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Unintended consequences of pharmacists working in GP practices

I was most agreeably surprised when watching ‘Breakfast’ on BBC to learn that the Royal College of General Practitioners is recommending that every GP practice should have its own pharmacist. Also it was good to see the interview with a pharmacist working in such a practice. From what the pharmacist was saying, it would seem to be ideal for all parties with the pharmacist managing many long-term patients. He also suggested that such arrangements would mop up the current surplus of pharmacists.

However, as a former community pharmacist myself, I soon saw that such arrangements could potentially cause disaster for many of my former colleagues who have established excellent working relationships with local GP practices. The Pharmaceutical Services and Negotiating Committee and others fought long and hard to establish services like medicines use reviews (MURs) in community pharmacy and, despite some opposition, have managed to keep the programme alive to the professional and financial benefit of community pharmacies.

One would assume that the whole MUR system would gradually collapse because patients would not want to have two reviews on their medicines. Also it would not make sense for the government to fund the community-based reviews any longer. One member of the public interviewed on the programme apparently thought, I assume mistakenly, that the presence of a GP practice pharmacist would allow his prescriptions to be dispensed on the premises to save a visit to the community pharmacy.

I am not a total reactionary and can see that the proposed scenario could benefit all parties in a large GP practice, which is served by a relatively large number of pharmacies. However, this is definitely not a one-size-fits-all situation. One has to consider those pharmacies established in the same premises as GP practices, where the pharmacist has the opportunity to interact with GPs and nurses. The amount of delegation to the pharmacist to manage long-term conditions and repeat prescribing will doubtless vary widely, but communication and cooperation should lead to a reduction in the GPs’ workloads.

In addition, there are still small, often rural, pharmacies serving a single smaller GP practice. In my pharmacy we developed excellent working relationships and trust with the GP practice, with the result that minor problems were sorted out without the patient concerned being aware. The GPs expressed an interest in devolving care for some patients to us but were inhibited both financially and from the professional indemnity point of view. The way things have moved on would present an opportunity for further discussions. Many patients trust their pharmacist implicitly and would welcome devolution of more aspects of their healthcare.

I would urge all parties to indulge in a great deal of negotiation and discussion before bringing in sweeping changes that could severely damage many good community pharmacies.

 

Roger King

Dorset

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2015.20068159

Readers' comments (2)

  • Hi Roger,

    Great to read this letter. I was indeed that pharmacist on BBC Breakfast on the 17th March explaining (trying to explain) the benefits of pharmacists working within general practice.

    As you can imagine, trying to get key messages across in a short period of time to the general public can be difficult and it is extremely difficult to encapsulate all of the roles that pharmacists play within general practice.

    Just to address some of your concerns that were mentioned above - Patients normally undergo two reviews yearly - an MUR in Community Pharmacy and a Medication Review within general practice by a GP. In terms of taking away from Community pharmacy I do not believe it does. I regular signpost to community pharmacy for additional services e.g. common ailments (when triaging), adherence MURs and NMS. I have a strong relationship with all my local community pharmacists. I act as a point of contact for them to ensure higher efficiency of that repeat prescribing process. It is unlikely that GPs will want to take MUR's away from community pharmacy at all - the workload in general practice is being shared, new skills are being introduced and it is building up the profession and breaking down the barriers. Its a great opportunity for us as a profession. We are creating a career pathway (esp with future/predicted oversupply)

    Furthermore, this role is essentially not about dispensing any medications within general practice - we are not a dispensing practice. Its about using the skills that a pharmacist has to support GP and Nurses to deliver a really high quality of care for patients - esp following the 5YFV - working in larger MDTs.

    I agree that this may not be for everyone and some areas may not need a pharmacist in a GP. I agree that community pharmacy can do a lot more - there is a lot of work to go around! I also agree that we need to link up general practice and community pharmacy more - I think by having a pharmacist within general practice, will allow for this.

    I am currently working on a project with pharmacy/GP colleagues to form links with CP and GP in terms of clinical services and screening for LTCs.

    Here is my blog - https://johnathanlaird.wordpress.com/2015/03/03/guest-blog-by-ravi-sharma-so-what-exactly-does-a-pharmacist-do-in-a-general-practice-ah-lots/

    Have a read and feel free to contact me to discuss further. My twitter is @rsharmapharma or ask PJ to send you over my contact details.

    All the best,

    Ravi Sharma

    GP Practice Based Pharmacist

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  • Chijioke Agomo

    I completely agree with Ravi Sharma and Dr. David Branford on this, that pharmacists positioning themselves in GP surgeries, will help advance the clinical knowledge, skills and relevance of pharmacists.

    I have made a similar argument a number of times. This is a profile changing opportunity for the profession, hence, every pharmacist must support this noble initiative. Well done RPS!

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