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Sunderland focuses on team work and the long term
Sunderland’s approach to the piloting of clinical pharmacy in practice puts the emphasis on teamwork, mutual support and looking to the long term.
Megan Blythe, senior clinical pharmacist with Sunderland GP Alliance and one of those working in a practice as part of the pilot, says that the federation’s over-arching role could provide a model for others to follow.
The local arrangement provides Blythe with nearly 17 hours of non-clinical time each week to support the other six clinical pharmacists working across 12 practices in the pilot.
This support includes:
- One-to-one mentoring with pharmacists
- Pharmacists shadowing Blythe in face-to-face clinics
- Quarterly clinical supervision sessions, team meetings and practice engagement sessions
- Additional clinical and system training to that delivered as part of the NHS England programme through the Centre for Pharmacy Postgraduate Education – including bloods interpretation and reading prescribing data
- A newsletter for practices.
Blythe has also encouraged the pharmacists – who each work part-time at one or two practices – to take part in multi-disciplinary team meetings and joint working with colleagues, such as home visits with community matrons.
“We work very much as a team and we’ve engaged some organisational development support to help us bond as a team. You can feel isolated at times so it’s good that we contact each other as we each have different areas of expertise.”
With just two of the pharmacists having previously worked in primary care, Blythe sees the extensive additional support the federation is providing as crucial.
“This extra support has been key to embedding the pharmacists into the practices and helping to meet practice needs. In particular, for the pharmacists who have not previously worked in practices it has helped smooth them into the role and improved their general understanding of general practice and primary care.”
Having previously worked for a company that provided pharmacists to practices, Blythe was determined that the local version of the Sunderland pilot would offer that high level of support.
“In my previous job I mentored pharmacists who had just completed the independent prescribing course but I only had an hour a week available and it was on a set day and time. That made it difficult if a pharmacist had a clinic at that time.”
Speaking about the pilot programme, she says: “Obviously we all attended the CPPE residential introductory course but some of the pharmacists came away with an idealistic view of what they would be doing in any practice. The mentoring work is about managing expectations from the point of view of both the pharmacists and the practices.
“We were shaping the practices’ view on what pharmacists could do while helping the pharmacists understand that the long-term goal is employment by the practice. “For example, the team came back with idealistic ideas around running clinics. Practices do not want to pay pharmacists to do blood pressure checks that health care assistants could be doing.
“They needed some understanding of the financial aspects and the return on investment for the practices as they start to fund more and more of the cost.
“We’ve had two practices leave which is really disappointing. They had both previously employed pharmacists for more time than was available in the pilot, and I think the difference between the pharmacists involved in the pilot at the beginning of the learning curve has been different to what they had previously experienced. There was an element of investment in their development which the practices had not previously had to consider.”
This relentless focus on the best use of the pharmacists’ skills means that the pharmacists are typically dealing with medicine queries, medicine use reviews, hospital discharge and outpatient letters and home visits.
Blythe says: “With the likes of medication reviews it might take a pharmacist longer than a GP but they are picking up quite a few things so we are improving patient safety and we link into safety event reporting.”
The pharmacists supply their activity data to Blythe on a quarterly basis with a view to establishing the benefit of the role – particularly by expressing the impact in terms of time saved for GPs.
In the first quarter of 2017 the pharmacists were involved in nearly 3,500 clinical interventions. In the nine months from July 2016 they reviewed more than 2600 discharge or outpatient letters, added medication to reduce risk for 50 patients (such as anti-platelets for stroke patients) and stopped unnecessary medication for 166 patients.
The federation, using a model for estimating the resulting cost savings to the NHS system of such interventions, puts those savings for the first three months of 2017 at close to £700,000. That figure does not include savings in the prescribing budget.
Despite losing two practices early, the feedback is overwhelmingly positive with most wanting more of the pharmacists’ time – an aspiration the practices are willing to pay to achieve.
“That is our next challenge. Some of the practices would like the pharmacist full-time but for the pharmacist working in two practices means they can take the best from each one as each practice is different.”
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