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Norfolk prescribes more practice pharmacists
9 June 2017
Word is spreading across Norfolk of the impact clinical pharmacists are having in GP practices.
When John Higgins began work as senior clinical pharmacist at the Norwich Practices Health Centre in Norwich in March 2016 he assumed supervisory responsibilities for two colleagues at neighbouring practices. They have recently secured independent prescriber status but up to seven more of the 23 practices in Norwich Clinical Commissioning Group are now seeking funding to join the NHS England pilot programme. He expects to be involved in the development of some of those pharmacists.
Higgins, who became an independent prescriber around five years ago, has had a varied career in community pharmacy and as head of pharmacy for Norfolk prisons. He feels his latest role will be for the long-term.
“It’s a very interesting and varied role that gives you plenty of contact with patients and means you can make a difference to the care of people with long term conditions in particular.”
Having had a long-standing interest in chronic conditions, Higgins has completed courses in diabetes and chronic obstructive pulmonary disease over the last 14 months – as well as the mandatory training and courses in fields such as leadership skills demanded by the NHS England programme.
Now a typical day for Higgins begins with reviewing the medicines requirements for a local 200 bed nursing home.
“The home includes a dementia unit and with the frail elderly their meds chop and change and there is always scope for error. I usually spend about an hour on that first thing in the morning.”
All medicines queries from patients and pharmacies are now initially directed towards Higgins, who resolves around 85% of them and refers the remainder to the duty GP. He has ten minute slots for calls to patients compared to the five minutes allocated for a GP call.
Higgins also reviews the medicines changes outlined in hospital discharge letters and contacts newly-discharged patients.
“Often patients will have a lot of new medications so we see if they have any queries and they welcome that.”
Another piece of proactive work Higgins has initiated is inviting people on ten or more medications for a half hour consultation.
“We know our hospitals are very full and people with ten or more medications are three times more likely to be admitted to hospital. They are delighted to come in when you offer a half hour appointment. Patients leave with a greater understanding of their medication and where appropriate I can increase medicine optimisation and address any worries.”
He also typically has eight 15 to 30 minute face-to-face appointments with patients each day – mostly people with long term conditions.
“GPs in the practice have reported a significant increase in their daily workload when I’m not present at the practice,” Higgins says.
The GPs are also able to see more patients each day as a result of the clinical pharmacist dealing with so many of the prescription queries.
Working full-time at just one practice and being an independent prescriber are both advantages in his new role, Higgins believes.
“Being an independent prescriber has the benefit that I don’t need to interrupt the GPs to sign my prescriptions when I have seen the patients. I know that some pharmacists are working across two or more practices but being fulltime at one helps you embed into the team and you can take care of any queries from colleagues quickly.”
That has also helped Higgins’ new colleagues understand his role and the skills and expertise he brings to the practice.
“There is a bit of an education role in terms of making colleagues aware of your skills and expertise. Their only contact with pharmacists previously was often a brief telephone call to sort out a query. Some staff felt threatened and were not sure exactly what I would be doing and you need to show the GPs that they can be confident about you being involved in a patient’s care.”
With his practice playing a leading role in the NHS England programme locally, Higgins is sure he is part of the future.
“In five years’ time every practice will have a pharmacist. It will be just like the move to appoint practice nurses that started 25 years ago – now every practice has at least one. The pilot programme started in response to the problem in recruiting GPs and that has got worse over the last two years – as has the recruitment of practice nurses and nurse practitioners.”
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