The Growing Role for Practice Pharmacists
GPs are in short supply. Meanwhile, there is an oversupply of pharmacists. Now a new role is under consideration: the practice pharmacist. It has been tested in a number of practices in over many years but has recently been revisited in a policy context, including by the NHS Alliance, the Royal Pharmaceutical Society and now the Royal College of GPs.
For example, in March 20151 the RCGP and RPS launched joint proposals on the role, describing pharmacists as a “hidden army” ready to ride to the rescue of general practice. The role had the potential to relieve pressure in general practice and improve patient care, they argued. It was not about having a pharmacy premises within a surgery, but about making full use of the pharmacist’s clinical skills to help patients and the over-stretched GP workforce. Having a pharmacist as part of the team could make a huge difference both to patients and clinical colleagues. Practice pharmacists can consult with and treat patients directly, relieving GPs of casework and enabling them to focus their skills where they are most needed, for example on diagnosing and treating patients with complex conditions. As part of the multidisciplinary team, practice pharmacists can advise other professionals about medicines, resolve problems with prescriptions and reduce prescribing errors. They can work with GPs to resolve day-to-day medicine issues and with practice teams to provide advice on medicines to care homes, as well as visiting patients in their own homes when needed.
Clearly there is an immediate opportunity for practices to review their current skill mix and consider the employment of a pharmacist within the practice. There is also a danger of considering the role in the narrow context of reducing GP workload rather than improving the quality of care. There are many opportunities for practice pharmacists and these must be matched to the experience and qualifications of the pharmacist and linked to practice plans for the pharmacist’s professional development.
GP practices may have to deal with hundreds of letters / communications and discharge reports each day. Administrative staff can manage many of these but those describing changes in medicines currently require the attention of a doctor. There are examples where practice pharmacists are responsible for updating the medicines in patient records. Experience from practice pharmacists has highlighted the discrepancies that require either a discussions with the patient or a call to the hospital or out-patient service to clarify intentions. With the introduction of electronic discharge letters from hospitals it is even more important that General Practice has a system that is fast, reliable and robust.
Many patients are on multiple medication for multiple co-morbidities. Polypharmacy is a particular concern in the elderly patients and those considered frail. Pharmacists are able to deliver medication reviews for the practice and put in place action plans to reduce the risk of emergency admission of patients to hospital.
An average GP authorises 200 repeat prescriptions each week. It is essential that the system is both accurate and efficient. NICE described a scheme within Walsall CCG which demonstrated that a pharmacist-led repeat prescription management system increased the quality of prescribing, reduced waste and saved GP time.
GPs are currently asked to deal with a wide variety of supply shortages and prescription issues which a practice pharmacist would be better placed to manage. The role of pharmacists within prescription management can include the additional management of high-risk medicines, management of patients under shared care and the delivery of medication reviews.
Practice pharmacists are well placed to support routine monitoring and efficacy of prescribed medicines and how patients take them to ensure optimal results. They can support formulary adherence to local area prescribing committees, ensuring that GPs and patients are prescribing safely and defensibly and the review and assessment of new medicines for the practice.
Acute common conditions
An estimated 57million appointments a year are used by people with common conditions or medicines-related problems. Pharmacists may have considerable experience of managing these within a community pharmacy setting. Some pharmacists are already offering an alternative to Nurse Practitioners and GPs for patients with such conditions. They have a potential role to play, diverting patients from GPs to a more suitable professional where reception staff are able to triage patients from a list of symptoms/conditions to see the practice pharmacist. There are examples of pharmacists working in walk in centres and in out of hours services delivering an identical service.
Practice pharmacists have an additional role in signposting patients to their community pharmacy within minor ailment programmes.
Chronic disease management
Approximately 50% of all GP appointments are for patients with long term conditions. There are examples of pharmacists with specialist training and independent prescriber status running chronic disease programs in association with the practice nurse. This model, described in the Nurse Prescriber Journal brings together different skills and knowledge to provide a service to a wider range of practice patients. Pharmacists are often involved within respiratory, cardiovascular and diabetes clinics, but there are many other examples.
Many practice pharmacists have a role within audit and service management to ensure that the practice achieves QoF, LES and DES payments.
Role in primary care practice research
Pharmacists are well placed to engage in this activity which can improve the care of patients and assist the practice in ensuring some income generation.
Practice pharmacists should be seen as making a positive contribution to a general practice and patient care, rather than a simple mechanism of reducing GP workload and keeping practices afloat. Work by the Royal Pharmaceutical Society and the NHS Alliance in 2014 has highlighted barriers to their employment. There remain gaps in GPs’ understanding of the role of the practice pharmacist as well as how practices can make best use of this role. In addition, there is work to be done to help general practice understand and plan skill mix to include practice pharmacists and to support their professional development. Work is required at a professional level to map out competencies and qualifications required by practice pharmacists2.