Taking part in the Heartbeat Clinical Pharmacists in General Practice Project was a great experience for me. I feel privileged to have been a part of it.
The project, which was arranged by a federation of GP practices in North Yorkshire, began in September last year. I was one of 14 pharmacists they recruited to add specialist clinical knowledge to decisions being made about patients’ treatments. The programme focussed on post-discharge care, polypharmacy, high-risk medications, reducing hospital admissions and reducing GPs’ workloads.
As part of the project, I started working at the Stokesley Health Centre. There was certainly a steep learning curve, but it was worthwhile. As the project progressed, my relationships with the surgery’s doctors, nurses and other staff – as well as local pharmacies – all grew stronger. Ultimately, these good relationships were of benefit to each of the patients I’ve been involved with.
It's over a year since my involvement with the project began now, and I still remember the biggest dilemma we all faced at the beginning.
I lacked knowledge of the surgery’s needs, while its staff didn’t understand my capabilities as a clinical pharmacist. Having spoken since to friends currently working in NHS England’s pilot scheme to place more pharmacists in general practice, it’s clear that the same problem exists for many practice pharmacists and the surgeries they work in.
While the beginning was difficult, good communication helped a lot. I’ve never been shy to say what I think professionally – in my experience, it’s a very useful trait. Having a protocol to follow regarding my needs and abilities, and those of the surgery’s staff, would have made our lives a lot easier from the very beginning. Perhaps there’s a need to scale up this understanding nationally.
All about the evidence
Durham University and the University of Sunderland are currently examining data gained from the pilot I took part in. Their work is ongoing, but it’s clear – to me at least – that a lot of GP time was saved as a result of my work at Stokesley Health Centre.
Sorting out hospital discharge errors took up a large proportion of our time, but did result in improvements to patient safety. I spent a lot of time looking into issues: such as patients being documented as having different medication to those they actually received in hospital; incorrect dosing being recorded on long-term medication; a lack of information about which treatments had been stopped; and documenting some treatments which related to another patient entirely.
I remember speaking to a few of the patients, who were all grateful for my interventions. The research will also qualitatively evaluate patients’, GPs’ and staff’s views of our work.
I felt proud to be able to help each of these groups in different ways. Patients loved being able to confide in me with their, sometimes odd, questions. The doctors relied on my ability to tailor advice to meet individual patients’ needs. The practice’s staff were thankful that I could sort out problems quickly and effectively. We all worked very well together.
Working for the future
Training is an area I’m interested in, and I completed an online training programme on working with GPs earlier this year.
I expected the programme to provide some information about the clinical systems that every practice pharmacist uses on a daily basis – for example, SystmOne and EMIS. But there was a lack of training related to using either system.
So for this reason, while I personally found it useful, in some ways it was insufficient to meet my needs, and those of other pharmacists working on this pilot. I think more effort needs to be put into providing relevant training for pharmacists with our specific roles.
There are a number of universities who have the relevant knowledge and skills to provide effective training to pharmacists like myself who work in surgeries – Keele University is one example, which I know from my own postgraduate training.
Spreading the word
Based on my experience with GP practices, I’ve now been asked to support similar projects at a number of GP practices within Hartlepool and Stockton clinical commissioning group, and to individual pharmacists working within practices – the vast majority of whom are new to this type of work.
There’s a lot of scope for expanding on the type of work I’m able to provide to local surgeries. Opportunities exist for pharmacists to collaborate to provide these services themselves. Ultimately, it’s up to the pharmacist to make the most of their abilities.
I’ll miss working with everyone at the Stokesley Health Centre. It was a great experience, and I shall always be indebted to the team for that. Despite leaving, I’m still invited to the surgery’s Christmas party. I’m looking forward to seeing the doctors and staff again. It’ll be interesting to find out how things have changed since I left.