My first impressions of life as a practice pharmacist
The Clinical Pharmacy in General Practice project began in September last year. The pilot was organised by the Heartbeat Alliance – a federation of GP practices based across Hambleton, Richmondshire and Whitby (pictured), a largely rural part of North Yorkshire – and aimed to test the role of clinical pharmacists working in general practice.
Our local scheme was a forerunner to NHS England’s national pilot, which the government announced in March will be expanded to recruit an additional 1,500 pharmacists to work alongside GPs over the next three years.
Initially, eight of us were recruited to work across a number of practices. This later expanded to 14 pharmacists. My job was essentially to add specialist clinical pharmacist knowledge to decisions being made about patients’ treatment.
Fear of the unknown
After more than 20 years in community pharmacy, this was a bit out of my comfort zone, so I was understandably a little nervous. I was confident in my abilities, having gained a postgraduate qualification in clinical pharmacy, along with my clinical training and many years of practical application. But as with any new adventure, the fear of the unknown – and of not being accepted by new staff – were my biggest doubts.
These challenges, combined with the fact that us pharmacists in the pilot were unsure about the specific requirements of the surgeries in which we were going to work, made the task ahead seem particularly daunting.
To further complicate things, the GPs and their practice staff were unfamiliar with what we could bring to the project, in terms of our knowledge, education, training and abilities.
I knew that this would be a difficult footing from which to begin the project. So before the launch, I decided to meet up with the GPs at my pilot practice, the Stokesley Health Centre, so we could get to know each other.
Even at the meeting, my nerves struck again. But luckily for me, the doctors were friendly, easy to talk to and very interested in what I had to say – not to mention excited about the possibility of me relieving some of their workload.
Learning new skills
My pilot work started by learning about SystmOne, the clinical IT system used in the surgery. It was soon evident that the practice made far more use of the system’s abilities than most pharmacies did of theirs.
I spent time learning how to create and use clinical reports effectively, and I initially carried out audits to assess the practice’s prescribing and safety. The GPs asked me to check on their patients who’d been prescribed drugs such as metoclopramide and domperidone over prolonged periods, and to identify those potentially at risk of long-term opiate abuse. I was also asked to assess elderly patients who were on four or more medications, and were at risk of readmission to hospital.
It wasn’t long before I began to work on all of the practice’s medication queries. Shortly after, the senior GP thanked me for saving him an hour of work a day. From then on, the doctors realised the potential of having an experienced pharmacist working in the practice, and my work – and relationships – have progressed significantly.
What is the Clinical Pharmacy in General Practice pilot?
The North Yorkshire scheme has deployed 14 pharmacists across the 21 practices in the Heartbeat Alliance GP federation. The pharmacists, employed on a locum basis, collaborate with the practices, with an initial focus on three specifi c clinical areas:
- Ensuring the medicines prescribed and dispensed for patients upon discharge from hospital are appropriate and error-free
- Working closely with hospital-based pharmacists to ensure any issues related to a patient's medical history and/or ability to comply with medication are accounted for
- Ensuring that delays in discharge due to medicines issues are minimised
Polypharmacy
- Focusing on multiple comorbidities and long-term conditions, such as diabetes
- Using medicines use reviews to ensure medicines are optimised to patients’ clinical and broader needs
High-risk medications and unplanned admissions
- Targeting patients taking NSAIDS, warfarin, diuretics and anti-platelet therapies to reduce their risk of an acute, medicines-related unplanned admission
Source: www.heartbeatalliance.org.uk
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