Tips for getting the most out of a pharmacist

GP partner Dr Paul Deffley and Lindsay Coleman outline steps to getting the most out of a practice pharmacist

Much of the work and care undertaken in general practice relates to safe and appropriate provision of medicines and more and more practices are starting to understand the benefits of having pharmacists on their team. The introduction of funding via Primary Care Networks for practices to share pharmacists is potentially bringing this option to many more practices.

There are many possible roles and tasks that a primary care pharmacist can take on. Which is best for your practice depends on many things – the skills and make-up of your existing clinical team (and any gaps you may have), the way that your admin team delivers repeat requests and of course, the skills, experience and interests of the pharmacist themselves. 

As well as deciding what your pharmacist will do, it is vital to consider how they do it.

If you’re employing a pharmacist for across a Network or other group of practices, don’t simply allocate their time between practices and send them off to work with a different team, in a different way for each day of the week – if they are expected to work in a different way in each practice, mistakes will occur and frustration will result, both for the practices and the pharmacists alike.

Instead, come together, make time for a proper engagement process and create a shared purpose between your practices. Agree what your pharmacist will do first and vitally, agree how they will do these tasks and create shared protocols that can be implemented in all practices.  

If you can’t agree on how something should be done, then focus on an area of work where agreement can be reached.  

Here are some key areas that a practice pharmacist can take on:

1. Updating patient records with medicines changes and dealing with queries relating to in-coming correspondence, discharge summaries or outpatient letters, which would otherwise have been undertaken by the GPs.
2. Medicines monitoring (such as TFTs, DMARDS) – reviewing your systems and ensuring they are implemented correctly and safely.
3. Taking responsibility for prescribing safely, risk management and information – acting on safety alerts, audits, medicine related incidents and complaints.
4. General prescribing audits required by the practice. In particular, they can focus on audits for the new QOF QI domains which relate to demonstrating continuous quality improvement activity. For 2019/20, there is a requirement to look at NSAIDS and gastric protection, lithium prescribing and valproate and pregnancy protection. Working across more than one practice will help as they are perfectly placed to facilitate the improved collaboration and learning between practices that is also a new QOF requirement.  
5. Advice, guidance and information for the GPs – for example, investigating alternatives when there are stock availability issues.
6. Same-day telephone appointments for issues like medicines queries from patients and requests from community pharmacists, which would otherwise have been undertaken by a GP – thus freeing up a GP appointment each time.
7. Support for ‘repeats’ process – for example responding to tasks from the script team, advice, guidance and training, reducing the script tasks being sent to GPs.
8. Medication reviews – this could be focused on certain patient groups where most value can be added, such as new registrations and nursing homes.
9. Long-term condition reviews – if there are gaps in the skills sets in your nursing team, the pharmacist may be able to support that would have otherwise been provided by a GP.
10. Care for specific patient groups – for example, hypertension clinics, minor illness/common ailments, benzodiazepine reduction programmes. The opportunities here are endless with the appropriate training.

Wherever you decide to start, remember to collect appropriate data relating to the work that your pharmacist is undertaking. Every appointment and task redirected away will save some GP time. An appropriate template in your clinical system can be set up to collect relevant information about activity and this can be presented back to the practice, so that you can be really confident that they are positively impacting on the quality of patient care and GP workload.

Dr Paul Deffley is a GP partner in Brighton and clinical director at Practice Unbound and Lindsay Coleman is a non-clinical partner in Brighton and director at Practice Unbound 

Resources

Pulse Intelligence – Job description: practice pharmacist

Pulse Intelligence – Guide to employing a practice pharmacist

Practice Unbound – free e-module on introducing a pharmacist to general practice

Primary Care Pharmacy Association – A guide for GPs considering employing a pharmacist

NHS England – patient leaflet for employing a practice pharmacist