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PSNC discussing hiring ‘clinical’ pharmacists in community pharmacies

PSNC: Contractors could employ 'clinical' pharmacists as part of primary care networks
PSNC: Contractors could employ 'clinical' pharmacists as part of primary care networks

PSNC has met with NHS England on “several occasions” to discuss whether community pharmacies could employ “clinical” pharmacists, it has told C+D.

The Pharmaceutical Services Negotiating Committee (PSNC) is in discussions with NHS England about the potential for “clinical” pharmacists to work in community pharmacies, it said in a summary of its committee meeting published on Monday (February 18).

PSNC has met with NHS England officials “on several occasions in recent weeks” to discuss the “broad topic” of whether “clinical” pharmacists could be employed by community pharmacies, it told C+D, and held its own internal discussions on the potential to pilot a model of how this could work in practice.*

C+D has asked PSNC for more details about the role “clinical” pharmacists could play in this pilot, if it becomes a reality.

These pharmacists could be recruited by primary care networks – groups of local GP practices covering 30-50,000 patients each – as outlined in the five-year GP contract, PSNC said.

Responding to the GP contract announcement last month, PSNC chief executive Simon Dukes said: “We must find ways for community pharmacists to perform some of the roles of the primary care network 'clinical' pharmacists.”

PSNC's committee used its February meeting to discuss the role community pharmacy could play in both the GP contract and the NHS long-term plan, and how the sector “must work to integrate itself into the emerging primary care networks”.

This article has been slightly amended to clarify that while NHS England and PSNC have had broad discussions about placing "clinical" pharmacists in community pharmacies, discussions on a pilot of this model have only been held internally at PSNC.

24 Comments
Question: 
Would you like a "clinical" pharmacist working in your pharmacy?

H Saw, Community pharmacist

I am seriously puzzled with this clinical thing now. Does that stand for pharmacologist with clinical diploma?

Benie I, Locum pharmacist

Rearranging the deck chairs on the Titanic springs to mind......

Bob Dunkley, Locum pharmacist

“Would you like a "clinical" pharmacist working in your pharmacy?“ NO there’s too many clever dick pharmacists as it is.

N patel , Non Pharmacist Branch Manager

OHHHHHH CR#######P... i hope they dont expect contractors to fund this latest wheeze......... so here is how i read this             ...]]                                                 open up lots of schools of pharmacy...... load of money for the Unis..... get the poor sods into an average 40k debt ..... oversupply of newbies all lookin for a job........hey ho lets put them into GPs surgeries on the cheap ,,,,,, give them a clinical title to make them feel better.....and as for me ... all the 30years of mine in community just does not cut the mustard as clinical....

 

 

 

N O, Pharmaceutical Adviser

"""The medication review is part of the GMS contract and the National Service Framework for Older People. Why not delegate this to a pharmacist as we are supposed to be the medicnes experts."""

That's my point my friend, only difference is the NHS is spending unnecessary extra funds by hiring a Pharmacist (and changing the title to clinical) instead of imrpoving on the community MUR service.

"""Do you think youre average pharmacy contractor would support you actively reducing a patients medication burden when they are being paid per item? I certainley dont see any recommendations for deprescribing on the MUR forms I see in practice?"""

Well, again, the answer for this is in your own post. But, I will try to put in a different way. If funded properly no contractor would say no to deprescribing if that helps their patients. If, going by your own words, the depriscribing is already happening then why would a contractor resist from that being happening from his end for a reasonable fee??

Now, as I mentioned, I am not against anyone taking a different career path if they feel so and if there is a demand. But, creating a non existent demand (just what the Cheap Pharmacist and the Ministers are trying to do) and then diverting the funds to supply for that demand are simply illogical and a big waste.

You may be hired by the GPs from their own pockets, but the proposals in the NHS Long Term Plan are different and clear that the Funding will be provided from the NHS Budget. This means less money or funding cuts to already existing sevices.

Richard Binns, Primary care pharmacist

Then use the endorsement of pharmacists gaining recognition in other sectors as a prop to secure funding to the community sector, draw up a draft sla and engage with an lpc and primary care group and try to develop a pilot, like the individuals who first started out in gp surgeries before all the mainstream attention to the roles

Adam Hall, Community pharmacist

"PSNC discussing hiring 'clinical' Pharmacists in community" - What am I? Scotch Mist?! 

Graham Turner, Non Pharmacist Branch Manager

I'd love to get right down into the roots of everything that's wrong with this article, but seeing as if I do so, then the article just gets bumped down the webpage because C&D cannot handle the truth, so I'll save my time.

In a nutshell:

Where is the funding coming from to employ these so-called "clinical pharmacists" when everyone keeps saying that they are broke? Why not just employ normal pharmacists? They have the same skill sets and knowledge, and cost the same. Why, you may ask? Because all pharmacists are clinical pharmacists so stop trying to create a divide within the profession. The only pharmacist I know who is "non-clinical" is one who spends all his time working for an investment banking company in Oxfordshire. And I can guarantee you that he is making many, many time more than a lowly £19 an hour.

PSNC - useless and don't have a clue what they are doing. Amazing how Sue Sharpe was able to stay there for so long. Maybe she has finally been moved to the Natural History Museum,

New roles - even if they are funded properly (they won't be), then in a few years time they will be axed.

GP's are VERY money-motivated, so don't expect them to fork out much for pharmacist services, if at all.

TL:DR - the government doesn't know what pharmacists even do, they don't want to pay youfor your contributions, if you're not too old then get the hell out and find a better job. It can't be long now before building societies realise what a crap profession this is and stop lending for mortgages to pharmacists. You're better off with an ice-cream van, my local one does £600 a day in summer (no revalidation and professional fees, plus if you forget to give someone strawberry sauce, you won't get a suspended prison sentence).

Richard Binns, Primary care pharmacist

ready for the stream of comments whinging about the use of the term 'clinical'...........

N O, Pharmaceutical Adviser

Oh.... I forgot to mention. You mentioned how pressured you were and hated to do a MUR in community Pharmacy. And now all of a sudden you had a change of heart to do the MUR under a fancy name of Polypharmacy. Is it because, now you have full access to the patient record and thats your main job?? or because you now have an easy job, 9-5 sorts, own room, table, chair, coffe/ looe breaks etc. with an addition of a new title ""CLINICAL"". How great !!!

Richard Binns, Primary care pharmacist

When have I mentioned about my personal experiences doing murs? I think you're possibly confusing my post with someone else's?

Interleukin -2, Community pharmacist

No he is not am afraid

Richard Binns, Primary care pharmacist

Sorry I really can't grasp what you are saying there

Richard Binns, Primary care pharmacist

Sorry read it again, think I can just about make out what you meant, are you typing a bit quickly?

N O, Pharmaceutical Adviser

I thought of not replying to your post in another topic where you were trying to defend your role in a GP setting.

Well I have to do it now.

Nowhere, in the NHS long-term Plan or any other documents from any of the people vying for this so called Clinical Pharmacist in GP surgeries, there is any clear definition of what is the exact role/ duties.

Since you defended yourself by winding us by ranting on one aspect: in your words "Polypharmacy MURs". Is that it ???

Lets discuss point by point so you can try this time to be precise

1. If funded properly and with access to advanced SCR (that was the aim from NHS digital, remember) can't we Community Pharmacists do these Polypharmacy MURs and then suggest changes??? Do you really get additional knowledge by doing a Post Grad Diploma to read the test results better than the 5 years we Community Pharmacists have spent before registering?? Or the test results are different to what we used to read when doing placements in Hospitals?? What about the use of BNF, NICE and other resources we use regularly and do CPDs (mandatory for GPhC registration) are these useless??

2. If you are doing these MURs then why are the CCGs hiring separate Pharmacy team to constantly visit/ pester the GP susrgeries and review all patient medications prescribed and suggest changes?? Are they not duplicating the same work as you mentioned?? So, there goes twice the money for a job that can be done at the Community Pharmacy.

3. Even if the GPs needed A "Clinical Pharmacist" for these MURs, why then they always book GP appointments every now and then (at least once a year) with these Polypharmacy (sometimes any) Patients in the name of review and blood tests?? Do they not lose payments if they don't conduct these reviews (just like how community pharmacies lose by not doing the 400 MURs a year) ?? So, if we take your argument of Poly Pharmacy MURs, then the GPs are being funded twice for the same job.

4. Before even we  address the Polypharmacy issue, don't you think there is a need to address who is responsible for this situation. Can't (or Don't) the prescriber do a thorrough check before initiating a medicine?? Is he/she not knowledgible enough to handle his/her prescribing, that he/she needs extra help from the Clinical Pharmacist in his/her practice and not the knowledge of the regular Community Pharmacist where the patient visits more than a visit to the GP??

5. Finally, if there is a role for a Pharmacist to do these non Patient TOUCHING roles, then is it not economical to use the already employed CCG pahramcists or the Community Pharmacists or as a final resort some Locum Pharmacists??? Why have full time Clinical Pharmacists just do the Paper Ticking exercise and waste the Funding???

I have nothing against any Intelligent Colleague trying to find a niche area for his/her carreer, but not the kind of role you have projected (Polypharmacy !!!)

Richard Binns, Primary care pharmacist

Why not Polypharmacy, it has huge impacts on patinent mortality and quality of life, as well as reducing falls and hospital admissions? 

The medication review is part of the GMS contract and the National Service Framework for Older People. Why not delegate this to a pharmacist as we are supposed to be the medicnes experts.

The evidence for these reviews in the primary care setting is there and plentiful, please have a read of the references I provided on the other post.

Could you kindly provide me some evidence in return for the patient benefits that have resulted from 14 years worth of MURs. Im not saying that this type of service couldnt be developed in community pharmacy, but lets not try to pretend the current MUR sevice is fit for purpose.

Do you think youre average pharmacy contractor would support you actively reducing a patients medication burden when they are being paid per item (or is that the source of your objections?) I certainley dont see any recommendations for deprescribing on the MUR forms I see in practice?

What I'm detecting from the post is a sense of hostility towards GP pharmacists as there is a sense that the NHS are taking funding from you and investing in us, for the record my role has not at any point been funded by the NHS, 3 years ago a GP partnership decided to take on chance employing me out of their own pockets as they felt the Multidisciplinary team within the practice would benefit from a pharmacist. 3 years down the line and I'm still here and the practice is still investing in me. 

I think if you honestly believe you are capable of an enhanced role, then actions speak louder than words, go out there lobby, explore and seize opportunites, engage with commising bodies and make a success of it.

just stop criticising others for exploring a different path and trying to belittle their role,  at the end of the day Im sure you will find yourself in very much the same position you started it, which from the tone of your posts, dosent sound a happy place

 

N O, Pharmaceutical Adviser

""Why not Polypharmacy, it has huge impacts on patinent mortality and quality of life, as well as reducing falls and hospital admissions? ""

You have still not answered to my question:

""Before even we  address the Polypharmacy issue, don't you think there is a need to address who is responsible for this situation. Can't (or Don't) the prescriber do a thorrough check before initiating a medicine?? Is he/she not knowledgible enough to handle his/her prescribing,??""

Back to you. 

Richard Binns, Primary care pharmacist

The assumption here is that the patients circumstances remain stable, as people age their frailty increases, the way they metabolise and eliminate drugs changes, their muscle mass decreases, they are more susceptible to side effects (I. E. Anticholinergic). The treatment goals change (I. E is there evidence that a 95 yo with a life expectency of less than 12 months would benefit from statin therapy, whereas a 40yo type two diabetic? ) evidence changes (remember when we used to give everyone antiplatlets for primary prevention)

So my point is that a clinician may be perfectly diligent initiating a drug, but the patients circumstances which dictate the suitability of the drug change as the patient ages, hence the need for a regular medication review

Graham Turner, Non Pharmacist Branch Manager

Are you suggesting that prior to the introduction of MURs in 2005, patients were not having ther medication reviewed? Complete and utter rubbish. In 2004 pharmacy was a great place to work, and patients understood what was going on. How many pharmacists have heard the phrase "but I just came from the doctors who checked all my medicines". And the HONEST response should be - yes but my non-pharmacist area manager is harrassing me into doing anther one with you right now so we need to do it again so that he can get his £28 whilst I get nothing and you waste 10 minutes of your time and miss your bus.

If a portion of the working day was actually allocated and dedicated to these services, there would be no issue. The danger arises from the fact that they are just slapped on with ZERO consideration to the other commitments that a pharmacist has. These same commitments of dispensing, offering advice and supervising OTC sales, have been the lifeblood of community pharmacy for decades and decades, and the model worked. Surprise, surprise, some idiot wants to change things and the profession becomes a complete and utter shambles.

I'd love to know who actually came up with the idea for the MUR. In principle I agree with the idea, but if no time is allocated to them, and the pharmacist doesn't even get a penny for it, plus the fact that patients were notproperly informed about MURs means that the whole idea was doomed to be a failure. A failure for pharmacists and their staff but a great idea for the multiples who can use MURs as a means by which to constantly harrass pharmacists about their performance.

And what's even worse is the fact that these bods who have never even worked in a pharmacy in their lives are sitting around twiddling their thumbs coming up with new ideas of useless jobs you can do, because they obviously think that pharmacists sit around all day doing nothing!

Richard Binns, Primary care pharmacist

Hi Graham I wasn't actually talking about murs, I was responding to a question about why there is a need to do polypharmacy reviews in gp practices.

My personal belief is murs have had a really negative impact on community pharmacy overall.

The person I was responding to was making the point why pay a pharmacist to review medicines on an annual basis in a surgery when a community pharmacist could do the same workload

Graham Turner, Non Pharmacist Branch Manager

Apologies, Richard. I agree with your comments. My argument is that GPs would not be willing to pay a pharmacist to conduct reviews in a surgery setting as they are too money-motivated to pay a pharmacist to perform a role that tradiitonally they have always performed. If a role is indeed created, I would not expect the pharmacist to be there in 5 years time.

Yes MURs have had an awful impact on community pharmacy, with no time allocated and zero incentive for your average pharmacist. And before people starting shouting me down for expecting the poor pharmacist to be remunerated for thier efforts, bear in mind that GPs would never take on a "free" role.

If the chains even offered 10% of the mur income to their pharmacists, they would probably find that most branches would hit 400. However, as most UK pharmacy employers treat pharmacist like something stuck to the bottom of their shoe, this will never happen.

Richard Binns, Primary care pharmacist

Hi Graham the GPS I work for have funded my salary 100% for the last 3 years and have made a significant financial investment upskilling me in the last 12 months, GPS realise they can't go on working the way they always have, the new gp contract is really heavy on working in multiskill teams, pharmacists and nurses have a huge role managing chronic conditions.

Which in my view is good, let the gps do the acute presentations and complex cases.
Look at it from a patients point of view, someone near and dear to you has developed a sinister looking mole, you want a gp appointment asap so they can refer them without delay to dermatology, you don't want them in a queue for an appointment behind the med reviews, asthma reviews etc

The way the population is aging, we are all having to get inventive to cope with the demands placed on the health service, that said community pharmacy is getting a particularly raw deal.

I just really take issue with this tribal attitude towards people working in different sectors which keeps cropping up

Graham Turner, Non Pharmacist Branch Manager

Richard, if you have a satisfying clinical role in a surgery which is reasonable secure for the not so distant future, then that is fantastic and I am very pleased for you. However, you must remember that you are very, very much in the minority! Where I live, none of the surgeries have taken on pharmacists.

Bear in mind that by far and away the vast majority of pharmacists in the UK are working for a pharmacy chain or in a hospital.

And to get back to the article, this is the PSNC we are talking about, anyone who is banking on this to get them a clinical role could be waiting a very, very long time!

Richard Binns, Primary care pharmacist

Completely agree regarding psnc, not sure what the answer is there apart from everyone lobbying en mass.

I'm not advocating from my posts that everyone jump to a other sector, there's people out there how perform a brilliant role in community and find the job extremely rewarding, and if we loose those individuals and their roles, I think we really are knackered.

But a bit of diversity in the profession must surely strengthen it over time

And thank you for the Intelligent replies, whilst I assume posting under your real name, seems some individuals on here have a lot to say for themselves whilst posting from behind the safety of anonymity

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