Clinical Pharmacists in General Practice

How can employing a clinical pharmacist help your practice?

Read this article to:

• Discover what activities a clinical pharmacist can carry out
• Learn how a practice pharmacist can benefit patients
• Find out about how Medical Protection can indemnify your practice pharmacist

The role of the clinical pharmacist in general practice is a fundamental part of the transformation of GP services. A recent announcement from NHS England revealed that it is committed to getting an additional 1,500 clinical pharmacists working in general practice by 2020-21, a commitment set out in the General Practice Forward View. Applications for this next phase, worth over £100 million, opened in January this year. This is in addition to a pilot scheme launched in July 2015, which has already seen 490 clinical pharmacists working in around 650 GP practices across the country.1 Keith Ridge, Chief Pharmaceutical Officer for England, said: “The success of the initial pilots has shown the benefits of having more clinical pharmacists in general practice, reducing GP workload and helping ensure patients are seen by the right professional in a more convenient and timely way.”2 It is believed that, by taking responsibility for prescribing for patients with chronic diseases, clinical pharmacists can free up GPs for other appointments. They work with community and hospital pharmacists to provide joined-up NHS pharmacy services for patients and so ease pressures on other parts of the health service.

As a clinical pharmacist in general practice, what activities do you typically carry out?

I work in a clinic set-up where we manage prescriptions, conduct consultations, call patients, answer queries and look at hospital discharge letters. We also conduct clinical audits and establish self-management plans and associated care plans – the tasks we undertake vary from day-to-day and weekto-week.

We regularly hold clinical discussions within the practice to talk through audits, technological enhancements and new guidelines or updates – it’s a bitesize clinical update that we believe other clinicians value. These meetings ensure the crossfertilisation of ideas, and the sharing of skills and information. Pharmacists help to provide a constant learning platform on medicines for other clinicians – this encourages consistency and cost-effective utilisation of NHS resources.

What advantages can a clinical pharmacist bring to a practice?

Pharmacists bring a unique skillset that has been missing in general practice. As experts in medicines, we help to improve efficiency and support medicine optimisation effectively within the practice. As an independent prescriber, we can be a onestop clinic for patients, therefore improving access to care and freeing up other professionals’ workloads.

We contribute towards contractual KPIs, support income generation within the practice and deliver the prescribing and medicines optimisation plan or incentive scheme. Pharmacists can train practice staff in areas such as repeat prescribing processes, data quality and information governance. There are considerable opportunities to undertake additional work, depending on the competencies of the pharmacist.

Multidisciplinary working with staff, both from within the practice and outside, such as district nurses, hospice teams, and social workers, improves patient care and avoids duplication of activity. This, in return, encourages an improved working environment. Maximising the skill mix within the practice can only be a win-win situation for everyone. Ultimately, pharmacists may help to contribute to an improved work-life balance for GPs, whilst also improving safety and quality across the whole practice.

What advantages can a clinical pharmacist bring to a practice?

In my experience, patients truly value this aspect. Patients do not generally have a protected forum to talk about their medicines, long-term conditions or the implications of their medicines. Pharmacists work with patients to improve their adherence to their medication and optimise the benefits. Perhaps what we can offer is a more holistic approach – a clinical, therapeutic assessment that ultimately aims to improve patient outcomes. This personalisation of patient care, provided by pharmacists, brings a unique element to primary care.

There may also be positive outcomes around the reduction in hospital admissions and the number of patients in A&E. If patient care can be optimised in primary care, then referrals to secondary care may not always be required. In addition, it is crucial to have robust systems within a practice to undertake assessment and medicines reconciliation post discharge. If these are in place, then the patient does not become a revolving door hospital patient.

I believe pharmacists are maximising the skills within the NHS, improving patient outcomes and using resources more efficiently. 

What advantages can a clinical pharmacist bring to a practice?

In general, I think a challenge arises if the pharmacist’s role has not been clarified – you don’t want a doctor, a nurse and a pharmacist duplicating the same work. There will be an element of overlap, but the last thing you want is a patient jumping between all three professionals. Sometimes, if role clarifications aren’t explained at the start, it could result in perceived negativity towards the role. For example, a GP may feel a pharmacist is cutting in on their responsibilities.

Practices must also ensure they capitalise on the new skills a pharmacist can bring to general practice – if a pharmacist’s responsibilities are limited and their skills not utilised, this can be demoralising. Having role clarification and using skills in the right place is crucially important to embedding the pharmacist’s skills in the practice’s system. I also feel that there could be a hesitation for some pharmacists to move to general practice due to fears over job stability, as well as there being barriers concerning pay. 

How can a practice support a pharmacist?

An important aspect which practices have to be mindful of is the continuing professional development (CPD) needs of a pharmacist. Practices should consider a formal mentoring programme to establish a career pathway for the clinical pharmacist in general practice, which should incorporate a regular appraisal, a clinical mentor and a professional development plan. Equally, pharmacists should be able to recognise their limitations and work within their scope of practice. With robust CPD plans they can progress to expand their competencies and take on additional clinical commitments, with appropriate supervision, as dictated by the needs of the practice.

Practices should also understand that a person coming into a new setting will need clear direction on what work they want the pharmacist to carry out. 

---

Rena Amin is a clinical pharmacist and managing partner at a GP practice in London. She is also the Joint Associate Director for Medicines Management at NHS Greenwich Clinical Commissioning Group. We talked to her about what role a clinical pharmacist could play in a practice.