NHS England has, for several years, put its money where its mouth is in promoting and supporting the role of clinical pharmacists in primary care teams.
It’s no surprise that the profession is seen as a key plank in the development of primary care networks (PCNs).
That is why Bedfordshire based clinical pharmacist Sally-Jane Hamilton was an obvious choice to speak at a PCC event in London in November that will explore how PCNs can make best use of the additional roles funded by the network DES.
She is one of four professionals who will tell the London audience about their experiences working for practices or GP federations.
Hamilton acknowledges she had a head start when she began work for a GP practice.
“I actually started working with GPs in 2008 when I was with a pharma company and from 2012 I worked for a clinical commissioning group – working with a lot of GPs, practice nurses and practice managers. That gave me an understanding of budgets, formularies and the way prescribing decisions are made. That helped me to hit the ground running.”
She did so despite – or perhaps because of – being handed “a very generic job description”.
“The important thing at the start is to communicate with the practice clinicians and practice manager – they need to know what you are capable of with the training and skills of a clinical pharmacist and the things that you can do. There needs to be a willingness to talk about what you and the practice want to achieve. Initially I did say that we could make it up as we went along and see what worked well and what didn’t but I had the advantage of a background in primary care. We then looked at the feedback from patients and the wider team.”
She urges GPs and practice managers to be clear about what they want out of the role and to support their clinical pharmacist – particularly as the role can be quite isolated within the practice.
Eager to prove the impact of her work, Hamilton swiftly gathered data on the number of patients on repeat prescriptions and the total number of prescriptions the practice was issuing.
“There was a very clear decline in both after I started because I was doing medicine reviews and had the time to talk to patients to de-prescribe – including in diabetes and asthma clinics.”
Those numbers went down for two years and are now stable with the work of Hamilton and a second clinical pharmacist. Having delivered savings the challenge now is to maintain them.
She says: “Doctors are very good at prescribing but they are not so good at not prescribing or stopping a patient’s repeat prescriptions. Although drugs are our bread and butter, as clinical pharmacists we love stopping them.”
“We are a dispensing practice and we also reduced the GP workload by handling about 80% of the dispensing queries and dealing with medicine management matters raised by the CCG,” Hamilton says.
Feedback from her new GP colleagues was almost immediate in terms of the impact on their workload.
“I went on holiday a couple of months after I started and when I got back they said I wasn’t allowed any more time off because they had worked so much harder while I was away.”
Patients too were quickly won over.
“From the patient perspective we are still getting feedback that their medicine reviews now are the best they have had. Many have co-morbidities and they feel listened to because we can give them more time to discuss the wider picture while the GP can focus on their main condition. People feel listened to and patients with conditions like asthma or diabetes have a better understanding of their condition.”
Hamilton recalls managing a patient off an opioid where her GP had continued prescribing it because of the intense withdrawal symptoms the patient had during previous attempts.
Looking to the immediate future of her profession’s role in a landscape dominated by PCNs, she believes a lot will depend on the approach the new organisations take.
“It’s difficult to know whether they will promote genuine multidisciplinary working without seeing them in practice. Having several pharmacists working together as a team for the network and practices will work better than one pharmacist trying to cover four practices. It remains to be seen how that will pan out. Will PCNs be genuine networks rather than still leaving professions and practices in silos?”