20th May 2019

Insight from Susan Ruben

Time in general practice

5 Months

Location

PHGH Surgery, Temple Fortune, London

Qualifications

Mpharm, RPS mentor

Current Role

Practice Pharmacist at a busy outer London general practice surgery. The surgery serves 11,000 patients in an affluent area of the city. I spend my day supporting the practice clinical and reception staff with pharmaceutical queries, local protocols, QoF, medication reviews and hospital discharges. I am also becoming involved in staff training.

  • Best thing about being a pharmacist in GP practice: The role has already expanded my clinical knowledge and I’ve been accepted as an integral part of the surgery clinical team.
  • The worst / most difficult thing about being in general practice is: Learning to know your clinical limits and when to say no to other team members who are overloaded with work.

My life before becoming a pharmacist in GP Practice

In my pre-registration year I was BPSA International student exchange scheme officer and then YPG secretary. These roles gave me the chance to work in the USA and learn about pharmacy in other countries as well as understanding our changing role in the UK.

My career began as a relief pharmacist. But I found relief work frustrating, so moved into store management. I started in a semi-rural pharmacy which gave me an insight into management, care home services and veterinary pharmacy. I joined Selfridges Retail Ltd as a pharmacist in 2001, eventually working my way up to the role of buyer and Superintendent Pharmacist. This role gave me a wide knowledge in herbal and homeopathic pharmacy in an internationally renowned pharmacy setting.

The last 15 years I worked for Lloyds Pharmacy managing branches in North London and Hertfordshire. I have extended my interest in training and the pharmacist’s role within the NHS. Experience included PCT / CCG liaison pharmacist, pre-registration tutor and RPS mentor; community dosage systems and services to residential and care homes; senior management, support and mentoring of staff; and Community Pharmacy services. I am qualified to run a community anticoagulation service.

I have been an expert member (pharmacist) for the National Research Ethics Service for the last seven years.

GP Practice experience

On being made redundant last year I decided to apply for the new role of General practice pharmacist and become an Independent Prescriber (IP). I was looking for a part time role outside the retail sector where I could expand my clinical knowledge and have a structured patient centred role using the clinical knowledge I had gained over the last 28 years.

I had some knowledge of what might be involved as I am married to a local GP and have helped out at his practice in various capacities over the years. I knew the issues of shared care, QOF payments and workload. I understood where a pharmacist’s knowledge and expertise could help whether an IP or not.

Having experienced being a practice manager for six months at my husband’s surgery a few years ago, I hoped to join them to train for my IP qualification. Instead an opportunity arose in a local GP surgery as a practice pharmacist without an IP qualification. I joined the Soar Beyond GP practice pharmacy team last October and am gaining experience before embarking on the IP pathway. This will allow me to specialise in preparation for the IP course.

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

Challenge #1

Working out what skills and clinical knowledge I am lacking and explaining to my colleagues where I can and can’t help within the practice.

Solution

Becoming more assertive in my ability to refer requests back, but dealing with the areas I am competent in so as to reduce the workload. Discuss clinical decisions with GPs and nurses to learn for the future. Attending clinical courses to increase my competence in areas I need training.

Challenge #2

The new cohort of practice pharmacists are not automatically enrolled on the CPPE pathway. I have found it difficult to link up with other practice pharmacists and know where help, training and support is available.

Solution

Get to know your CCG pharmacy team and they will help you link up with other pharmacists in the area. Use conferences and training days to increase your links with other practice pharmacists. I have been lucky enough to join the Soar Beyond team of pharmacists with whom I can ask for advice and support which is a privilege.

Key Messages

Always believe in your own abilities and knowledge. You know more than you think and that knowledge can be applied in clinical practice much earlier than you were initially aware.

What are your current priorities / key areas of focus?

  • To streamline the processes within the practice regarding medication prescribing and repeat prescriptions;
  • To carry out medication reviews of patients with more than 6 medications to avoid unnecessary polypharmacy and falls risk;
  • To ensure all patients discharged from hospital have a medication review within 2 weeks of discharge;
  • To assess and improve prescribing habits for long term vitamin D therapy, COPD and asthma.
  • To support the lead GP in patient group consultations in asthma and COPD

How have you demonstrated impact and value in your practice?

  • I am the lead contact for prescription and medication queries. This has made a marked difference to the clinical team workload and has allowed them to deal with the pressing clinical emergencies and decisions rather than pharmacy issues. I am now contacted directly by the local pharmacies and care establishments with medication queries freeing up GP and receptionist time.
  • In association with our lead GP we have been running patient consultation groups for asthma and COPD. During these meetings and as part of the review process we have reduced our high dose steroid inhaler patients by 64% in four months.
  • Patients are getting personalised face to face medication reviews centred around themselves rather than the clinical conditions. Polypharmacy is reduced where appropriate and compliance improved.

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

I have realised that my basic clinical knowledge is outdated in many fields and have decided to revalidate my knowledge in asthma and bone health as these areas are most important to the practice. I am also learning to interpret blood results so as to carry out better level 3 medication reviews.

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

  • It is very important to be open and supportive of all levels of staff in the practice. Share your knowledge and learn quickly how to fit into the team and where your strengths can support those around you.
  • Learn your limits and don’t be afraid to admit what you don’t know. Always be open to constructive advice and attend all clinical meetings to learn from others.
  • Plan your time and resources well to provide a good service. Go slowly at first and build up clinics and responsibilities over three months.

What has been your perception of the i2i Network?

I love the ease of access to clinical information and quick training modules on the website.

I found the circle of competence tool very useful to decide my abilities and areas of confidence and competence. It has already been interesting to see how I have developed and evolved in my role in the first few months of the job.

I wish someone had told me………

How varied and rewarding being a team member in General Practice can be. There are so many ways you can make a difference to patients and team members in a short space of time, whilst expanding your own knowledge and confidence.

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