow, through Soar Beyond, as a senior practice pharmacist in Feb 2018.

GP Practice experience

Having worked only for three months, the first month was very much settling in and learning new skills including IT system navigation and becoming familiar with how the GP practice functions. The clinical work I started to work on was the medicines management related activities at the practice including actioning clinic letters via Docman, medicines reconciliation of discharge summaries, telephone consultations for medicines queries, conducting polypharmacy medication reviews in clinic plus Local Incentive Scheme (LIS) work for local CCG and audits. My role is still very much developing. I am finding it very rewarding as I provide a valuable contribution to the practice team and to our patients giving them the best care, I love my job!

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

Challenge #1

LIS work on ONS (oral nutrition supplements) to be done by end of March, task given in the 1st week of March 2018.

Solution

Using the i2i ABCDE methodology, this is how I tackled my first clinical challenge in practice:

Agree scope: In the first week of March, the GP practice asked me to work on the LIS work on ONS which needed to be completed by the end of March 2018.

Stakeholder Buy-in: I needed input from the CCG pharmacist so I arranged a meeting with him to set up a search. I spoke to Anna (my line manager from Soar Beyond) to gain her help in identifying any tools I could use to search for and monitor all ONS patients in my practice, and how to set up a review of these patients. I also learned about the MUST toolkit which dieticians use for management and prescribing of ONS.

Conducting Preparation: Week by week I went through all the 59 identified patient records to check if they met MUST criteria and updated their records accordingly.

Delivery: I arranged for patients to come to my clinics to get their up to date weight and BMIs and to calculate their MUST score.  I then coded this information on to their records. I also assigned some patients to GPs where their input was needed and arranged for the GPs to review them by 31st March 2018.

Evaluation: I submitted my data to the CCG pharmacist on time and showcased my work by completing the report provided by the CCG.

Key Messages

This was my first clinical delivery in practice – I had never done an audit like this before to meet the LIS targets! It was a very challenging and time consuming process to undertake alongside the other tasks to be done on daily basis. I was pleased that I met the deadline for submission.  My key learnings were that I had the right support, process and resources to help me to do this in an efficient manner and to the high standard and quality required.

What are your current priorities / key areas of focus?

  • Polypharmacy medication review clinics every Friday – identify patients for medicines review through prescription request queries and through GP/Nurse referrals
  • Telephone consultations on Wednesday afternoons – tackling medication queries/counselling /reconciliation of hospital discharge summaries
  • ONS LIS/Audit – follow up patients for monitoring weight/BMI and update all patient record with MUST score
  • DOACs monitoring – start audit work this month
  • CPPE – complete 18 months training for GP practice pharmacist role
  • Revise and implement resources to set up a pain clinic to help the surgery review these patients. The surgery already has nurses delivering LTC respiratory and diabetes clinics, so my skills will be best used in monitoring patient medications where pain medications are a priority in the practice. My IP was also in musculoskeletal pain management as it was my area of interest, so am well placed to help with this workload.

How have you demonstrated impact and value in your practice?

It’s been three months since I started working in my practice and I have become more skilled and confident with dealing with the daily repeat prescription queries.  I am now only having to rely on GPs for things that I am really not sure of which is great as this gives the GPs more appointment time to see and deal with the more complex patients.

The GPs appreciate me doing the medicines reconciliation of hospital discharge summaries in a thorough manner as the quality of care to patients post discharge has improved with less medication related mistakes occurring. My previous hospital pharmacy experience has given me the skills to do this well and it is something I am confident in doing.

Often, I do get queries from doctors on prescribing medicines and I always help them using reputable resources that I am familiar with. They value my contribution in practice to be able to ask at the point of prescribing which ultimately helps to improve their prescribing habits.

With conducting the recent work on the ONS LIS work, I had good feedback from my GP supervisor at the surgery on the work that I had done and the impact on these patients care which is great to hear.

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

Being new to a practice pharmacist role, I feel it is important to ask questions to your GP or practice nurse or even other pharmacist work colleagues when you need advice.

I am currently undertaking CPPE training and have attended a few learning sets with senior CPPE pharmacists and other GP pharmacists which I have found very useful. I am looking forward to completing this CPPE training successfully.

I shadow my GP supervisor once a week for an hour to learn and improve my consultation and clinical skills.

I need further training on improving my IT skills specifically on conducting EMIS searches, to enable me to conduct useful audits for the practice.

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

Along with being an expert in medicine, you have to be a person who can work as a part of the multidisciplinary team (MDT) influencing your role and capability in providing patient centred care. You must be well organised and open to learning new clinical skills in various clinical areas including those of your personal interest as well as for the interest of the practice ie diabetes, respiratory, minor ailment and many more.  You need to become an integral member of the MDT and you definitely need good time management and consultation skills working in primary care.

What has been your perception of the i2i Network?

I met the Soar Beyond team for the first time at the Clinical Pharmacy Congress in 2017.  I was so impressed by their professionalism and expertise in general practice pharmacy that as soon as a role came up, I applied and was successful. The i2i Network is a great and provides practice pharmacists with essential training and resources for free. I personally haven’t been to any workshops yet, but I look forward to attending one soon.

I wish someone had told me………

That I could have applied for a GP pharmacist role without having IP qualification – I would have been a practice pharmacist much earlier!

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