Worcestershire practice shows how pharmacist can make a difference

8 May 2017

Overcoming the image of the high street pharmacist packaging pills and offering over the counter remedies for a sore throat is a challenge for practices employing clinical pharmacists.

Mohammed Jivraj has had a significant positive impact since taking up the post of clinical pharmacist at the Spa Medical Practice in South Worcestershire just over a year ago.

However, business manager Joy Smith says realising the full potential of his skills and the role he fills has required education of both patients and the rest of the practice team.

“We have worked to build staff confidence in going to Mohammed for advice rather than asking a doctor. We’ve pushed that along by providing him with a clinical room in the nursing area so, for example, a nurse doing a respiratory review can use him as a sounding board.

“We had a comprehensive induction plan which saw Mohammed attending doctors’ meetings, nurse meetings and the admin team meeting so everyone understood his role and he understands how the practice works.

“We’ve also asked all staff to use the term clinical pharmacist when talking to patients. People hearing the word ‘pharmacist’ tend to think of someone behind the counter just dispensing pills. They don’t realise that many pharmacists can review conditions and prescribe medications.”

“We took time to interact and build understanding with our patient participation group so that they could help us educate fellow patients with this new clinical pharmacist role.”

Smith and the practices had been exploring the idea of appointing a clinical pharmacist for some time. They leapt at the opportunity offered by NHS England’s clinical pharmacists in general practice programme – which is being administered in south Worcestershire by the local GP federation, SW Healthcare.

One of the impediments to an earlier appointment was concern over whether the practice would provide sufficient work for a clinical pharmacist working full time.

Smith says: “We recognised the value of developing a clinical pharmacist role and the different skills they brought but, as always, we had to think about the money.”

Those financial concerns were eased with the financial support from NHS England, which is part-subsidising the employment costs. Initially the Spa practice shared Jivraj with a neighbouring practice, but he is taking up a full-time role with the Spa practice from May.

Smith recruited Jivraj with the support of SW Healthcare’s lead clinical pharmacist, Marianne Tucker-Martin, who was involved in the appointment process of all 28 clinical pharmacists in south Worcestershire to ensure they had the right clinical and consultation skills.

An independent prescriber for patients with asthma and other respiratory conditions, Jivraj’s key functions at the practice include:

  • Half hour consultations each morning for patients with asthma
  • Six 15 minute consultations with other patients
  • Medicine optimisation audits and leading the practice’s activity around the clinical commissioning group’s local QOF requirements for asthma and chronic obstructive pulmonary disease management
  • Medicines use reviews – under the supervision of the practice’s prescribing lead GP
  • Responding to telephone calls from patients with enquiries about prescriptions, side-effects and whether one prescribed drug can be safely used with an over-the-counter medicine
  • Highlighting drug alerts to colleagues
  • Managing medicine changes following hospital discharge.

If his scheduled clinics are not fully booked, Jivraj will often look at the duty doctor’s list of call-backs to patients and telephone patients he thinks he may be able to help – further reducing the burden on GPs.

As Jivraj has a background in retail pharmacy, Smith says he has also proved a great source of knowledge for the GPs about the most cost-effective medicines.

“If Mohammed has any concerns about the best treatment for a particular patient he obviously links back in with one of the GPs but he has made himself an integral part of the clinical team with his really different skillset.”

The practices have continued to work with both Tucker-Martin and PCC’s facilitator for the pilot programme in south Worcestershire, Polly Goodwin.

Smith says of Goodwin’s role: “She has helped us focus on the need for wider engagement with staff and patients about Mohammed’s role. We needed the time out to think about those things and our sessions with Polly allowed us that. At the start she asked us what success would look like and one of the things we said was that we would have him here full-time and that it would be a permanent role. That is happening now which is great.

“All the GPs say they have felt a positive benefit in terms of reduced workload – although the level of demand from patients is such that even with the other initiatives to reduce their workload we’re not seeing a financial saving because as yet we have been able to reduce the time demand of our GPs to within their statutory working hours.  We will continue to move towards this.”

Meanwhile, Tucker-Martin and Goodwin have worked with the continuing professional development supervisor to ensure clinical pharmacists in south Worcestershire receive training linked to issues identified in professional assessments – such as interpretation of biomedical results.

Tucker-Martin says: “We’ve been identifying development tools that might help one individual but will also be of benefit to the other pharmacists. We’ve worked with Polly to understand the leadership and sustainability plans for each practice.”

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