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Thousands of 'clinical' pharmacist roles funded by 5-year GP contract

NHS England has called the contract the “first major pillaring of the NHS long-term plan”
NHS England has called the contract the “first major pillaring of the NHS long-term plan”

NHS England has opened up "thousands of opportunities" for "clinical" pharmacists to support GPs as part of a multi-billion pound GP funding deal announced today.

GP funding has been increased by £4.5 billion, some of which will be used to recruit an “army” of staff to help practices work together as part of local primary care networks, in the “first major pillaring of the NHS long-term plan”, NHS England said today (January 31).

Pharmacists will become a core part of GP practice teams – along with paramedics and social prescribing support workers – and “will take on an expanded role” within primary care networks – groups of local GP practices covering an average of 50,000 people, NHS England explained.

GP practices will be reimbursed 70% of the cost to recruit a “clinical” pharmacist in 2019-20, capped at £37,810, the commissioning body said.

NHS England chief executive Simon Stevens said the new GP contract is “unarguably the biggest boost to primary care in more than 15 years”.

Under the new contract, primary care networks will be established across England by July, and backed by funding of £1.8bn by 2023.

“Confidence in the pharmacy professions”

England’s chief pharmaceutical officer Keith Ridge said the GP contract is “a boost for patient care and a tremendous vote of confidence in the pharmacy professions”.

Work is already underway to recruit “clinical” pharmacists to primary care networks, he said.

These pharmacists will receive additional training to “undertake medication reviews for patients most in need – including those with dementia, cardiovascular disease and other major conditions” – improve medicines safety, support care homes and reduce inappropriate antibiotic use, Dr Ridge explained.

PSNC: Same approach must be taken with pharmacy

Pharmaceutical Services Negotiating Committee (PSNC) chief executive Simon Dukes said the funding deal gives a “clear indication of the way in which the government and NHS England want primary care services to develop in the foreseeable future”.

The five-year funding package is “exactly the approach the NHS must now take with community pharmacies, so that we too can play our part in improving local healthcare”, Mr Dukes stressed

“For community pharmacy, the changes offer a unique opportunity for us to embed ourselves within primary care…[and] we must engage proactively with [GPs] and find ways to position ourselves within those primary care networks,” he added.

RPS: “Significant step forward”

Royal Pharmaceutical Society (RPS) English board chair Sandra Gidley said the contract was a “significant step forward to embedding pharmacists’ clinical skills and medicines expertise across all areas of primary care”.

However, Ms Gidley also called for a NHS-wide workforce strategy, to “ensure pharmacists from every sector feel well equipped to deliver high quality healthcare”.

CCA concerned over impact on workforce

The Company Chemists’ Association – which represent the UK’s largest multiples and supermarket pharmacies – raised concerns about the impact the plan could have on the community pharmacy workforce, given existing pressures.

“As with all large-scale change, the nature of the implementation of this deal will be critical to its success,” CCA chief executive Malcolm Harrison said.

“We hope that this five-year package will be mirrored by a similar long-term funding plan for the community pharmacy sector, so that we have the certainty we need to fully play our part in this new system,” he added.

NPA: Contract adds to sector dilemmas

While the National Pharmacy Association welcomed the investment in primary care, it stressed that the push to recruit more “clinical” pharmacists “intensifies the dilemmas faced by community pharmacy owners who invest in training and development, only to see people migrate to general practice”.

“This is a risk that must be carefully managed, so that these new primary care workforce targets genuinely add to capacity.”

29 Comments
Question: 
What do you make of NHS England's five year GP contract?

PRIMARY CARE PHARMACIST, Primary care pharmacist

There are already community pharmacists seconded to work in GP practices in my area. They have been doing this for about 12 years or more. 

 

 

Sam Patel, Community pharmacist

It is a good news for locum Pharmacist. Rates should go up and its about time proprietors increase the rate. I feel there are over supply of locums in certain areas at the moment 

Chemical Mistry, Information Technology

I think it's a case of reap what you sow therefore for years mainly multiples have treated their staff with contempt and so when new new roles open for them where they can be treated with dignity and valued the mutiples start whining and go off to recruit in Eastern Europe again.

they never learn from their mistakes this where the decline started in that instead a fair wage for a professional they started a race to the bottom and so like karma everything comes full circle so instead looking a thing how they can improve their employees conditions such has specified lunch hours enforced no pressure for Murs and other conditions to help their employees being valued  

Peed Off Superintendent, Superintendent Pharmacist

GP NHS funding boosted. Community pharmacy funding slashed. Are dispensing doctors now getting a free pharmacist and getting rid of their remunerated Pharmacy Managers?....seems likely. Thank you PSNC, RPS, GPhC, NPA, LPC's etc etc for nothing. I see you have all thrown in the towel already. Lets look forward to current loss making internet pharmacies selling to Amazon or being funded by a pro internet dispensing government (Hello Mr Hammond) to replace community pharmacies. Anyway you look at it community pharmacy is screwed and when the scripts dry up most CCG's as now will offer us few or no remunerable clinical services in their place. Anyway, lets look forward to FMD and more medicine shortages.

Lucky Ex-Boots Slave, Primary care pharmacist

Non-pharmacist managers are overrated and most of the time they know nothing about pharmacy at all but keeps being annoying and bossy about targets. I was really tired of dealing with them back then because they simply weren't intelligent enough to get it. Multiples should learn not to promote some random shop floor assistants to managers.

Graham Turner, Non Pharmacist Branch Manager

Well said, I have met non-pharmacist managers who don't even know what MUR stands for, yet they ask about them several times a day.

John Cleese, Production & Technical

The flip-side to this is that there is a common assumption that pharmacists make good managers: some of the worst managers I have ever known have been pharmacists. "Non-pharmacist managers" seem to make a good job of managing, well, everything else in the world, actually.

N O, Pharmaceutical Adviser

Has anyone read Mr. Ridge the Cheap Pharmacist's letter??

As per him, in the letter, Clinical Pharmacists have extra knowledge to do 1. Medication reviews 2. Medicine Optimisation. These are the main jobs they would be doing in GP surgeries & Care Homes. Now, how many Community Pharmacists (not clinical as per Mr. R) have not done or not capable of doing these jobs?? Why fund extra and give a "CLINICAL" title for doing something that is already being done through community Pharmacies?? All Bollocks!! Waste of money to fulfil someone's EGO and then making sure smaller pharmacies close due cuts and then back to square 1.

Snake Plissken, Student

That's interesting. Are you saying community pharmacy are able to carry out level 3 face to face medication reviews? What with exactly...SCR??

Thomas Wilde, Community pharmacist

'Type 3: Clinical medication review – addresses issues relating to the patient’s use of medicines in the context of their clinical condition. ''

Are you saying this can't be done in community? would love to hear why not.

Snake Plissken, Student

Hmm interesting. The bit about face to face reviews of meds with patients full notes is missing. It would be very interesting to know how getting access to full notes including clinic letter, GP consultations, full lab results at a Pharmacy would be achieved. So how exactly are you proposing this level of medication reviews are done? Phone up the GP reception staff for info?

 

 

 

 

 

Thomas Wilde, Community pharmacist

You mean this part 

''Level 2: Treatment Review – a review of medicines with the patient’s full notes (8B314 or 8B3S). 

In 2008 the National Prescribing Centre published A Guide to Medication Review.4 This is a framework for medication review with practical advice and examples. It describes different “types” of review in a less hierarchical manner than previously, as it recognised that different types of review each have a useful purpose and it is possible to have a useful discussion with the patient about their medication (face to face) without having the full notes as described as a level 3 review.  ''

 

Care to point out where I'm wrong here. Level 2 talks about needing patient notes Level 3 is having a face to face conversation about medication but with emphasis on if its working. This is what a good MUR involves anyway we don't just ask are you taking these and leave it at that. 

Snake Plissken, Student

The code you listed 8B314 and 8B3S for a start are incorrect. You might need to sit a desk with access to Emis or SystemOne to see exactly what the code is referring to  (also take time to read your own post which you,be nicely copied and pasted from SPS about what a level 3 review is). Also will be worth reading the post after this about level 3 medication reviews. 

 

 

 

Dominic Smith, Locum pharmacist

I don't know why so many community pharmacists are so defensive over the clincal label. Obviously a level 3 must include the parts of a level 1 and 2. I don't doubt a large amount of community pharmacists could carry out clinical roles given the right equipment but it's just not to hand in a community pharmacy.
Do you really have time to spend pouring over patient histories on EMIS or ICE to check wether a statin was started in 2002 for hyperlipidemia and is no longer indicated as per current guidance? no probably not and you really dont want that expectation as it's just more to do.
If "clinical" pharmacist means community pharmacists are not clincal professionals then surely a "clinical" pharmacist is not part of the community?
I've worked in primary care, secondary, specialist services and community locum. There are reasons why whole positions are made for certain jobs it's not about a lack of quality of each other but the amount of work requires a whole post. Dont you dare make it so community pharmacists are expected to another persons job for no more money

Snake Plissken, Student

My posts aren’t aimed attacking community pharmacy/pharmacist. I have worked as one and seen very “clinalically competent” community pharmacists. However I’ve had dealings with likes of a boots company who have done a great job in commercialised community pharmacy and working at any of their branches is anything but clinical. 

 

Sunil Patel, Pharmacy owner/ Proprietor

Future looks very grim for community pharmacy: funding cuts and cash flow problems, shortages, regularly dispensing at a loss, endless bureaucracy and now further losing workforce to GP world. NPA where are you? Are you not supposed to represent us independents? Do you care? 

Sue Per, Locum pharmacist

Good news,

This a warning shot to the community sector, which has been fixated on manipulting the volume led contract, at the expense of quality clinical services.. The MUR's are concentrated on 1-2 item scripts and repeated annually for the same items.Those with several items are ignored as they would take much longer to complete.The NMS's are a duplication and a waste of time, as in most instances the patient has a clinical review with the doctors within two weeks of commencing the new medication.

Perhaps the community sector with rethink their strategy, stop the free MDS , collection, deliveries, managed repeats and suck like, and focus on developing and delivering clinical services and/or wothwhile services for the funds recieved from the tax payer.

Leon The Apothecary, Student

I agree with MDS and would add that they have been shown to have very little benefit to the vast majority of people in improving compliance.

"MDS is a medication storage device designed to simplify the administration of solid oral dose medication. MDS can potentially address the issues of difficulty accessing medication and following the regimen due to sight impairment and/or confusion / forgetfulness. However, the evidence to support these benefits is limitedi . There is no evidence based research to suggest that MDS improve patient concordance.  " - http://www.neneccg.nhs.uk/resources/uploads/files/guidance%20on%20the%20use%20of%20monitored%20dosage%20systems.pdf

Reeyah H, Community pharmacist

So... what’s in it for the ones who don’t want to be sitting at GP practices? Nothing. Not everyone wants to take on Dr’s stress without the Dr’s pay. 

Aldosterone antagonist, Locum pharmacist

I face a different dilemma; I'm planning on leaving the profession in a few years time for a different career. Doing an independent prescribing course won't be worth it, so will stick to locum work for however long community pharmacy survives...

Leon The Apothecary, Student

You're not alone.

Aldosterone antagonist, Locum pharmacist

Thankfully.

Although I would need community pharmacy to stick around for a good 3 years at least (wishful thinking) so I can put some money forward for flying lessons! Got my eyes on becoming a commercial airline pilot.

Leon The Apothecary, Student

Had a friend who did that Aldosterone. They loved it, although landing lessons were always a worry! Flying not so bad, very little in the way of things to crash into up there!

Graham Turner, Non Pharmacist Branch Manager

I've got my eyes on anything except pharmacy.

Kevin Western, Community pharmacist

good luck with the cpl!

Lucky Ex-Boots Slave, Primary care pharmacist

Excellent news for those wanting a more clinical career and to become an independent prescriber. Bad news for those who rather stay in community sector because it basically means more funding cuts incoming in contrast! More opportunities have now arised for those eying on the sector jump but have been struggling to find a position! Now grasp your chance to jump the sinking ship before it's too late!

Chris Pharmacist, Community pharmacist

This is good news....but lets stop the divide and rule bs shall we?  I'm interested and will certainly make enquiries.

I work in community as a manager for amultiples. Disilluisoned? Certainly, but not naive enough to think all will be rosy working in a GP practice, the pressures perhaps reduced but certainly significant. After all, why are £100k+ earning GPs leaving in droves? Also, a 30%  (from £60k to circa £40k) drop in income an additional concern.

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

Lucky Ex-Boots Slave, Primary care pharmacist

I strongly urge you to read the nhs long term plan before talking.

 

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

Ashley Cohen, Community pharmacist

I dont 100% agree. Why can't community pharmacists look to work in this area also. It doesnt have to be always black and white (them and us). We are a very small independent group but we already support Community Trusts, Prisons, rehabilitation units, Care Homes. All fully paid for. I have a team of individuals working in these areas and also community pharmacy to support services. I can upskill my Pharmacy Professionals (Technicians and Pharmacists) and it gives us a great link into other "clinical" areas. Seems like a win : win for those that can grab the opportunity. 

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