MY name is Ravi Sharma – I am a senior primary care pharmacist working in general practice. I have been doing this for the last two and a half years and have developed a number of special interests along the way. One of my key roles has been surrounding the development of pharmacist-led clinics in general practice.
The purpose of these clinics is to:
• Improve patient health outcomes.
• Increase access to healthcare for patients.
• Improve screening, diagnosis, treatment and management of chronic and common ailments.
• Reduce A&E admissions and attendances.
• Reduce medicines wastage and overuse.
• Improve patient safety and care.
The model of care was nominated for a Health Service Journal (HSJ) award in Primary Care Innovation as well as a General Practice Innovation Award. As you read the this post, I hope you will appreciate that pharmacists in general practice play pivotal roles within the day-to-day running of the practice as well as the number of services offered to patients and the general public
The role of a pharmacist in general practice can be difficult to encapsulate in a blog, but I will try to elaborate on some of the key roles. Let’s consider some of the clinical services that are provided:
Management of chronic conditions : health checks and early screening for chronic conditions; diagnosis, treatment initiation, monitoring, follow ups and annual reviews; detecting early deterioration of conditions and triaging to appropriate services/practitioners; and empowering patients by helping them manage their conditions and explaining when they should seek medical advice.
Home visits (particularly care of the elderly): bed side management for patients who are unable to get to the GP practice, bringing care closer to home; common ailments, chronic disease management, dementia and falls assessments
By doing home visits pharmacist can understand the needs of the frail and elderly and can address them. Pharmacists provide good feedback to the multidisciplinary team and points raised are actioned immediately. Pharmacists also communicate with the wider healthcare teams in creating a package of care for vulnerable patients e.g. health and social care, district nurses, community matrons, carers, hospitals.
Care home visits : provide advice on medicines optimisation and management ; help manage chronic and common ailments; and provide staff education.
Other services: pharmacist practitioners offer on-the-day appointments for many conditions e.g. urinary tract infections (UTIs) and chest infections.
Roles surrounding medicines
1. Greater efficiency of the repeat prescribing process – pharmacists are responsible for monitoring the system to achieve a high level of efficiency and safety.
2. Act as a point of contact for medication queries for patients and healthcare professionals – pharmacists add a layer of pharmacovilgance to the process, improving patient safety around repeat medication.
3. All medication reviews completed by pharmacist, especially complex medication management.
4. Safer management of patient on high risk medication e.g. methotrexate and other drugs with a narrow therapeutic index.
5. Act as a liaison between all healthcare interfaces – particularly important in regards to safer medicines reconciliation when patients are moving in and out of hospital/intermediate care/care homes.
Other medicine roles include :
- Delivery of prescribing incentive schemes.
- Monitoring prescribing within general practice – producing savings from the prescribing budgets, promoting cost effective prescribing.
- Medicines optimisation and reducing medicines wastage.
- Helping with de-prescribing – medication that is not needed for patients, reducing risk of interactions and adverse drug reactions especially in the elderly population.
- QOF management
- Audit work
- Delivery of Local and direct enhanced services
- Help with CQC preparations
- Supporting on junior staff e.g. pharmacy, nurse and medical students
Focus on outcomes
The outcomes that have already been achieved through innovative use of pharmacists, include:
• All GP practices have exceeded QIPP targets – achieving 100% in all interventions.
• Improvements around chronic disease management – in particular diabetes outcome. In one of our practices >69% of patients have a HbA1c 70% diabetic patients had a BP 30%.
• Pharmacists in walk in centres alongside GPs and Nurses – >70% of patients can be seen by pharmacists prescriber. Please note this data have been taken from internal audits from our pharmacy team and data provided by our local CCGs. I am working on getting the data validated and published next year.
Overall as part of general practice, pharmacists are:
1. Increasing access and services offered to patients.
2. Promoting health to local populations through self-care initiatives, interacting with local support groups and working more with the 3rd sector.
3. Targeting patients with the greatest needs e.g. frail and elderly.
4. Improving the quality of care and patient outcomes.
5. Engaging with QIPP agenda, QOF optimisation and improving productivity.
6. Creating, improving and implementing policies and guidance’s – which can without a question act as the blueprint for the introduction of pharmacists into general practice on a national scale.
Some of my other work includes the development of a junior pharmacist role within general practice. The role is new and quite diverse and it is aimed mainly at newly qualified pharmacists who are looking to get more involved in general practice, so I have developed an in-house training syllabus. Following 2 years post pre-registration, these pharmacists will have the opportunity to become independent prescribers and I am now working on creating pharmacist pre-registration placements within general practice as well.
We now need to:
• Engage more with MPs, commissioners, providers, voluntary organisations and most importantly patients about the role of pharmacists in general practice. We need media coverage in order to raise awareness.
• Share and scale working care models – there is some great work locally, but we need to now take this to a national scale and platform.
• Produce high quality outcomes data – which needs to be published in high quality journals.
Overall, there are three 3 key take-home messages of why pharmacist’s integration into GP needs to happen:
1. It will help relieve the unsuitable pressure on general practice – the current pressure will cause the model to buckle.
2. Pharmacists are a skilled, enthusiastic and a willing workforce with a ‘can do’ attitude and are available now – pharmacists have a huge potential.
3. Having pharmacists in general practice will enable effective use of skill mix in order to improve patient care. It will allow the formation of stronger and more versatile multi-disciplinary teams. The great thing about the role is that pharmacists are not only learning from other healthcare professionals, but they are also able to share their expert knowledge as well. This has given rise to not only improving patient care and continuity of care, but helps create a positive learning environment in general practice which promotes continual professional development for all members the MDT team.
We as pharmacists can help shape the future of pharmacy, but also help shape the future of the NHS.
However, collaboration is key. It is important that all healthcare professionals work together and help each other, as this will allow us to deliver a better quality of care to our patients. It is all about a patient-centred approach.
I am a strong believer that every GP practice would benefit from the knowledge and skills that a pharmacist has to offer.
At the tender age of 25… I am loving my job and am excited for the future of our profession!
Ravi Sharma is Head of Primary Care Integration and Lead GP Practice Pharmacist at GreenLight Healthcare and a GP Practice Partner.
Follow Ravi @RSharmaPharma