Peterborough practice pharmacists proving their worth

9 June 2017
Having appointed a clinical pharmacist before the launch of NHS England’s pilot programme, Cambridgeshire GP Dr Amrit Takhar has been buoyed by the impact and the potential for further development. Wansford surgery has already appointed a second pharmacist – this time directly through the pilot programme.
 
“When we made the first appointment 18 months ago we were not sure what they would do but knew we could use their skillset to replace work currently undertaken by GPs. One measure of the success of this is that I now leave the practice at 6.30pm rather than 7.30pm knowing that all the day’s medication queries have been handled properly and appropriately.”
 
Both the clinical pharmacists are attending university and taking part in other training through the NHS the NHS England programme to become independent prescribers.
 
Takhar says: “We saw that we needed a second pharmacist – not least to provide cover as we really noticed when the pharmacist wasn’t there. We believed in clinical pharmacy in the GP practice anyway before the NHS England programme started.
 
“They have certainly reduced GP workload and that is how we will fund them. Their biggest impact has been through reconciling medicines of patients who have been discharged from hospital or whose medications have been changed by a consultant after an outpatient appointment. They deal with around 50 such hospital letters per day. The pharmacists contact the patient proactively which makes the patients feel better and helps them get to know the pharmacists so they can contact them about medicines rather than their GP.”
 
Although the senior clinical pharmacist only works 0.6 of a week, in a typical month he and his pharmacy colleague conduct around 200 telephone or face-to-face consultations and perform around 20 complex medicine use reviews.
 
Like other practices, the Wansford Surgery near Peterborough receives daily medication queries from community pharmacists, nursing homes and patients. Most of these, Takhar says, are now dealt with by the clinical pharmacists.
 
The practice, which has ambitious development plans including establishing a second practice with sheltered and extra care housing on-site, also has a contract to provide GP time to a 105 bed nursing home for people with severe brain injuries. Takhar says the pharmacists have come into their own in supporting the nursing home staff – issuing an average of ten items per month for each of the patients.
 
“These patients have very complex needs with many on PEG feeds. Although we are contracted to provide GP care on site, as GPs we used to spend another ten hours a week dealing with daily calls about medication. The patients have around 950 prescriptions per month. The pharmacists have effectively removed that time from our workload by proactively calling the home each day.”
 
Two of the practice’s six GPs are mentoring the pharmacists as they develop the skills and knowledge they need for independent prescribing. In time, Takhar says, they will run their own clinics under supervision, with pharmacist-led hypertension and diabetes clinics already being developed.
 
Takhar says: “GPs see clinical pharmacists as an expensive employee but GPs are even more expensive so it is obviously a practical approach as long as they are not doing things that other staff could do. We plan to build some surplus capacity then we could look at making our pharmacists available to other practices.”
 
For Takhar, it is important that the pharmacists are supported by the right structure and culture within a practice.
 
“We try to create a culture around development and we have a particular approach that maybe others don’t have. It’s not just about developing the practice leadership but all the team. We look to embed professionals – such as a mental health nurse – in primary care where the public can access them because they have different skillsets to the GPs. That culture means the pharmacists have fitted in well to the team.”
 
They will also be involved in a clinical trial for a new psoriasis treatment that the practice is participating in.
 
He says that PCC facilitator Janice Steed has played a valuable role in helping the practice and the professionals involved define the role and the most appropriate functions.

For information about PCC’s support for primary care development, contact enquiries@pcc-cic.org.uk

 

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