Blogs

Insight from John Hamill

18th June 2018

Time in general practice

Current full time role for 17 months, but have been actively working within GP practices over the past 11 years

Location

South Belfast Federation of GP Practices - 16 Practices

Qualifications

BSc. Pharmacy (Q.U.B. 1997), Dipl. Asthma Management (OU), Dipl. Independent Prescribing (Q.U.B.), Dipl. Diabetes Management (Bradford). Leadership Management (William Clinton Leadership Centre/NICPLD), Accredited Inhaler Trainer (WCPPE), ICON 1 &2 COPD Trainer, Specialist Smoking Cessation Provider(NICPLD)

Current Role

Lead Practice Based Pharmacist [PBP] (South Belfast) currently with responsibility for 9 PBPs within 16 GP practices. Responsibility for delivering the KPIs for the Federation in line with local guidance and evidence based practice, and NI Formulary implementation.

My life before becoming a pharmacist in GP Practice

  • Worked as a Community Pharmacy Manager since 1999 until Jan 2017 with almost 15 years in my most recent role at McMullan’s Pharmacy, Belfast.
  • As a Community Pharmacist (CP) I was passionate about delivering enhanced patient care and pushing boundaries in providing excellence in healthcare provision with the patient at the heart of my activities.
  • Achieved many accolades in that time including Best Practice, Pharmacy Management, Health Promotion, and Service Development and Provision Awards. I was voted in top 100 most influential Healthcare providers in NI in 2016.
  • Was a previous member of the Pharmaceutical Council for NI and held the position of Vice-Chair of the Professional Pharmacy Forum.
  • After almost 20 years in CP I needed a new challenge and sought an opportunity to develop further my Respiratory interests. I applied to become a prescriber and from there gradually worked myself into a full-time GP Practice role.

GP Practice experience

  • I have worked over 10 years as a prescribing advising pharmacist within a GP practice as part of the Local HSCB prescribing initiative (MMPI)-this was the forerunner to the GP Federations model
  • Work to evolve and develop the role of the Practice Based Pharmacist within Primary care, including leadership and line management of PBPs with varying levels of experience within South Belfast
  • To provide Practice Pharmacist duties within my own allocated practices (x2) including:
    • Running Respiratory and Diabetic clinics
    • Acute and Repeat prescribing activities
    • Medication Review and Reconciliation post discharge
    • Travel Vaccine clinic
    • Flu Vaccinations
    • Internal audit of prescribing and implementation of solutions
    • Advice and guidance around medication issues
    • New patient registrations
    • BP clinics
    • Formulary Development and Implementation
  • Most of all- saving GP time and enhancing the profile of Practice Pharmacists as key members of the Primary Healthcare Team

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

Challenge #1

To manage change when change is difficult: Reduction in pregabalin prescribing.

Solution
  1. Assessed the level of prescribing through audit.
  2. Engagement with the practice team to develop/implement an action plan.
  3. Utilised the audit tools available through the HSCB and increased my understanding of the key issues.
  4. Spoke with fellow PBPs with previous experience.
  5. Communicated via letter, then via telephone, inviting patients to attend the clinic to be assessed by a GP.
  6. Following review I managing the reduction to quit programme.

The timely engagement with the patients and all inclusive approach with  the practice personnel had been fundamental to the success of this  initiative.

Challenge #2

Conflict of interest with the practice nurse around running Asthma Reviews within the practice following my attainment of IP status  -She felt I was duplicating her work and undermining her ability.

Solution

It was a misunderstanding of the situation and I needed to clarify how my new role would compliment the work she was involved with. I explained how my up-skilling to IP status within Respiratory Care was part of a longer term plan for the practice. With my practical skills around respiratory review and inhaler technique training we would work in tandem to re-enforce the key concept and maximise patient understanding and future management.

Following this the clinics where adapted to include a QOF orientated clinical review with the nurse, then each patient would have a review with myself.

This proved very beneficial for the patients and helped streamline our service.

Key Messages

Communication with, and appreciation of everyone’s roles and how as a PBP you can contribute substantially to better outcomes without damaging relationships with fellow HCPs, as well as better engagement with the end user-the patient to maximise success of your initiatives.

What are your current priorities / key areas of focus?

  • As a collective, I hope to develop the current PBPs and the future incumbent ones to deliver on the key aspects of the Federation model. Equally as important, I want to become an enabler to other PBPs achieving their personal goals and working to provide excellence in their roles through education, training and working to a high degree of competence and professionalism.
  • To target better patient outcomes which are measurable, including better management of long term conditions through evidence based practice and development of the PBPs in to confident prescribers in their own personal field of expertise.
  • To enhance the role of PBPs to be integral to Primary Care and develop a career development pathway that will sustain the role going forward and promote advancement to higher grade PBPs.

How have you demonstrated impact and value in your practice?

  • Improved time management evident from time saved for GPs to undertake other activities.
  • Integral member of the practice team with responsibility for most Respiratory and Diabetic patients as first point of contact.
  • Analysis of COMPASS reports for the practice indicates clear evidence of cost effective prescribing in line with local and national guidance.
  • Continually be asked to carry out internal audits for the practice and my opinions are respected when I suggest improvements etc.

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

I would like to continue to advance my knowledge base and skills within diabetic care following recent completion of the Bradford Diabetes Diploma to enable me to prescribe within this area.

Utilisation of my Leadership qualification in the day to day management of my PBP team within South Belfast to deliver excellence in patient care and formulating a strategic plan to evolve the role of PBPs within the Federation model.

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

  • Confidence in own ability to offer advice around medicines
  • Patient focused
  • Determination to succeed and make a difference to the future outcomes for the patients
  • Be prepared to be multifaceted
  • Take one in depth therapeutic area at a time in developing -whilst needing to have a grounding in the basics of many
  • Basic skills are essential including analysis of bloods, IT, consultation skills, time management and meds reconciliation when dealing with Hospital discharge.

What has been your perception of the i2i Network?

The i2i Network workshops help me to engage with other HCPs both within and outside my clinical practice, to advance the management of my patients with long term conditions. The process is excellent, as the structure leads the pharmacist through the consultation, identifies issues and focuses on key therapeutic outcomes for the patients.

I wish someone had told me………

‘That Rome wasn’t built in a day’-making steady progress is the way to attaining high Standards of Care and don’t expect things to happen without putting a bit of effort in. And finally, never give up on your ambitions sometimes those who succeed are the slow starters but with determination and drive there is no such thing as impossible!!