17th June 2019
I’d been a hospital pharmacist for more than 20 years, specialising in care of the older person, and loved it. My current trust is an integrated care provider so for the last few years I’d worked with community nursing and intermediate care teams and I had some understanding of the problems patients faced at the complex interfaces of care. When the opportunity arose to work in partnership with local general practices innovating safer ways to transfer care and manage medicines, it felt like the right thing for my patients to say yes to it. I’m surprised to find I don’t miss my inpatient work.
I’m the lead for a prescription hub staffed predominantly by pharmacy technicians. We support six surgeries; their clinical and administrative staff task us with appropriate work relating to medicines, for example patient queries, stock shortages, formulation changes and hospital letters.
GPs and their practice staff often don’t understand what skills pharmacists and pharmacy technicians have and what they can offer for patients.
Framing your service in the correct context and persuading people with influence is obviously helpful but the financial incentive offered by NHS England, first in the clinical pharmacists in General Practice pilot and now in the DES for Primary Care Networks, was key – once a practice has seen what you can do, they rarely want to be without it.
Balancing the needs of the practice staff with those of the registered population and those of the clinical pharmacists i.e. helping the practice to reduce GP workload and meet patient need, without just creating a back-room job that a highly skilled clinical pharmacist / technician would probably not want.
Discussion with practices to identify common goals and reviewing practice workflow procedures to ensure use of your skill mix in the best way.
Introducing clinical pharmacy staff into general practice isn’t a ‘bolt-on’ service, you will need to redesign some of your workflow and processes to do it successfully.
My current priorities are supporting the new local Primary Care Networks to make good decisions about employing and utilising pharmacy resource and developing our local peer support network of clinical pharmacists and pharmacy technicians in primary care.
GP estimation of time saved (45-120 minutes per GP per day), number of medication reviews done by the clinical pharmacists (5-6 per hour on average), patient satisfaction with their pharmacist encounter (100%), activity in the prescription hub (700 tasks and letters per week for 55,000 registered patients).
I’ve just started a Systems Leadership development programme in conjunction with counterparts from the local council, CCG and mental health trust. We’re working on redesigning systems and pathways that don’t currently work well for service users because of the complex interplay or poor communication between organisations.
Advanced consultation skills such as goal setting, shared decision making and coaching are really important to achieving good outcomes with your patients. Medicines information enquiry answering skills also come in very handy.
It’s a great resource for pharmacy peer support in the fast-changing context of primary care.
Connections and personal relationships are the key to success.
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