One of the things I really like about the early months of the year is the increased number of conversations I have about lifestyle changes where patients are genuinely engaged.
All good medication reviews should address lifestyle factors. This can help reduce the burden on patients of handling their medicine and improve the management of many chronic diseases. However, I confess it’s not always the easiest part of a consultation.
I felt the same when doing medicines use reviews (MURs) in the community sector. There was an unpredictable and mixed response from patients to questions about diet, alcohol consumption and weight. When I first moved into general practice, I thought that influencing lifestyle change might be easier. This was based on an ill-conceived notion that because the advice was coming from a doctor’s surgery it somehow carried more importance.
However, you can always rely on family to prove you wrong. My mother, who chooses to ignore my advice on a regular basis, went on a diet following an MUR with her local community pharmacist who she sees regularly and trusts implicitly. The pharmacist tactfully managed to explain how weight loss could improve management of her chronic obstructive pulmonary disease.
Experience has taught me that most patients see pharmacists as a collective profession regardless of work setting. Lifestyle interventions work best by continually ‘chipping away’ in the hope that eventually you will intervene at just the right moment when the patient is most receptive to change.
All pharmacists, regardless of sector, have an important role to play in supporting patients in improving their lifestyles. In fact, arguably community pharmacists are better placed to support this due to their accessibility to the public.
I was reflecting on this the other day when a community pharmacist friend, who is applying for a job as a primary care network (PCN) ‘clinical’ pharmacist, asked me which of their existing skills they should focus on in the application. It is without question the knowledge that pharmacists carry as medicines experts - being able to help patients manage their medicines and long-term conditions safely and effectively.
One of the core services to be delivered as part of the new PCN contract will be ‘structured medication reviews’. These will replace MURs, which are being phased out in the new community pharmacy contract. My understanding was that the reviews would be delivered by the new workforce of PCN pharmacists based in GP practices. However, the draft service specifications published in December suggest that GPs and advanced nurse practitioners could also be involved.
Healthcare policy is increasingly focussed on a people-centred approach. We are trying to reduce pressure on general practice, and pharmacists are integral to medicines safety. So why are we taking away a service that should be delivered by experts in medicines, only increasing the workload of GP surgeries?
Surely a more pragmatic approach would be empower community pharmacists, through access to training and integrated IT systems, to deliver structured medication reviews in the community?
The GP Pharmacist is a former community pharmacist working in a general practice