Insight from Anna Prescott
16th January 2019
Time in general practice
Location
Qualifications
MPharm, Post Graduate Diploma in General Pharmacy Practice (London School of Pharmacy), Independent Prescriber (interest in respiratory)
Current Role
Clinical Services Manager at Soar Beyond. I support the team of practice pharmacists we have working across 9 practices in North West London. I also spend one day a month as a pharmacist in a dispensing practice in Oxfordshire, where I support them with clinical audits, QOF, local incentive schemes and general management of dispensary issues and SOPs.
The best thing about being a pharmacist in GP practice is that variety is the spice of life!! There are so many opportunities and different ways to really make a difference in general practice, regardless of your skillset/previous experience.
The worst thing about being a pharmacist in GP practice is the lack of understanding of the role – we are not GPs, we are not nurses, and we are not admin staff! I think this is slowly changing, but there is still a long way to go before the role is fully embedded, respected and understood – even by us as pharmacists!
My life before becoming a pharmacist in GP Practice
After leaving Nottingham University, and having done various placements in community and secondary care, I decided to embark on a career in hospital pharmacy. I was lucky enough to work in 3 big teaching hospitals in both Nottingham and London, where I held various roles including resident pharmacist, rotational senior pharmacist and eventually as lead pharmacist for neurosciences.
I really thrived working in such a large multi-disciplinary environment, and particularly enjoyed the variety that hospital work offered, from working out doses for the tiniest of neonates, bursting TPN bags on a Christmas night shift(!), attending ward rounds with surgeons and consultants and in my latter roles, inputting on departmental policies, audits and processes.
Despite really enjoying the hospital role, I eventually got itchy feet, and decided to move into a practice support pharmacist role at the local CCG. I was involved in a range of workstreams including IFR panels, guideline writing and production, cost-effective switches and supporting practices with medicines optimisation. It was here that I realised the potential pharmacists can have in general practice, and the need for expanding the skill mix. I was delighted then when the opportunity came up with Soar Beyond to support a team of pharmacists in practice, and I felt that I could really start making a difference and showcase how the profession can improve outcomes in general practice!
GP Practice experience
- As I mentioned, I started in practice as a CCG practice support pharmacist, where I was responsible for 13 practices across a very mixed London borough. I really started understanding the intricacies of general practice and primary care in general, including commissioning workstreams, funding, contracts etc. and enjoyed going in to practices to analyse prescribing patterns, offer solutions for improving these (quality as well as cost!) and really working with the GPs to change practice where it was identified as necessary. I carried out my IP in asthma, and really saw how pharmacists do have the transferable skills to be able to support the management of LTCs.
- I don’t utilise my prescribing qualification at the moment, as I work in a dispensing practice where they do not have the space to free up a clinic room, and really need the expertise of a pharmacist to oversee their audits and dispensary workflow. I enjoy this as much as the direct clinical work, as I really feel I support the practice across multiple streams, drive efficiencies and help manage their non-patient facing clinical workload.
Key examples of personal challenges of practice pharmacy – what were they and how did you overcome them? (including skills, knowledge and training)
Challenge #1
Recruiting pharmacists for practice roles
Solution
Still a work in progress. GPs are so stretched and are looking for easy solutions to the ever-diminishing workforce. Currently, there is not a big pool of highly skilled practice pharmacists. We have been working on a range of tools (including the i2i Circles of Competence) to help practices and pharmacists work together to understand what pharmacists can do now, what they can do with relatively low-level input (i.e. over the next 3-6 months), and what is totally out of scope. This has really helped GPs understand competence, realise that a pharmacist’s skillset is wide and understand what their own priorities are. This has enabled us to recruit pharmacists with the right skillset whilst also ensuring the practice are prepared to invest time in upskilling their pharmacist in the identified longer term areas.
Challenge #2
Just because a pharmacist is a prescriber does not mean they can hit the ground running in practice
Solution
Again, this comes down to managing expectations and communicating from the beginning. Asking practices what they feel they need from a pharmacist, or even running a bit of a diagnostic to highlight what their pressure points are can determine whether they need a prescriber, or if they can manage with someone who isn’t with the idea to provide the support to become one in the longer term.
The key theme here is communication – let GPs know what you can do rather than what you can’t. I have a prescribing qualification that I don’t use, as this is not the need for the practice I work in. That’s ok – you don’t need to be a prescriber, there is a lot that can be done without it!
What are your current priorities / key areas of focus?
QOF deadlines are fast approaching, so a key priority will be supporting the practice to ensure they obtain maximum points across all domains. I will also be focussing on the clinical LES for AF and diabetes.
From an operational perspective, the falsified medicines directive (FMD) will be enforced from early Feb. I have already provided the practice with guidance for what they will need to do to prepare for this and will focus on updating their SOPs and ensuring staff are effectively trained.
Within the team of pharmacists I support, I would really like to implement the i2i way of setting up clinics for the new pharmacists we have starting out in practice, and this will be my main focus for the coming months.
How have you demonstrated impact and value in your practice?
There were plenty of examples of impact and value which we routinely measured when working at the CCG, however sometimes it is a very simple thing that can make a big difference….
When I started working at the dispensing practice, I noticed they had a big notepad that they wrote prescription queries in. This note pad was checked ad-hoc by GPs throughout the day who would remove the book, decipher the many different scrawls and action the scripts. The book often went missing or was wanted by GPs at the same time.
I implemented a new process (a simple intervention!) that enabled the dispensers to raise the query using EMIS. The book no longer exists, clinician and dispenser time is saved and there is an audit trail so less time is wasted when patients call.
A very simple intervention which has made the prescription process much more efficient as well as improve the experience for dispensers, clinicians and patients!
What development do I need / am I undertaking at this point in my journey?
I would like to look at ways of developing my role so that I can go back to some patient facing elements.
What skills or competencies do you feel are important to have in your role as a practice pharmacist?
Good interpersonal skills – you deal with lots of different people within the practice and need to be responsive to their needs and challenges and understand where they fit in the practice as well as with your role.
Flexibility and adaptability – the role is constantly changing!
Good clinical knowledge, or at least where to look for it – particularly important for me at the moment as I am not working in a patient facing capacity.
What has been your perception of the i2i Network?
Although I may appear biased as I am employed by Soar Beyond, I can genuinely say that attending my first i2i workshop in my second week was so refreshing. Having been to umpteen training days in my career, I had never seen a session delivered with such passion, focus and understanding. The best thing about it is the implementation piece – it really empowers you to go away with a “can-do” attitude.
I wish someone had told me………
That general practice could provide so much opportunity for career development, whatever your previous background.