Clinical pharmacists improve workload, safety and patient satisfaction at four GP surgeries

9 February 2018
Four practices taking part in the clinical pharmacists in general practice programme have seen significant savings in GP time. They have also reported high levels of patient satisfaction and improvements to safety.
 
The four Midlands based practices, all part of the IntraHealth primary care group, employed seven pharmacists working part-time and in rotation, with each practice getting the services of approximately 1.2 whole time equivalent staff.
 
The pharmacists have now been in place for 18 months and were initially supported in their new roles by PCC during phase one of the programme.
 
Local medical director for IntraHealth,Dr Kamran Ahmed, is in no doubt about the value the pharmacists have brought to the practices.
 
“The clinical pharmacists have been a revelation. It has completely changed the way I view my working week and has freed up more of my time so I can focus on complex patients, practice management and more importantly family time.
 
“I was struggling under the increasing burden of work in general practice and taking work home with me on evening and weekends. Thankfully that does not happen anymore,” he says.
Dr Ahmed’s enthusiasm is underlined by the figures. A cost benefit analysis showed that over a three-month period there was a net saving across the four practices of £46,800 made by using pharmacists to do work that would otherwise have fallen to GPs.
 
In the same period, over 100 hours GP time of direct patient contact was saved by clinical pharmacists seeing patients for medication reviews, minor illness appointments as well as for the management of long-term conditions.
 
The pharmacists were also able to save GPs almost 800 hours in administrative tasks such as repeat prescription authorisation, processing discharge letters and dealing with queries from reception staff and local community pharmacists.
 
Sheetal Kotecha, a pharmacist at Kingshurst Medical Practice during the pilot, said that while the potential cost and time savings are an important part of the attraction of employing clinical pharmacists in the practices concerned, there were also significant quality benefits.
 
“We have been able to do medication reviews and reconciliation of discharge letters, both of which are really important ways to check that patients are on the right medications. Obviously this is a big patient safety issue, but it also has a knock-on effect on workload if, for example, patients are still being prescribed drugs that should have stopped after they were discharged from hospital.”
 
Kotecha gives another example to show how a quality-led approach was able to identify potential improvements to care and savings for the wider health economy.
 
Asked by the CCG to do a polypharmacy review, Kotecha reviewed approximately 1% of her practice’s list, or around 70 patients over the course of a year, using a template she developed to ensure that consistent quality indicators were being addressed and to set a benchmark for future reviews.
 
On completion of the reviews, an audit was carried out by the CCG prescribing support pharmacist on 10% of the patients reviewed. The audit showed a staggering 42 interventions were made, three of which would have prevented hospital admission.
 
“Extrapolated to the whole patient population across all four practices we can see potentially large benefits both for individual patients and for the wider NHS,” Kotecha says.
 
Tasks undertaken by the pharmacists included:
 
  • Monitoring patients with complex long-term conditions
  • Repeat prescribing issues
  • Increasing the uptake of ScriptSwitch – enabling savings for the practices
  • QOF enhanced services
  • Medication reviews, polypharmacy reviews, acute clinics
  • Care home reviews – streamlining ordering processes to reduce waste
  • Discharge reconciliation
  • Conflict resolution
  • Developing local protocols
  • Audits such as antimicrobial usage, high-risk drugs
  • Supporting CCG local incentive schemes by delivering required KPI measures to secure funding
  • Actively engaging with the local general practice improvement programme – involvement in multidisciplinary discussions addressing “frequent-flyer” patients’ needs by optimising treatment options and thereby freeing up GP appointment slots.
 
IntraHealth’s third objective for taking part in the programme, after reducing workload and improving safety, was to improve patient satisfaction. A survey conducted at the outset of the pilot established that patients saw a pharmacist as a positive addition to the general practice team. There was equal enthusiasm when patients were offered the opportunity of a review of their medicines – with more than three-quarters (77.5%) responding positively.
 
A quarterly survey which asked patients to rate their satisfaction with doctors, advanced nurse practitioners and clinical pharmacists, showed the proportion of patients rating the service good or excellent reaching 98% in one quarter and never falling below 95%.
 
Patients reported that they appreciated the extra time available for consultations – 15 to 20 minutes with the pharmacist versus 12 minutes with a GP – and the opportunity to discuss their health and medication in greater detail. One said: “[It was] a very positive and reassuring consultation. I left feeling very well cared for.
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