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Evidence based approach reduces the risk of building multidisciplinary teams
4 December 2018
As general practice is changing to meet the evolving needs of patients, new clinicians are joining multidisciplinary practice teams to make a wider range of skills and specialisms
available in more patientcentred services.
As part of workforce development under the General Practice Forward View (GPFV), clinical pharmacists are being recruited into practices across the country through an NHS England (NHSE)-funded initiative. Some GPs have struggled to find the time and resources needed to persuade partners of the potential value of a practice-based clinical pharmacist and to invest in the necessary induction and support for a new patient-facing role in their practices.
Primary Integrated Community Services (PICS), an NHS provider in Nottinghamshire has developed an evidence-based model of support for GPs based on the effective delivery of a pilot clinical pharmacist scheme in 2015-16, the learning from which is informing the implementation of the NHSE programme across the county.
Gerald Ellis, programme manager for GP clinical pharmacy transformation for PICS explains how important it is to engage directly with GPs and practice teams from the beginning, sharing evidence of the benefits clinical pharmacists bring and encouraging people to think how a pharmacist might fit within their teams.
Key findings from the pilot scheme were that to be effective clinical pharmacists need enough time in practice to provide continuity of expertise and care. With one day a week, progress was slow, it took longer to develop relationships with the team and for people to understand what the skill set is and how to use it.
It was difficult to change behaviours or introduce new ways of working and many of the potential benefits were lost.
PICS has encouraged practices to think about employing clinical pharmacists for a minimum of two days a week, even where the NHSE funding does not cover the full investment, and GPs are looking at the evidence and making the investment in additional time. PICS provides ongoing support as clinical pharmacists embed in practices and a peer network for the pharmacists themselves.
Employing clinical pharmacists on behalf of GP practices
A key concern of GPs is the risk of employing a clinician in a new role within primary care when they are not sure if it will work for them. The PICS model has evolved to provide a full recruitment service that matches clinical pharmacists to the needs of individual practices.
Practices can then employ the pharmacist directly or PICS will employ them for the duration of the NHSE programme.
This approach takes the employment risk away from GPs, the advertising, shortlisting and interviewing, DBS checks and references are done for them before they meet potential matched candidates.
Ellis says: “Generally the people we put in front of them are good enough to do the role, we then need to see if personally they click, see can the parties work together. If they don’t click, PICs will find an alternative and re-locate the clinical pharmacist in another practice – this has worked well already – finding the right match between practice and clinician.”
At the end of the programme, PICS will meet practices and agree how they want to go forward. Practices welcome the idea that PICS is not saying they have to employ the pharmacist at the end of three years, that PICS could continue to employ them or they could choose to employ them directly, and they are not required to make a decision at this point.
“Practices are unlikely to say ‘thanks very much and goodbye’. The reality is if they (clinical pharmacists) have been there for three years they can’t do without them, they are part of the furniture.”
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