Making time to care about prescriptions

30 August 2017
While working across two Hull practices keeps her busy, clinical pharmacist Emma Hewitt says that having the time to spend with patients with complex needs or worries is a key element of the role she started last year.
 
After a decade in community pharmacy and three years working as a medicines management pharmacist with clinical commissioning groups, Hewitt is relishing the new challenge.
 
She enjoys having the opportunity to spend as much time with a patient as they need rather than being tied to ten-minute appointments.
 
Recently, for example, she worked with a person with learning disabilities who had complained to the practice manager after feeling that a GP had not explained a prescription change. He was also unhappy with the GP’s attitude towards him.
 
“I telephoned the patient initially and was able to reassure him about the correct dose of the drug from the most recent hospital letter and offered him an appointment to come in and see me for a full medication review.
 
“When he came in I was able to see that he had been given the medication from two pharmacies in different packaging so I explained that it was the same medication.
 
“During the consultation I discovered that the community pharmacy dispenses his medicine in a monitored dosage system so I telephoned the pharmacy while the patient was with me to arrange to have this new medication added to his weekly prescriptions. The patient didn’t really know what all the medications were for so I explained that and at the end of the consultation he said his mind was at rest.”
 
This was the first of several contacts with the patient and his wife to support him over a six week period. Hewitt identified a potential issue when processing a clinic letter for the patient which requested a complex dose titration of a medicine. She worked in close collaboration with the community pharmacy to ensure the patient received the best possible care.
 
“I had continuity with that patient and the luxury of time so I could prevent problems arising.”
 
Her work with that patient alone probably avoided several GP appointments.
 
Hewitt has largely enjoyed a positive response from patients at the two weekly clinics she runs at each of the practices. As well as conducting medicine reviews, she holds hypertension clinics.
 
“Some patients coming for medicine reviews were initially dubious because they felt it was a waste of time but because I could take the time to talk things through, give specialist advice on medicines and give them opportunities for questions they recognised the value and gave positive feedback.”
 
The biggest challenge she has found is the novelty of the role – and she sees good communication as the solution to that.
 
“Initially there was a challenge involved in creating a new role and integrating yourself into the team. But it wasn’t a hideous challenge – the GPs were keen. You have to make sure you are accessible and visible and that the practice team understands your role. To some extent you grow the role yourself.”
 
For Hewitt, that role includes reviewing discharge and outpatient letters as well as handling all medicine-related inquiries. This reduces GP workload and her presence gives them access to prescribing support.
 
“With the two practices I am kept fully occupied and from my point of view full-time in one practice would perhaps be ideal. With my experience as a medicines management pharmacist I would like to have more time to contribute to the education of the practice team and also to influence prescribing to ensure it is in line with local and national guidelines.”
 
She is employed by City Health Care Partnership, a community interest company that provides primary care services in the region. Hewitt is optimistic that the organisation will recruit more pharmacists in the second phase of the NHS England clinical pharmacists in general practice programme, which is now underway.
 
PCC provides individual development support to all the practices involved in the clinical pharmacists in general practice progamme, facilitating discussion, business planning, staff and patient communications, and process and culture change to ensure that the clinical pharmacist role is successfully embedded.
Download the full edition of Commissioning Excellence September 2017.
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