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What will the push for access in the new GP contract mean for pharmacists?

Will England's new access-focused GP contract help or hinder practice pharmacists, asks Danny Bartlett

England's new GP contract, announced last month, has made a lot of primary care pharmacists I have spoken to feel slightly adrift in their roles and responsibilities.

Read more: New GP contract marks 'another blow for primary care', says PSNC

Last year's contract included a huge push on medicines-related indicators, as well as incentive payments associated with achieving them. This included structured medication reviews (SMRs) for clinically vulnerable groups, statin initiation for raised cholesterol, and ensuring all patients on long-term high risk medication were reviewed.

It meant pharmacists in general practice were able to take the lead on these processes as the medicines experts, holding specific clinics to set target and achieve these goals.

From personal experience, we were able to drive forward positive medicines outcomes as a team working closely with community pharmacy colleagues, GPs and the wider healthcare system to ensure patients were getting the best out of their medications.

Read more: Pharmacists are not 'cheap' substitutes for GPs – we are so much more

One brief example was our PCN's work in care homes, where 239 unnecessary medications were deprescribed in around 470 care residents through our SMRs. This reduced the likelihood of hospital admissions and ensured these patients were not overmedicated.

Without a set of criteria pushing for these types of targets and the financial incentives that came alongside them, it is a worry that these hugely beneficial reviews and workstreams may fall by the wayside in favour of the much bigger emphasis on patient access under the new GP contract.

My main concern is that the majority of the indicators in the new contract focus on access to mainly acute GP services and this leans much more towards an acute setting.

This means solely focusing on patients presenting with ‘on-the-day’ complaints such as infections and injuries. Though this is undoubtedly a vital part of general practice and something we all need to ensure we have systems in place to facilitate, it seems like we already have an established plan for this.

Read more: ‘Chaos’: GPs to ‘signpost’ patients to pharmacies from tomorrow

Advanced clinical practitioners (ACPs), paramedics and physician associates have been recruited into general practice to help with this acute workload and unless pharmacists lean more towards becoming ACPs themselves, they generally won’t fit into the more acute setting.

In my view, pharmacists are fantastic at reviewing and optimising patients with long-term conditions and patients who need more in-depth medication reviews, and I’m keen we don’t lose that.

Whether it’s a medication review in a community pharmacy, a post-hospital discharge review in general practice or an inpatient review of current medications in hospital, we need to reinforce these skills and feel empowered to tackle the more chronic disease workload. I feel that the new contract will not help to maintain the work we achieved last financial year.

Read more: ‘GPs on the cheap’? Pharmacists must not be seen as GP substitutes, says RCGP

It’s not all bad news, though. Primary care networks (PCNs), which have had great developments in their own pharmacy teams and already have buy-in from the GP practices within them, can ensure we keep up the good work we've already started. PCNs must also not lose sight of what we as pharmacists are fantastic at doing; ensuring patients get the most out of their medications.

I am keen to involve more community pharmacists in this chronic disease journey. With many community pharmacists already qualified as independent prescribers (IPs) and already dealing with more complex patients on multiple medications, we need to try and map out how we involve them more in managing this ever-increasing workload. 

Access to GP services is obviously essential. But we need to be firm in defining this as being not only access to acute and GP-related issues, but also access to pharmacists and our invaluable expertise in improving patients’ outcomes with their medications.

 

Danny Bartlett is a lead pharmacist at a PCN in West Sussex and a senior lecturer in medicines use

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