Our experience of preregistration training in general practice

The role of pharmacists in general practice has evolved and expanded considerably in recent years. Subsequently, the GP pharmacist preregistration training programme has grown to reflect this change.

Prior to 2019, GP pharmacist preregistration training placements were not available through Oriel, the UK portal for recruitment to postgraduate pharmacy training programmes. However, in 2020 there will be over 200 pharmacist preregistration placements listed in Oriel that include at least one three-month placement in general practice.

As former GP pharmacy preregistration trainees we want to give pharmacy students an inside look into the training year and share some of our experiences.

As preregistration trainees in GP practice we witnessed just how much the multidisciplinary team (MDT) value pharmacist input. We saw first-hand how clinicians rely heavily on the pharmacist’s in-depth medicines knowledge and frequently seek medication-related advice from both registered pharmacists and preregistration trainees.

A core part of a GP pharmacist’s role is ensuring patients continue to be prescribed medication that is clinically appropriate. In order to do this, we were taught to rationalise medication and identify opportunities for deprescribing using patient records, GP notes, blood test results and specialist clinic letters.

Many surgeries also care for patients in residential/nursing homes. These patients often require in-depth reviews due to the higher probability of polypharmacy, we were often required to assess and help manage these issues. This process helped build confidence and led to a sense of satisfaction as we could see our recommendations having a positive impact on patient outcomes.

As preregistration pharmacists we were responsible for prescription requests. This involved frequent communication with the staff at both the surgery, the nursing home and local community pharmacy – resulting in the development of good working relations.

We were able to regularly shadow GPs, pharmacists, nurses and residential home healthcare assistants during consultations with patients. These sessions provided exposure to a wide range of clinical scenarios and the unique consultation styles employed by different healthcare professionals. We compared and practiced various techniques under supervision to help us discover their own consultation style.

Attendance at MDT clinical meetings, where interesting patient cases are presented to the group, facilitated development of clinical decision-making skills. We become increasingly aware of when patients should be discussed at these meetings and got a better appreciation for when it may be necessary to refer patients to a specialist. The meeting highlighted the importance of working within an individual’s own competency and when to seek support.

We worked closely with the local medicines management team. After attending their meetings we gained a better understanding of the financial pressures facing primary care and appreciating the rationale behind cost saving initiatives.

Preregistration trainees were actively encouraged to take on projects in any areas of interest. While support wass provided,  students were given the freedom to manage and organise their research independently. These research projects were a chance to implement quality improvement measures which have a real impact on patient welfare. For example, managing medications in a difficult, complex group of patients and identifying areas to reduce dose or stop medicines where appropriate. These projects were an excellent opportunity to produce evidence against General Pharmaceutical Council (GPhC) performance standards, for example standard A4.8 Have successfully engaged in a quality improvement process. As a GP pharmacy preregistration trainee there are typically a wide variety of existing clinical audits to get involved in (e.g. making sure MHRA alerts are routinely reviewed).

The amount of support and learning opportunities offered to trainees will differ between GP placements. However, we attended practice pharmacist-led fortnightly tutorials as part of our training programme that included topics such as clinical case studies and how to use the BNF. This protected study time allowed for peer discussion of interesting cases we encountered and challenging aspects of learning.

Our training programme included a cross-sector placement in community pharmacy allowing us to develop an insight into the issues facing community pharmacists. We were encouraged to share ideas on how primary care and community pharmacy can work better together to provide a positive experience for both patients and pharmacy professionals. This placement allowed us to develop skills essential to a range of GPhC performance standards, for example over-the-counter counselling (performance standard B.1(6)) and dispensing (performance standard C.1). Having the unique opportunity to follow the journey of a patient from consultation in general practice to dispensing their medication in the community pharmacy was enjoyable.

We were enrolled in an external training programme to further prepare us for the preregistration assessment. One benefit of this was the opportunity to meet with other preregistration trainee pharmacists from different sectors. We also attended local training and support meetings focusing on specific topics and issues facing pharmacists in general practice. This was a great way to network with colleagues and learn from the experts who deliver the training.

For more information on preregistration training in general practice visit: https://www.hee.nhs.uk/our-work/pharmacy/pre-registration-pharmacist-training-general-practice