I first worked in GP practices over 10 years ago as part of a medicines management project for the then Buckinghamshire Primary Care Trust (PCT). The project involved medication reviews for patients over the age of 75 years who were taking four or more medicines. I was assigned to three practices and my first job was to visit the practices and convince them that this was a valuable review and that I, as a pharmacist, had the required skills. My initial meetings with the practices did not always prove particularly promising; in one I was told that they had not had much success with pharmacists in the past and they were not very keen on the project. After some persuading, all three practices agreed to the review, one of which was Tower House Surgery.
I must have done something right as 2 years down the road two of the practices approached me to work regularly in the practice. I am still working there now and I have also worked on a self-employed basis in at least 10 practices within Buckinghamshire PCT/Chiltern CCG. Most short-term contracts have been for cost-saving purposes but my role has expanded in my regular practices.
So what do I do? Everything is based on the patient receiving the most appropriate yet cost-effective therapy and minimising any untoward side-effects. My role mainly involves reauthorising repeat issues and carrying out medication reviews, which include:
- checking for drug interactions
- checking for clinical indications
- ensuring full instructions are listed on repeat prescriptions, including:
- timings for doses, if necessary
- how long inhalers should last (as people often over-order)
- recommended testing (e.g. for people with diabetes)
- actioning ScriptSwitch changes if appropriate and pre-agreed by GPs
- checking requests are at appropriate intervals
- checking blood tests are up to date, and referring if required
- referring any clinical issues back to GPs.
As time has gone on my role has expanded to include:
- reviewing and ensuring prescription requests for stoma/ catheters are not being requested too often
- resolving community pharmacy queries, without having to involve the GP
- writing medicines management and repeat prescribing policies and reviewing processes
- providing a medicine information service and advising on the best products to prescribe with regard to local CCG guidelines and traffic-light system
- holding clinical meetings every 2–3 months to discuss any general issues arising from medication reviews, MHRA warnings, CCG and NICE guidelines, and any other relevant topics
- performing clinical audits for common conditions, such as diabetes, atrial fibrillation, and osteoporosis
- developing blood-monitoring guidelines on drugs for in-house use for QOF
- discussing drug-related issues with individual patients.
Apart from the obvious clinical competence, what skills does a pharmacist need to be part of a GP practice? The following testimonials from two of the GPs at Tower House Surgery, High Wycombe, help to answer this question.
‘I think you bring a great deal to the party by:
- overseeing complex prescribing issues (such as foods for special diets, appliances, new medications, inappropriate prescribing from secondary care, "specials”)
- achieving consensus and consistency from the doctors
- providing support and education to the clinicians
- positively interacting with patients and taking responsibility for clinical decisions
- liaising with pharmacists and CCG advisors
- helping the practice achieve QOF targets
- understanding that guidelines are support tools and are not written in tablets of stone.'
‘To influence the doctors, you have to be respected, and be part of the team. You bring knowledge, warmth, kindness and understanding. Only a small part of these qualities relates to your pharmacy degree.’
‘We have an excellent relationship with our in-house pharmacist who has earned our trust over many years with her expertise and common sense. During this time she has progressively improved the quality and value of our practice prescribing, for example, by implementing the latest drug-safety bulletins, and looking for better value drug substitutions. She has also saved the doctors a lot of time by dealing with prescriptions that we know little about such as appliances, stoma kit, and dressings.’
I don’t do any patient-facing clinics as I now only work 1 day per week but I think pharmacists can make a big contribution to GP practices by providing similar services to those listed above. I am sadly reaching the end of my working life but I am privileged to have worked in this role as a pharmacist and hope that it has helped pave the way for pharmacists in the future to become a valuable part of the healthcare team.