18th December 2018
I was fortunate to have the opportunity to work for one of the large multiples from I was 16 whilst still at school and throughout university, also completing summer pharmacy student placements and then on to pre-registration year. At the time of recruitment for pharmacist roles, the offer I had wasn’t personally suitable and I nervously made the decision to leave.
My first post was in a really busy health centre pharmacy which was a complete baptism of fire and whilst I enjoyed it, there just wasn’t the scope for patient contact that I’d have liked. I moved to one of our local multiples and after a short time managed one of their stores. Again, I enjoyed aspects of the role but it became clear the retail environment wasn’t for me.
I moved to the Ulster Hospital in 2003 and worked initially in the dispensary and then moved to be the Emergency Department Pharmacist in 2004 – this is where my passion for generalist work truly began. Personal circumstances led to a change of track in 2007 and I left ED with a heavy heart with the intention of going back to secondary care in future. My own GP practice, and two other practices that they share resources and the building with, were advertising for a sessional practice pharmacist and the rest as they say is history.
I sort of fell in to general practice by accident as a stop gap, as I thought up until that time that I would have wanted to consider returning to secondary care. What started as a stop gap has become a passion! Word of mouth and support from the local health board prescribing advisers quickly led to work with other practices and before I knew it I was providing support in different guises to a number of practices – approximately 13 in total over my 9 years. This really allowed me to develop and to figure out the nuts and bolts of life in general practice. Over time and with developing relationships and supportive practices, I was then able to explore various ways in which pharmacists in general practice could really make an impact.
Before 2016 pharmacists in general practice had funding under a LES and often practices, realising the benefits, funded additional sessions themselves. In 2016, the NI GP Federations commenced recruitment of practice pharmacists and I took up the Lead post for Ards Federation. I had worked with most of the practices within Ards previously and those existing relationships certainly made life easier. Ards has 16 GP practices and we currently are a team of 9 pharmacists providing practice support. We’ve just completed uplift recruitment and once everyone is in to post we will be a team of 13.
My role is a split between a clinical role with 3 practices (all in the same building – the same ones I started with back in 2007), and the lead role for the federation.
Certainly when I first started, having a practice pharmacist was very new to the practices I was working with and they seemed to think pharmacists were the ‘green pen police’ who were just being sent to police their prescribing etc. It was a challenge to breakdown this stereotype and to become a valued part of the MDT.
I’d come across similar when I took up post in ED, it was the first time they had ever had a pharmacist working as part of their team as well and I think no-one was quite sure what to do with me or avoided trying to have much to do with me in case I would attempt to tell them what to do or not do with regards to prescribing. The same as when I started in ED, the solution was to build relationships, really work to understand the environment those teams are working in, including the demands and constraints, and then demonstrate how you can contribute to the team in a meaningful way whilst keeping your medicines focus.
The Lead part of my current role was a completely new post and there were many challenges, many are still works in progress. One of the biggest challenges is attempting to balance the varying expectations and needs of practices with the pharmacists’ scope of practice. Whether that is the practices really not being able to see anything other than an admin role or, on the other extreme, those expecting a new pharmacist to arrive who would just jump in and work like a GP locum. Similarly pharmacists have come from different backgrounds and need an understanding of how working in general practice is a very different environment to others.
Similar to previous, building relationships has been key to this alongside consistently challenging misinformation. Whilst I am always keen to explore new ways of working, sometimes we have to establish the basics first – pharmacists and practices need to build relationships and develop at a pace which works for both.
MY KEY MESSAGES ARE THEREFORE:
Right now, it’s sort of back to basics for me. I’m fortunate that there will be a full time pharmacist joining me in the practices that I support and I’ve been working with the practices to ensure we’re utilising the pharmacist resource to best advantage, and that both myself and the new pharmacist are in rewarding roles using our expertise for patient benefit as part of a large MDT.
Over the coming months, we will be welcoming new pharmacists to the team and so the priority will be getting them settled in to post, working with them and the practices to ensure we are all headed in same direction of travel to get there.
Exciting, busy times ahead!
There are unlimited opportunities to demonstrate impact in practice and with varying focus. I’ve been involved in many over the years and will continue to seek opportunities. Some examples include improving patient care by enhancing LTC management by pharmacist run clinics, improving patient safety by reconciling and reviewing medications at transitions of care which also improves GP capacity, and even something as straightforward as working as part of the MDT to develop practice formularies which support everyone in their day to day work.
Having just completed a yearlong leadership programme, I am hoping to continue to develop my skills in this area by putting to good use what I have learned as we continue to develop the role within the federation and welcome our new colleagues.
At the risk of sounding like a broken record, relationship building and the skills to do so is vital. You must be able to operate in the grey – there’s not much in general practice which is black and white. It is essential that you keep up to date with current practice as things can often time change rapidly. You also need to just get stuck in, be brave! It can seem daunting at the start but you are a medicines expert and that will shine through.
I first met the team on a fairly miserable NI day and wasn’t sure what I was expecting, but from a brief conversation I quickly realised they really understood the practice pharmacist role and what the challenges may be. The LTC education model is fantastic and is what I would like to have created for my team but had no resource to do so. On the ground feedback has been excellent and pharmacists really value the structured approach to getting started with LTC clinics.
That general practice would be so rewarding!
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