A split pre-registration placement: at the CCG

As a pharmacy pre-registration trainee, I split my training between Leeds South and East Clinical Commissioning Group and Leeds Teaching Hospitals NHS Trust. I have written about my experiences in the hospital here.

Between two three-month hospital pharmacy blocks, I trained in the CCG for six months. This period was broken into three months of prescribing support followed by three months in medicines optimisation.

What took me by surprise initially was the dynamic in workflow. Work was no longer prioritised around high risk patients, new admissions, discharges or urgent enquiries. In general, workloads were consistent and set based on a structured collaboration with GP practices to implement medicines optimisation at a patient level.

In the first three months, I worked with pharmacy technicians and CCG pharmacists, gaining experience and skills through familiarising myself with a new patient record system. I helped with assimilating information on medication safety and orlistat prescribing, writing guidelines, developing clinical audit reference packages for new staff, running searches for Medicines and Healthcare products Regulatory Agency alerts and identifying clinical appropriateness of prescribing.

I finally understood the primary care system properly when I undertook a project that examined the drug therapy monitoring practices of amber level 3 drugs. The traffic light system provides a framework for defining where clinical, and therefore prescribing responsibility should lie through categorisation of individual drugs. Local policies state the drugs should be started and stabilised in secondary care before responsibility for their management is transferred to primary care.

I conducted my audit on lithium therapy monitoring in primary care. I was provided with generous time to prepare and conduct the audit, and opportunities present the results to stakeholders and at conferences. The audit highlighted the disparity in communication between primary and secondary care. Additionally, technology still has a long way to go to support the management of tests and results. The role of pharmacists in this setting is fundamental to prevent patients being ‘missed’.

My most enjoyable rotation was in medicines optimisation. I was able to use the drug history taking skills and ward support experience I learnt in hospital to support care home visits, conduct medication reviews for care home patients, support GP practices with discharge reviews and answer GP enquiries. The rotation demonstrated the role pharmacists have in patient care and safe prescribing within primary care, something of which I was not previously aware.

As part of my training I became familiar with using the STOPP-START tool for stopping medication (deprescribing) to maximise the benefits and reduce risks to patients from medicines, as well as clinical knowledge summaries from the National Institute for Health and Care Excellence and the local medicines traffic light system for primary care prescribing guidance. I found this helpful for preparing for the registration assessment because it involved solving problems and learning about the most prevalent conditions in the community by applying a structured approach to account for every prescribed medicine for a diagnosed condition, and ensuring it was the right dose and clinically appropriate for the patient.

Training and support

The pre-registration year is challenging in many aspects, especially because studying alongside working and completing coursework is exhausting. However, the concise training programme at Leeds, combined with support from peers and mentors, strengthened my ability to complete the pre-registration programme successfully.

Leeds Teaching Hospital provides comprehensive weekly in-house tutorials covering topics examined in the registration assessment, as well as running mock exams, giving us plenty of practice with exam and question format. Additionally the programme includes regional training, comprising study days and four residential trips through the year. The teaching and support provided was brilliant and prepared me well for my appraisals and quality improvement project, as well as for the assessment.

With regard to training support, I had two pre-registration tutors — one at each site. I had fortnightly meetings with my one of my tutors where I would share my portfolio of evidence at the end of each rotation to demonstrate my competence.

Meeting the standards for registration

Many prospective trainees may be concerned that the type of work in the CCG — with no medicines handling and no direct contact with patients — will make it difficult to demonstrate all the performance standard necessary for registration. However, with careful planning and discussion with tutors and supervising pharmacists, it has not at any stage been a problem.

Working with my tutors, I divided the standards into those I was required to obtain in hospital and those that were possible to obtain in the CCG. The two-week cross-sector experience in a community pharmacy provided exposure and time to gain experience in, for example, advising patients on over-the-counter medicines, handling emergency supplies and applying the Medicines, Ethics and Practice (published by the Royal Pharmaceutical Society) to practice.

I would advise getting into the habit of doing continued professional development (CPD) regularly from an early stage in your career. It was a requirement in my programme to do at least one piece of CPD in the year. However, with a minimum of nine once registered, it makes sense to double count the pre-registration evidence and write it up into CPD entries.

Reflections

I completed my pre-registration year three months ago and was in the first cohort to pass the new style of registration assessment. The diverse experiences I have had across primary and secondary care have not only helped with my learning and pre-registration training, but broadened my outlook on understanding the patient pathway and shaped my practice in becoming a better pharmacist.

As the future of the profession is slowly paving its way into primary care, more pre-registration sites are offering the opportunity to experience primary care pharmacy. I advise all pharmacy students who are interested in this sector to contact their local GP pharmacist or CCG medicines management team to arrange a chat, visit or placement. Rise to the challenge, ask questions and don’t be afraid to use your initiative — it is down to you to make things happen for yourself. This will broaden your learning horizons and help you discover new things.