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Pharmacy’s read-write scheme hailed as alternative to GP pharmacists

Independent prescriber Crispin Bliss says patients "love the model"
Independent prescriber Crispin Bliss says patients "love the model"

A pharmacy’s read-write access to a nearby GP surgery’s records has been hailed as a community pharmacy alternative to NHS England’s push for more GP pharmacists.

A National Pharmacy Association (NPA) report published last week (July 3) cited the “enormous potential” of a partnership between a GP practice and pharmacy in Sheffield (see below) allowing community pharmacists to read and annotate the practice’s patient records.

With funding from a government grant, more than 1,000 interventions were carried out at the community pharmacy using this record access in the nine months between October 2015 and June 2016, the NPA said in the report, with “every four minutes of pharmacist time saving approximately two minutes of GP time”.

“If every pharmacy were to provide just one day of clinical support to general practices each week, it would release in excess of 18 million GP appoints a year,” it argued.

Referring to NHS England’s ongoing drive to recruit pharmacists into GP practices, the NPA said this policy is “not the solution to the GP capacity crisis alone”. Instead, the model in its report “demonstrates that the community pharmacy team can provide care at scale, offering a cost-effective alternative or supplement” to NHS England’s current strategy.

How does the model work?

Garry Myers, owner of Basegreen Pharmacy and GP practice partner at Jaunty Springs Medical Centre in Sheffield, explained to C+D that the pharmacy and practice formed a legal partnership eight years ago. The pharmacy was first granted access to the practice’s clinical system the following year, after purchasing a GP practice laptop.

While his pharmacy has a “legal right to that information”, Mr Myers stressed that other community pharmacies “don’t need the legal structural integration that we’ve got in order to deliver this model”.

A four-hour session each week is allocated for the pharmacy to support the surgery, using read-write records access to: help with acute queries; sort repeat prescriptions; flag up errors; book appointments with a nurse or GP; and check through new medication.

“Once you have read-write access, you effectively become an extension of the practice – it’s as painfully simple as that,” Mr Myers said.

“The GPs can send messages to us and we can send messages to them, which pop up on our screen,” he explained. “We don’t even need to use a phone sometimes.”

Flack from NHS England

Mr Myers said he is expecting his pharmacy’s solution to draw criticism from NHS England, which may be concerned it “undermines their preferred model” of recruiting pharmacists into GP practices.

“We’re trying to present an alternative approach, because the NHS England [model] wouldn’t work for my practice,” he said. “[It] would be too costly and it wouldn’t give us the coverage that we’ve currently got.”

Pharmacies from London, the north-east and elsewhere in Yorkshire have all expressed interest in trialling the model, Mr Myers added.

Commenting on its report, NPA chair Nitin Sodha said: “It is time for NHS England to review this alternative model in more detail and ensure funding is allocated from the pharmacy integration programme to support the fuller deployment of the community pharmacy network.”

“The patients love the model”

Independent prescriber Crispin Bliss gives C+D insight into how Basegreen Pharmacy's read-write access works in practice:

We find that we have slightly quieter times of the day, so that is when we do the [patient] queries. We tend to do the general medication reviews and the COPD reviews on a Thursday afternoon, because the surgery is closed then, otherwise it’s on an ad-hoc basis.

Being an independent prescriber has its benefits, but an awful lot of the straightforward work could be done without being a prescriber. It just means that if you did have a patient coming in ad-hoc, then you could prescribe straight away. The patient may not get their medication immediately, but typically the doctor would be happy to prescribe and we’d be able to sort out a prescription in 15 minutes or so.

The patients love the model, because we can solve a lot of problems. We can flag up where an error has been made by the surgery, but also help to make sure the right information is on the record. So it saves money for the NHS and it just means the patient has a happier time using the NHS.

It is especially useful at present with all of the out-of-stock medicines. We can recommend that we’re going to change patients to an [alternative] item, for example, and push that past the GPs just to check it’s OK with them.”

A lot of people are interested in the model, but it’s taking that step into the unknown and [having] a clinical commissioning group that’s open-minded enough. I think if you get a senior GP that’s going to push it from their end, then it’s more likely to find purchase.

What do you make of this read-write model?

Graham Phillips, Superintendent Pharmacist

Before knee-jerking agianst, I would read the actual report and not over-rely on a brief report in CandD.  Garry and his team have done some outstanding work here and we should all hope to support it and replicate it wherever we can

RS Pharmacist, Primary care pharmacist

I have several issues with this article, but I will raise two.

1. To the editor: the title or is misleading/incorrect – the word in the title “alternative” should be replace with “alternative or supplement" as per wording in the article which shows the full quote.

I would agree that the scheme is correct but it ridiculous to suggest it would be an “alternative” to having a pharmacist in the practice; at best it would “supplement” the current strategy.

2. It is fantastic that Mr Myers was given the opportunity to purchase a “GP practice laptop”, how about the other local pharmacies, are they allowed to purchase a “GP practice laptop”?

Mike Hewitson, Superintendent Pharmacist

I disagree. Even at full scale by 2020 the NHSE GP Practice Pharmacist programme will be at the equivalent of what? 1 day of pharmacist support per practice per week? By empowering community pharmacists to do more, and enabling full read/write access to the patient record (although these records are curated by GP practices in reality it is the patient's record), there are opportunities to significantly improve the safety of the current system, and enable more integration of the community pharmacy workforce. In my view that is a more scalable and sustainable solution than the NHS England approach. Many GPs do not want to take on the cost and employment risks associated with directly employing a pharmacist. 

I view the NHS England pilot as proof of concept that pharmacists can take on extended roles to support General  Practice. Only thing that stops these activities from being delivered from a community pharmacy rather than a GP practice is prejudice. 

A LOCUM, Community pharmacist

government grant ? how lucky are some folk , all i get is bills !

It is fraught with difficulties with GDPR. Why would a practice rather do this than employ their own "pharmacist in GP practice" for x sessions a week? They then have complete control and freedom. This example only worked as "the pharmacy and practice formed a legal partnership eight years ago". 

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