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How we are utilising pharmacists’ skills in our general practice

Care for people with long-term conditions is thought to consume about 70% of health and social care spending. Add on to this the estimation that 340 million consultations are undertaken each year, which is 40 million more than in 2008. Currently, GPs frequently handle all appointments regardless of need and severity, meaning they are overloaded and, ultimately, the overall care provided can take a long time to deliver.

Alternative solutions are being sought to widen the care delivery model. One such recent approach is the development of clinical pharmacists in primary care. The Practice Group, which I founded, is developing a strategy to enable GPs to operate at the top of their skill set and experience. The approach involves developing the role of the pharmacist within general practice to:

  • Target hard-to-reach patients with long-term conditions with the aim of increasing medicines compliance and knowledge;
  • Introduce health promotion sessions throughout the year, either as group sessions or one-to-ones between patients and pharmacists;
  • Promote medicine compliance through individual and group sessions with pharmacists. Increase access to healthcare services through a change in skills mix within surgeries. Pharmacists will consult with patients in a number of ways, including face-to-face, via the telephone and through electronic means such as Skype and email;
  • Enhance continuity of care and case management for those patients with polypharmacy, vulnerable and elderly patients;
  • Provide additional care home support, including the review of all new residents within the care home and biannual reviews of all other residents to reduce negative drug interactions and unnecessary polypharmacy. As an example, a pilot ran by The Practice Group regarding additional care home support showed a 17% reduction in general prescribing, with a significant decrease in the use of specials and a reduction in the dosages of antipsychotic prescriptions.

To manage these changes effectively, pharmacists will need to be trained to take on tasks, including prescription queries from patients, reception staff, clinical staff and pharmacies; the review of secondary care discharge medication and outpatient letters; dealing with requests from external agencies and for acute medicines not on repeat prescription from patients; care home medication reviews, including appropriate interventions immediately without needing a GP review; maximising the use of systems and technology; and educating patients, carers and staff around medicines ordering, use and compliance.

The aim of these changes is to reduce accident and emergency (A&E) department admissions through better management of medicines, particularly for those with long-term conditions. Additionally, we are working with the clinical commissioning group to review the possibility of savings from avoided A&E attendances and hospital admissions being reinvested into the pharmacists, developing business cases where appropriate.

These changes will positively affect patients through increased continuity of clinical care, more frequent and comprehensive medication reviews, improved efficiency in assessing medicines, the promotion of better compliance, an improvement in clinical outcomes and avoidance of unnecessary side effects and interactions.

From a GP surgery perspective, the benefits will include an increase in shared workloads, reduction in GP locum costs and increased job satisfaction. For the NHS, the benefits will be more cost-effective prescribing, meeting national quality standards, and a reduction in costs and overall burden thanks to a reduction in reactive urgent care.

A wider variety of healthcare individuals on the frontline with our GPs is the way forward. Clinical pharmacists are a great example of a group that could help more with increased training and scope. By taking approaches to make this happen, we will not only assist GPs’ workloads, but will also improve patient care and value to the NHS in the longer term.

Ajit Kadirgamar

Clinical Lead and Founder of The Practice Group

Amersham, Buckinghamshire 

Citation: The Pharmaceutical Journal DOI: 10.1211/CP.2016.20201393

Readers' comments (3)

  • Graham Phillips

    Whilst I am supportive of the practice-based pharmacist initiative I am profoundly disappointed that the PJ has chosen to propagate the divisive and tautological term "clinical pharmacist" which pejoratively devalues all others in the profession. I feel no need to define myself as a "clinical" community pharmacist any more than hospital colleagues would feel it necessary to describe themselves as "clinical" hospital pharmacists.

    Equally, if not more disappointing, is that there is no mention in the article of the mutually-complementary and supportive roles that PRACTICE-based and COMMUNITY-based pharmacists can play.

    Graham Phillips
    FRPharmS

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  • Dear Graham,

    'Clinical pharmacy', according to American College of Clinical Pharmacy, is a "health science discipline in which pharmacists provide patient care that optimizes medication therapy and promotes health, wellness, and disease prevention. The practice of clinical pharmacy embraces the philosophy of pharmaceutical care; it blends a caring orientation with specialized therapeutic knowledge, experience, and judgment for the purpose of ensuring optimal patient outcomes. As a discipline, clinical pharmacy also has an obligation to contribute to the generation of new knowledge that advances health and quality of life. Clinical pharmacists care for patients in all health care settings. " (http://www.accp.com/docs/positions/commentaries/Clinpharmdefnfinal.pdf).

    I appreciate your concern that some sectors in pharmacy may incorrectly claim to be more 'clinical' than others. But semantically, clinical pharmacy is 'sector' agnostic. We have non-clinical pharmacists in hospitals, mainly focusing on medicines procurement; in industry, where they are involved in drug discovery and development; and in academia, where they are not patient-facing and are teaching basic sciences such as pharmacology, in community, where they are more involved in management and administration, in medicines information, etc. We also have clinical pharmacists in all these sectors.

    Any pharmacist who is directly engaging with patients is clinically involved. Although, there are advanced postgraduate courses available for pharmacists who want to be further trained in therapeutic areas; eg. Clinical Pharmacy (MSC) in the universities of Manchester and De Montfort in Leicester, Clinical Pharmacy course (PgDiploma) in university of Aberdeen, among many others.

    We strongly believe that all pharmacists should be clinical in community, and hence our journal 'Clinical Pharmacist' is now received by all members of RPS, regardless of their sector.

    Thanks again for your comment.
    Arash Hejazi, MD.

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  • Graham Phillips

    Thanks for your reply, Arash but it completely fails to address my point. Community Pharmacy is being serially undermined.... on the that this article was published the entire sector was waiting with bated breath the much-promised DH announcement about the #pharmacycuts. Announcement came their none but the sector still faces decimation.

    The PJ is not simply an academic journal - it is the official voice of the RPS. Language matters and the PJ cannot but be aware of the difficult situation we in community pharmacy face.

    The proposed cuts are all about the politics of the NHS and nothing to do with evidence - witness the fact that the promised impact assessment has STILL not been published.

    I have always supported the editorial independence of the PJ.. but it must be exercised wisely. No amount of intellectual somersaults can justify the irresponsible pubication of this article, written in this way, at this time

    Regards

    Graham

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