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Are pharmacists in GP practices just a passing fad?

Pharmacy minister David Mowat saw practice pharmacists in action at an Ealing GP pilot
Pharmacy minister David Mowat saw practice pharmacists in action at an Ealing GP pilot

Are pharmacists in GP surgeries the saviours of the NHS, or another passing fad?

In 2015, NHS England began a pilot scheme to spread an estimated 450 “clinical pharmacists” across 650 GP practices. A year later, it inserted a commitment into its General Practice Forward View document to parachute a further 1,500 pharmacists into general practice by 2020.

NHS England says the "appetite" among pharmacists and GPs for the pilot scheme was "high". But the expansion of the initiative – which came with £122 million in additional funding – prompted concern from some community pharmacy representatives that the plans were diverting resources to general practice that could have been used more effectively in their own sector.

So is this another NHS fad that will fall by the wayside when the money dries up? Or is this a sustainable model that will become embedded into primary care?

Getting with the programme

According to NHS England, more than 490 pharmacists have now been placed into 650 practices as part of phase one, and the first wave of sites opting to take part in phase two will be announced "shortly".

“Providers of GP medical services will be able to apply for the programme funding over at least the next three years,” a spokesperson for the commissioner told C+D. However, they could not confirm how many applicants the scheme has attracted so far.

For pharmacists and GPs who piloted the scheme, it’s been a mostly positive experience. Lessons have been learned about the need to avoid professionally isolating the pharmacists from other practice staff, and ensuring a formal career path is set out.

The early adopters

Sarah Woffinden was the first pharmacist to work for the Haxby Group, which covers 50,000 patients across 10 GP surgeries in York and Hull. Her role pre-dates the pilot, having began almost five years ago, when she left her position as a hospital pharmacist.

She identifies prescription management as a “quick win” for her role. “We have some long-term plans for care homes and medicines reviews," she adds. "We have been trying to build up gradually.”

Ms Woffinden was initially hired for a medicines management role, to free up GP time. But her success prompted the practice to take on more pharmacists and apply for the pilot scheme.

“I was on my own for a few years, and it is good now that I have colleagues I can bounce ideas off and draw on different knowledge and skills. I kind of see it like a hospital team,” she explains.

The demands of the job change from practice to practice, she points out. “Different surgeries want different things, and actually it depends what staff they already have.”

Mike Holmes, a GP partner at the practice agrees that – if he was to do it all over again – he would have brought in more than one pharmacist at the start, to avoid having one employee who was professionally isolated from among the clinical and nursing staff.

“It has been a very positive experience for us, but it has taken a lot of development and mentorship time,” he says.

Dr Holmes points out that not all the pharmacists they have employed had the same experience and skills. As a result, he believes there’s a need to develop the right career structure for pharmacists in general practice. He is convinced clinical pharmacists are here to stay, but thinks the role is not for everybody.

Graham Stretch, a senior practice-based pharmacist and independent prescriber at Ealing GP Federation, has also been doing this a long time – since 2010 in his case.

He leads a team providing medicines and prescription management to 10 GP surgeries in Ealing, and has developed a unique scheme using pharmacy technicians and pre-registration pharmacists in these practices.

Mr Stretch says the constant CVs dropping into his inbox are proof that this is something pharmacists are very keen on – although he agrees that the role doesn’t suit everyone.

“In 10 years’ time the pharmacist [in general practice] will be the same as the practice nurse is now,” he says. But just sticking a pharmacist in the GP surgery, is not the answer, he warns.

A role of two halves



Mr Stretch's bid for NHS England funding is based on a model where pharmacists are based in the community half the time, while running sessions in GP surgeries the other half.

“Pharmacists should be managing all the repeat prescribing and monitoring of therapy – and there’s no reason why that can’t happen in community pharmacy.

“We have [one] pharmacist [where] the patients she sees in general practice [also] goes to the pharmacy to see her, because they know they can get that level of service by someone who has their feet in both camps. I think that's what integration means,” he says.

Mr Stretch pitched his ideas to David Mowat MP during the minister’s recent visit to his Perivale practice (see image above).

“We hope to put one of our pharmacists [to] work in each of the general practice networks. This is the only way we can do this [model] at scale,” he adds.

This innovative Ealing and Hammersmith pilot is being evaluated as part of a student’s PhD. As well as interviewing participants, the study will look at output – not just how many patients the pharmacists see, but what happens during these interactions.

Mr Stretch can already point to successes. One 17,000-patient practice was completely overburdened with repeat prescribing, but is now able to offer afternoon appointments of 15 minutes, rather than the standard 10.

In order for this to become an attractive long-term career option, Mr Stretch wants to see better recognition and pathways for training – something he is working on with the Royal Pharmaceutical Society.

“Professionally, I’m really keen that GP pharmacists can work towards consultant pharmacist status,” he adds.

A happy accident

Hala Jawad (pictured above), a clinical pharmacist in Fulham, London said she fell into the role by accident back in 2015, after spending a week volunteering in a GP surgery to find out what it involved.

She has since worked in four practices, with key responsibilities including: authorising prescriptions; calling patients about medication queries; managing long-term conditions; conducting medicine reviews; addressing polypharmacy issues; dealing with minor ailments; and reviewing blood test results.

It's a career path she can see other newly qualified pharmacists adopting. “Only the other day, a pre-reg pharmacist gave me a call, as she's doing half her year in a GP surgery and the second half in a community pharmacy.

“I can see that the new generation are so motivated to learn, and I do recommend that every pharmacist has the opportunity to work in a GP surgery.”

As with other such forward-thinking GPs, Caroline Jewels, managing partner at the Sands End Health Clinic where Ms Jawad is based, says she initially hired a pharmacist to ease the workload on doctors without reducing the quality of patient care.

“We hoped that by employing a pharmacist, we would improve our prescribing practices by being more efficient and implementing more robust systems.”

Dr Jewels' advice for other practice considering taking the plunge is to go for it.

“We see a full-time pharmacist in general practice as an essential part of our workforce. We very much hope that this will be sustainable, and we will prioritise the position in our workforce planning,” she adds.

With so many GPs already converted to the idea of employing a practice pharmacist, it seems this primary care position is here to stay.
 

What is the funding future for practice pharmacists?
 

NHS England says it will “make a financial contribution to participating providers” in the practice pilot scheme. “The contribution is towards the costs of recruitment and employment, [and] will be tapered over a three-year period," it adds.

However, after these three years, each practice must go it alone.

As a result, all participants must demonstrate “an absolute commitment that the role will be sustained during and beyond the programme”, NHS England stresses.


Considering a role as a practice pharmacist? View primary care pharmacist vacancies on C+D Jobs here.

46 Comments
Question: 
Would you consider a career as a practice pharmacist?

Pharmacy Tech, Pharmaceutical Adviser

Wow, there is always so much negativity from pharmacists towards other pharmacists who happen to work in a different enviroment to community. I have worked with several GP pratice pharmacists and the feedback I hear is that they find it very rewarding. The surgeries also wouldn't be without them and not because 'they are cheap labour' but because they do an excellent job.

Valentine Trodd, Community pharmacist

Gosh Dr. Stretch you've really hit a nerve here!

J Eliott, Manager

*This comment has been deleted to comply with C+D's community principles*

E Boyle, Pre-reg Pharmacist

I've heard of the Pharmacy Integration fund, but didn't realise thats how you got it

janet maynard, Community pharmacist

I started workingin a GP surgery in 1999- hardly a fad! The present scheme and funding may have started in 2015 but we were trailblazers 17 years ago!

Tom Cowie, Community pharmacist

Just want to point to the last paragraph in this article....

“The contribution is towards the costs of recruitment and employment, [and] will be tapered over a three-year period," it adds.

However, after these three years, each practice must go it alone.

As a result, all participants must demonstrate “an absolute commitment that the role will be sustained during and beyond the programme”, NHS England stresses.

Currently - Lack of funds....3yrs time....probably no funds.

Each practice must go it alone - GP's are leaving practices, what chance is there for any sustainability, let alone an NHS??

 

Tom Cowie, Community pharmacist

What were you doing back then?? Signing prescriptions?? Didn't think so. Running clinics?? Didn't think so.

The pilot involves running clincis etc etc...What you did back then was synchronising scripts, cost effectiveness, and script switch. Hardly any need for any trails to be blazed.

 

Brian Austen, Senior Management

I was managing a Pharmacist led Benzo & Zs reduction clinic 10 years ago. I submitted a bid for funding and it was commissioned by the then PCT and local authority Safer Neighbourhood Scheme. It was very successful for patients, GP Practice which even went on to provide substance misuse shared care and outreach services, Pharmacist commissioners and reduced practice prescribing budget. A win for everyone.

Ian Baker, Superintendent Pharmacist

Such activities were not possible (although we know nurses ran clinics and simply got the doctors to sign prescriptons to free up time).

But Prior to the Independent Prescribing Course was Supplementary Prescribing, which was groundbreaking when it started back in 2003. Most other GP related activites were carried out by the PCT Pharmaceutical Advisors, who would look at budgets and cost expenditure, as well as 'Script Switching' either via Pharma companies or a search on EMIS Health.

Andy Colerman, Community pharmacist

We're all working hard, who says we're not?? But you too Mr Troll Hunter * Yes, I agree but look at the Professional Career which was so highly prized and respected, whats happened to it?? By the looks of it, going downhill, on a rollercoaster without brakes may I add. To blast it further, where has all the money gone? => back to the GP's. Would be good to have an 'insider' to help the community he works for, rather than working as 'Batman'. Daytime in surgery, nightime in his internet pharmacy (all for the good of himself).

*This comment has been edited to comply with C+D's community principles*

Ted Kramer, Pharmacy technician

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Unmask the rat (sorry Bat).. :-)

Sorry couldn’t resist. This debate has got too serious,

I have enough stress during my working hours, wish I too was in an office.

 

Troll Hunter, Community pharmacist

More personal attacks... *Sigh*

Mike Burton, Community pharmacist

?? This is not a personal attack.......This is the way Community Pharmacists unite, shame not done like this at national level....... We'd get a lot further if we did. Shame we can't be more like the GP's in terms of voice and unity. If you worked in community, you'd undertsand our culture and what we're going through.

Ian Baker, Superintendent Pharmacist

Nationally we are not represented in a whole manner, shown by the recemt breakup of Pharmacy Voice/NPA and in the past RPSGB/GPhC.       Regarding the new funding cuts, I have now suggested to all our employees, we are not doing any services for free anymore. We simply refuse to hand out Vit D for free, or refer any NHS Healthchecks patients to diabetic referrals for free. Simply too much other work to do, better not to do it and utilise the time for other productivity tasks. If I met any of the ministers, funds would be my first priority talk followed by photos.

 

Troll Hunter, Community pharmacist

In true, C&D 'below the line' fashion its become a troll fest! Do any of the comments live up to the community principles or indeed the "but please express them in the spirit of a constructive, professional debate." which is written directly below the box I'm writing in? It's a very personal attack on a pharmacist who works hard to advance the profession which now maliciously attacks him.

When you have to create an anonymous account due to the fear of a backlash due to the commenters on here, it reflects, badly on C&D, the individual commenters & sadly the profession as a whole. Such a great shame.

H Parsons, Community pharmacist

This sounds like a familiar voice?? ....perhaps same as http://www.pulsetoday.co.uk/graham-stretch/118487.publicprofile 

J Eliott, Manager

Pulsetoday...huh! C+D all the way!!! But read the article and certainly seems similar..

Your Busted! What can I say.

¯\_(ツ)_/¯

Troll Hunter, Community pharmacist

Nope

H Parsons, Community pharmacist

Dr Graham Stretch leads a team providing medicines and prescription management to 10 GP surgeries in Ealing, and has developed a unique scheme using pharmacy technicians and pre-registration pharmacists in these practices. 

Good luck to cheap labour! (And I’m not talking about the Labour Party)

*This comment has been edited to comply with C+D's community principles*

Valerie Raeburn, Community pharmacist

“But just sticking a pharmacist in the GP surgery, is not the answer, he warns”....Looking at a past Pulse online article, it surely does seem Graham is not busy as a surgery pharmacist, as he has time to not only run his internet pharmacy, and Pharmacy show talks, but also write comments and articles. This is not what i was taught at school of pharmacy to use time wisely...Article here: http://www.pulsetoday.co.uk/graham-stretch/118487.publicprofile

Robert O'brien, Academic pharmacist

This new pilot is a good idea, however lacks some fundamentals. Firstly the idea of Pharmacists rushing into surgeries is a god-send for doctors. These Pharmacists are classed as cheap labour. They are not on same salaries as their counterparts. Their counterparts do not even have a clue as to what a pharmacist does. Secondly when this funding dries up, what happens next?? *

*This comment has been edited to comply with C+D's community principles*

Phil Stapleton, Community pharmacist

This makes me laugh from his website :

“Never put your faith in a packet of pills. Put it into the qualifications of the people who prescribe them.”

Thats like saying I’m getting a lot of CV’s thru my letterbox, because theres no jobs out there….

;-)

Ashfaq Ahmad, Community pharmacist

*This comment has been deleted to comply with C+D's community principles*

E Boyle, Pre-reg Pharmacist

It gets worse...this Dr Graham Stretch now says “Professionally, I’m really keen that GP pharmacists can work towards consultant pharmacist status,” he adds.

What is a Consultant Pharmacist?? A better impersonator? This really will confuse patients.

B Sandhu, Primary care pharmacist

I thought Dr Graham Stretch is a doctor....name says it, pic on website shows it.

Valentine Trodd, Community pharmacist

He trained as a pharmacist followed by a PhD examining the absorption of cardiac and anti-viral drugs. So yes he's a doctor but not by the layman's definition.

Valentine Trodd, Community pharmacist

Down voted for what - stating the facts? I'm not defending him you morons.

Ian Baker, Superintendent Pharmacist

*This comment has been deleted for breaching C+D's community principles*

Tom Cowie, Community pharmacist

Thanks Valentine, I think we're all clever enough to know this (this is a professional healthcare site).

Any PhD is a doctor, but what we're trying to distinguish here is that a "PhD" doctor working in a Doctors surgery could be mistaken for a doctor! It's the layman that need to know this, and could easily be misidentified. Now that 

 

Valentine Trodd, Community pharmacist

"I thought Dr Graham Stretch is a doctor"

"Thanks Valentine, I think we're all clever enough to know this (this is a professional healthcare site)."

Obviously not...

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