Pre-registration training in a CCG: a tutor’s perspective

Leeds South and East and Leeds North Clinical Commissioning Groups (CCGs) have just completed the first year of having pre-registration trainees as part of split placements with Leeds Teaching Hospitals NHS Trust.
The pre-registration trainee came to us for a six-month period having spent three months in hospital.

For the first half of the placement, the trainee was allocated to work with pharmacists and pharmacy technicians undertaking practice audits, including those against alerts from the Medicines and Healthcare products Regulatory Agency, National Institute of Health and Care Excellence or locally agreed choices. Initially the trainee was shadowing staff but then progressed to undertaking her own audits, discussing action plans with GPs, implementing any medication changes needed and contacting patients about such changes when agreed with the GP. All was undertaken under supervision.

The second half of the CCG placement concentrated on clinical medication review. Pharmacists in Leeds South and East CCG conduct comprehensive medication reviews for care home patients, patients who are at high risk of admission to hospital and patients discharged from hospital. Again, the trainee initially shadowed pharmacists reviewing GP records or visiting care homes, but she then undertook her own medication reviews, which were sent as weekly tasks through SystmOne or EMIS GP record systems and discussed with the pharmacist before being implemented. As part of this the student had a chance to speak to GPs to go over patient care plans and agree any necessary changes in medicines.

The trainee also undertook a quality improvement project as part of her CCG placement. She audited the monitoring of lithium in two GP practices and shared the results with the practices as well as the local mental health trust. This culminated in a poster presentation alongside other pre-registration trainees in secondary care across Yorkshire & Humber — our trainee won second prize for her poster and presentation. The poster was also submitted to the British Pharmacy Students’ Association (BPSA)/UK Clinical Pharmacy Association pre-registration research poster award and was presented at the BPSA event.

Overall the placement went well, although the first couple of months could have been planned a little more in terms of whom the trainee was shadowing and what she were expected to do; this wasn’t helped by staff changes and new team responsibilities. The student particularly enjoyed the more clinical aspects of the job towards the end of the time with us.

Travel, technology and space was an issue. Because the team works both in the CCG office and out in member practices, there was usually daily travel, although this was kept to one move in the middle of the day where possible. We were unable to secure a laptop for the trainee, which meant some difficulty where there was no space in the office — a downfall of hot-desking with laptops — or in the smaller GP practices. This was solved somewhat by the use of an encrypted USB drive but was not an ideal solution.

Having regular meetings with the joint tutor at the hospital helped create an early working relationship before the trainee worked at the CCG and plan the trainee’s final three months at the hospital and what needed to be covered there.

We are still learning from the process of setting up the scheme because there was little experience from elsewhere to guide us. Towards the end of the year, all hospital and CCG tutors from within Leeds met, with the trainees, to review the year and plan for placements in the future. The trainees’ views were invaluable. Following this feedback session we have decided next year to have six months of hospital experience first, before coming to CCGs for four months. This will allow for more hospital clinical experience before working in CCGs but means that the “classic primary care” prescribing support section of the placement will need to be condensed. Annual review and evolvement of the scheme will be ongoing.