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RCGP calls for 'army' of pharmacists to support practices

RCGP chair Maureen Baker says GPs have "huge respect" for pharmacists' skills

Royal College of General Practitioners chair Maureen Baker says many GP practices are "very interested" in taking up its proposal to employ on-site pharmacists

A “hidden army” of pharmacists could save GP practices struggling to meet patient demand, the Royal College of General Practitioners (RCGP) has said.

Employing pharmacists in GP practices across England would slash waiting times and improve patient care, the RCGP announced at a summit by think tank The King’s Fund in London today (March 17). These pharmacists could help manage patients with long-term conditions and save money by reducing medicines waste, it said.

The RCGP’s comments came as it launched a joint proposal with the Royal Pharmaceutical Society (RPS) for GP surgeries to employ pharmacists “as soon as possible”. They would help practices deal with “day-to-day medicine issues” and liaise with hospitals and care homes to ensure “seamless” patient care, the RCGP said.

RCGP chair Maureen Baker told C+D that the college had an “ongoing dialogue” with NHS England about the initiative and there would be a more detailed announcement “in the next few months”.

While demand for GP services had “risen rapidly”, the number of GPs had remained “relatively stagnant”, Ms Baker said. The over-supply of pharmacists meant the sector could potentially “step in” to treat patients in surgeries, which would make a “huge difference” to patient care, the RCGP said.
 

'Huge respect' for pharmacists' skills


Ms Baker told C+D that no practices would be forced to take on pharmacists, but expected high demand as GPs had “huge respect” for the sector’s skills. “I know lots of practices are very interested and I think they should be encouraged and supported to move on down this route,” she said.

“This isn’t about having a pharmacy premises within a surgery, but about making full use of the pharmacist’s clinical skills to help the over-stretched GP workforce,” she added.

RPS English pharmacy board member Sandra Gidley said the proposals would allow patients to book an appointment with a pharmacist when they called the surgery. These pharmacists would work closely with local community pharmacies and act as “catalysts” for the sector to deliver more services, Ms Gidley told C+D.

“It’s by no means a replacement for anything that community pharmacy does,” she stressed.

Ravi Sharma, primary care pharmacist at service provider DMC Healthcare - which employs 12 pharmacists to work across six GP practices - said on-site pharmacists could be of “massive benefit”. “We know there are roles for prescribing and non-prescribing pharmacists, it’s about getting that skill mix,” he told C+D.

The RCGP’s announcement built on plans unveiled by NHS England last year for pharmacists to work in expanded GP practices as part of a new model of care. Last week, the commissioning body revealed the 13 “vanguard” sites that would trial this new care model.
 

What will practice pharmacists do?
  • Reduce wasteful prescribing
  • Work with colleagues in community and hospital pharmacy to develop a referral process for patients
  • Run medicine intervention clinics
  • Deal with minor ailments and triage patients appropriately 
  • Review the medication of “high-risk” patients, including the frail elderly, patients with renal impairment, and those with a history of drug abuse
  • Liaise with community pharmacy colleagues to co-ordinate MUR and NMS services
  • Educate prescribers in the surgery

Source: Royal Pharmaceutical Society

 

What do you think of the RCGP's proposals?

 

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47 Comments

N O, Pharmaceutical Adviser

All this is definitely leading to a scenario where the GPs want to control all aspects of profitable healthcare. In other words, the GPs want to retain the maximum NHS fund to themselves and get more work from others for a tiny bit of the leftover money. One question comes to mind is, why there is no urgent regulations brought in by the NHS in order to stop all the Dispensing Practices from providing pharmaceutical services (now that there are pharmacies in every village, leave alone towns) and ask them to focus on providing services for which they are trained ??? Why do they want to over power the already under pressure Pharmacists ?? In the guise of filling the vacant gaps left by more demands to GP related services, they will drive away all the services out of the community Pharmacy and then slowly push the Pharmacists to do all their dirty work for peanuts. Stop DDs from dispensing to anymore patients and let them focus purely on diagnosing and prescribing, we the Pharmacists will do the rest.For those who are trying to depict a rosy picture of working with GPs ----- what you are doing is nothing but Practice Based Commissioning, which many PCTs had funded earlier to get the GPs to meet their prescribing targets and control unnecessary prescribing (credit crunch, cuts, ???) Even now we can see some CCGs continuing this legacy from the earstwhile PCTs, but it is more of a common practice where few practices come together and spend a pot on these Pharmacists to clear off their mess rather than to really contribute anything for the well-being of the patients. All these Pharmacists are doing is to help these GPs achieve their QoF targets and other targets to increase their funding. So this is more of a short term contract based WORK rather than a long term Partnership between two healthcare providers.

Chris Maguire, Community pharmacist

I have been doing this for 3 years in multiple gp surgeries. GPs are more than happy to invest of you are going to save them money and make them money. Be getting to grips with their systems and drivers we are in an amazing space to aid them. Being a prescribed isn't even required in my opinion. I can review patients from their medical notes, decide if they are being treated to nice standards, invite them in or call them to discuss and then prescribe under the GPs direction. For community pharmacists to get involved its a steep learning curve but a very rewarding one to sit and have clinical discussions with GPs and nurses on the best course of action for a patient. Everyday I feel valued,I help with patient outcomes and in return I am saving the gp money in the long term and short term and increasing their practice income. It's win win win.

Gerry Diamond, Primary care pharmacist

It's a bit crap when you get to the end of a consultation or review and you tell the patient, hold on while I hover outside the GPs door to get a signature. You must be joking, get your prescribing course completed, No excuses.

Gerry Diamond, Primary care pharmacist

I view practice pharmacists roles as part time personally so spread my time between prison and community too. Each practice may have different expectations, such as audit, medicines optimisation, medicines review, prescribing, searches, and clinics, smoking cessation, minor illness and respiratory. Main thing is to have a portfolio of skills and focus on long term conditions, copd/asthma, diabetes and cardiovascular.

Mohammed Rafiq, Community pharmacist

I’m an IP and have successfully been working in general practice for 2.5yrs with excellent pay. I typically see approximately 70 patients a week; GP support is excellent and I see 75% of all patient groups/conditions. I had no problems finding a supervising GP, simply approached my local GP practice where I had an excellent relationship.

London Locum, Locum pharmacist

What's excellent pay? no need to be coy, that's the problem with pharmacy that has partly landed us in the current mess. The fear or mention the M word(MONEY).

Mohammed Rafiq, Community pharmacist

Average Locum GP rate: £80/hr Average community pharmacist Locum rate: £22/hr Therefore makes sense for IPs to pitch at £40/hr

Graham Stretch, Primary care pharmacist

Concur

Angela Channing, Community pharmacist

Do you feel, or are you ever treated as a 'pretend Doctor' ? I mean, you are in one consulting room on £40 an hour and your GP is in the consulting room next door on £80 an hour doing pretty much the same stuff??? Or is being a Pharmacist IP very very different to being a GP???

Graham Stretch, Primary care pharmacist

I'm still a pharmacist, using my pharmacist skills just in a gp surgery. I have the same title (PhD) but no, theirs is a very very different job.

Graham Stretch, Primary care pharmacist

Pleased to see another optomistic view on here, this is a good news story. Pharmacist are out there getting on with this work, would be good to try to bring out all the examples for others to take along to local practices as a way of adding to the momentum. My GPs would happily recommend pharmacists in surgeries to others... Why do pharmacists tend to be 'glass half empty types'? Where are you based Mohammed?

Mohammed Rafiq, Community pharmacist

Berkshire. If anyone would like to sit in on my clinics let me know.

Graham Stretch, Primary care pharmacist

I'm in West London and would also happily help with time 'on the job' for people undertaking IP training.

B akbar, Pre-reg Pharmacist

Hi Rafiq, I approached my GP and was told no due to no time etc, I also approched others which i got the same response from. do you have any advice for me for finding one?

Mohammed Rafiq, Community pharmacist

The key is to be proactive and build a relationship. Do you have the email address of your local GP? Do you have their direct line number? Do you send them a regular out of stock list? How did you help the GP with the recent amlodipine / simvastatin guidance?

Really? Wow, Superintendent Pharmacist

Bakbar, your title says pre-reg graduate. Is this correct? Under current law you have to have a minimum of two years post-qualification experience and already be somewhat specialist in an area. The IP course does not teach any clinical skills, it is there to show you how to put what you already know into practice....in a nutshell.

Graham Phillips, Superintendent Pharmacist

Maybe what we need is a mixed model? Pharmacists working in some surgeries and all community pharmacies working closer with their local GPs? http://www.nhsconfed.org/blog/2014/10/pharmacy-could-save-the-nhs-argues...

Gerry Diamond, Primary care pharmacist

You must be joking...one day in retail per week is as much as I can cope with after 30 years front line and I try to do the best with that experience.

Angela Channing, Community pharmacist

It sounds wonderful Graham, but I was promised all this 25 years ago and we're still barely any closer even after PIANA and being at the 'crossroads'. Pharmacy seems to have been at a Crossroads longer than Noele Gordon! (Although what the 'other' Graham is saying does sound incredibly interesting and my lecturers would be happy. (Well the ones still with us!))

Gursaran Matharu, Community pharmacist

The vast majority of patients walk past their community pharmacies to reach their GP. So why can't these wonderful services be located in the community pharmacy? Why can't we have access to patient records? Why can't an independent prescriber pharmacist work from within the community pharmacy? Why not give the patient the choice? Why do pharmacists need to be employed? If we're that good why aren't we offered partnerships in the surgeries? I fear our general practice colleagues view us as a cheap resource rather than equal partners.I'm sorry but this is not a good new story and the unintended consequences may prove to be fatal to our profession.

Graham Stretch, Primary care pharmacist

I agree it can be done from the pharmacy, one of our IPs offers spirometry in the GP surgery and at his pharmacy for example. I use my NHS Rx pads at the community pharmacy to treat minor ailments (ENT, MSK, UTIs etc) we have full access to notes via laptop. This access to notes seems to work well with three surgeries located close to the pharmacy. MURs are much more effective if you can see patients notes (with their permission) and if you are an IP change their repeats, dosages etc and order bloods. This doesn't have to be one size fits all, decide what will work for your patients and talk it over with the GPs, you may be surprised. This kind of support and publicity can really help.

Peter Clarke, Pharmacy

Fully agree with you Gursaran. This wants thinking through carefully by a pharmacist nationally respected for his or her independent and farsighted thinking and able to calculate the likely scenario for pharmacists generally when or if such a usage of professional value ever comes about. The professional body must be involved to ensure that the ethical aspects are protected.

geoffrey gardener, Community pharmacist

Need more GPs then open more schools of medicine, they will find that the oversupply will force down Wages, and we will be able to employ more GPs. Think this has the ability to turn pharmacists into poor mans doctors rather than advancing our professional abilities .

Ivor Hadenuff, Primary care pharmacist

That sounds good, but doctors don't want to become GPs at the moment. Applications for GP training are falling year on year. That's why pharmacists working within the practice are being seen as a way to manage some of the many problems around medicines - clarifying hospital discharges, medication queries from script clerks, medication reviews targetted at high risk patients, liaison with hospitals, community pharmacies etc etc. There's lots of scope and good salaries are available. There may not be a lot of these jobs yet but it is coming and the best way to be involved is to have a diploma and IP, although I can appreciate the difficulties in finding a GP to support.

London Locum, Locum pharmacist

The pay will inevitably be very poor. Subservience will remain, only your master will change. Any views to the contrary will be greatly received

Graham Stretch, Primary care pharmacist

IP rates were discussed on the RPS prescribers discussion group and the rates suggested varied from £35-50ph. http://groups.rpharms.com/_forum/forum_posts.asp?TID=24976&KW=Hourly&PID... (Closed group)

London Locum, Locum pharmacist

'rates suggested''. Is this what people are actually achieving or what they think they should get ?

Graham Stretch, Primary care pharmacist

What they get, all the ip pharmacists I know are in this range.

Disillusioned Pharmacist, Community pharmacist

I am IP + MSc and not on this range!

Graham Stretch, Primary care pharmacist

Then, sorry, you are selling yourself short. Are you seeing patients at the surgery and prescribing. What kind of time/volumes?

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