Insight from Rocco Hadland
15th March 2019
Time in general practice
Location
Qualifications
MPharm, MSc Clinical Pharmacy, Pharmacist prescriber
Current Role
- Best thing about being a pharmacist in GP practice – There is so much that I can do as a pharmacist to improve patient outcomes and workflow in general practice.
- Worst thing about being a pharmacist in GP practice –There is so much to do and so little time to do it all in!
My life before becoming a pharmacist in GP Practice
- I have a good understanding of a wide variety of pharmacy roles – I worked as a locum in community pharmacy, I have worked in the hospital setting on admissions wards, ran pre-op assessment clinics and have had the joy of working as part of the out of hours service in hospital on the on-call rota!
- I was excited by the new role split between general practice and secondary care. This split role has the benefit of having a foot in both camps that is used to streamline care for my patients.
- I now work as a specialist heart failure (HF) pharmacist which I have been doing for the last 8 years, and work within the multi-disciplinary heart failure team in an interface service delivering clinics between primary and secondary care.
GP Practice experience
- The two disease areas that I have been focussing on in some GP practices are HF and anti-coagulation
- I have been reviewing HF patients in general practice and take responsibility for this HF workload as a Quality Outcome Framework (QOF) domain in one of my practices since April 2014. This allows me to optimise treatments and includes reviewing patients following hospital admission to ensure that any treatments that are withheld e.g. in acute kidney injury, are safely and appropriately re-commenced.
- I have been reviewing anti-coagulation in other practices that I work in, with the aim to identify patients anti-coagulated with warfarin who are inadequately controlled and make clinical decisions on changing or considering alternative forms of anti-coagulation therapies for these patients. I am developing a register of patients that are anti-coagulated on Direct Oral Anti-Coagulants (DOACs) and review this group to ensure the necessary monitoring is done and that patients are reviewed.
Key examples of personal challenges of practice pharmacy – what were they and how did you overcome them? (including skills, knowledge and training)
Challenge #1
Identifying key members of practice staff that can be crucial in supporting my role or in setting up a new clinic.
Solution
Aim to be an integral member of the practice, understand who key influencers in your practice are. I have found that it is often members of staff such as Health care assistants who are invaluable in supporting the setup of new clinics.
Challenge #2
Demonstrating my impact in setting up a new service. This information is vital for practices to see the benefit of my role as a GP pharmacist.
Solution
Ensure that baseline data is collected before any new service or change in practice is implemented and show the impact of the new clinic after a few months.
What are your current priorities / key areas of focus?
A particular area that I am focussing on at the moment is how I can make the repeat medication re-authorisation process more efficient, by forging close working relationships with the prescription clerks in practices. As pharmacist our skills are well suited to support this process whether dealing with queries and subsequently identifying patients that need to come in for a review. These activities will ultimately improve patient safety, outcomes and reduce workload on GPs.
How have you demonstrated impact and value in your practice?
I have been recording all activities that I have been involved with that require medication optimisation that will generate revenue for the practice such local enhanced services and QOF work. Additionally I record the medication related queries that I deal with as GP time freed.
What development do I need / am I undertaking at this point in my journey?
I have come to realise that that Type II diabetes is a condition that some of the practices could benefit from further support in optimising patient’s treatment. I am aiming to upskill in this field through attending training events and spending time with the specialist endocrinology pharmacist and the diabetic specialist nurses.
What skills or competencies do you feel are important to have in your role as a practice pharmacist?
It is important to identify opportunities to improve patient safety and to maximise treatments in long term condition management. Build confidence in a particular disease area and this will lead to further projects.
What has been your perception of the i2i Network?
I have been very impressed with the i2i methodology where workshops are presented by experts in the field who understand the challenges of general practice. Delegates leave the event equipped with online tools and the knowledge to develop a clinic or service, which is what adds the most value to the delegates to enable them to implement their learning back in their practices. I have not seen this in any other training event that I have attended.
I wish someone had told me………
… the intricacies of the GP QOF when I first started!