GP partner Dr Paul Deffley explains what practices need to consider when transferring a practice clinical pharmacist to a primary care network
Although included in the baseline staff assessment, pharmacists recruited and employed under the Clinical Pharmacists in General Practice (CPGP) and Medicines Optimisation in Care Homes schemes, who were in post as at 31 March 2019, are the only group of existing employed staff that can be transitioned to Primary Care Network (PCN) funding. The deadline for this was recently extended to 30 November 2019.
The process for transitioning is fairly straightforward, but there are some clear steps that need to be followed.
It’s important for the network to be clear with their pharmacist(s) about all the member practices’ expectations, how they will be supported at each site they are working, how you will monitor and measure their contribution to the clinical workload and how you will keep them interested and in a fulfilling role.
Here are some pointers on how to make the transition as smooth as possible.
As with any contractual change to terms and conditions of employment, it is important that a proper procedure is followed. In line with employment legislation, your practice’s HR protocols and good practice, you should have a consultation process where you talk to your pharmacist about the changes to their contract and the implications of this for their work.
The changes will of course depend on what you intend them to do, how you intend to share them with the other practices in your PCN and the locations they will be working from. Once the changes have been discussed and agreed, your pharmacist will require an updated contract of employment, which outlines the changes and stipulates that they are now working as part of the PCN.
CCGs are responsible for ensuring that you are claiming reimbursement appropriately so make sure you understand what they require. They may wish to see a copy of the contract of employment or require you to complete a local assurance form. They are generally following their own local processes, particularly around payment, so find out what the requirements are in your area.
Once approved, funding will be paid to the practice or organisation that is responsible for the network funding. If this is different from the employing practice, funding will need to be transferred according to the processes outlined in your PCN agreement.
Claims can be submitted monthly and payment should be 1 month in arrears.
Remember that as the scheme started on 1 July only 75% of total annual reimbursement will be paid during 2019/20.
The contribution to the salary under any of the schemes should be really helpful when the pharmacist is in their first year of work and may be on a very steep learning curve and still taking extra time to complete tasks.
Once the pharmacist is fully embedded into a practice (or network) and helping to address a clinical workload gap (ie, doing work that was previously undertaken by a GP), and they are working reasonably efficiently, then they tend to represent good value to practices. If there is a GP vacancy, then the funding for the salary should be there.
However, most pharmacists working effectively in primary care will be looking for salaries considerably higher than the maximum reimbursable rate under the Network Contract DES, and with many jobs available, they are in a strong position to negotiate their salaries upwards. Some PCNs advertising their vacancy at the reimbursable salary rate are struggling to recruit.
Some practices have decided not to transfer their pharmacist to the PCN. The most common reason given was that the pharmacist was already embedded in the existing practice teams and with a WTE providing care to 15,000 patients, moving to sharing across around 40,000 patients was not attractive, either for the practices or the pharmacists involved.
For many practices, particularly those in the third year of the CPGP scheme and where the practices who came together to create their CPGP application are the same practices that came together to create a PCN and are already sharing a pharmacist, the additional funding toward the salary costs is very welcome and should not cause so much disruption to the services already in place.
Experienced pharmacists and independent prescribers are now typically being paid above the current reimbursed rate. Those who tend to apply for positions at the reimbursable rate tend to be less experienced, need much more support in practice and are able to provide a narrower scope of services. In every role, there is a pay-off between skills and experience and the level of remuneration that the clinician can demand.
Make sure the new contract of employment is fit for purpose and works in conjunction with your PCN agreement to share risk and benefit from the employment of an additional member of staff.
Pharmacists are covered for clinical negligence under the new state-backed indemnity scheme and so indemnity should be considered in the same way that it is considered for other clinical staff – additional cover may be needed for any activity that falls outside the delivery of the contracted NHS services.
There is a real danger that moving to having one pharmacist providing services to around 40,000 patients, across additional practices, could result in them working on a very narrow range of tasks or appointment types, resulting in a lack of job satisfaction and professional development.
It is essential that you do not under-estimate the support your pharmacist will need in the first 3-6 months of their employment. If you are transitioning a pharmacist who is newly appointed, unless they have worked in primary care before, there will be lots to learn – regardless of whether they have a secondary care, community or CCG background they will still need to know how the practice runs, how work is allocated, how your clinical IT system works, all processes that relate to the safe provision on medicines.
The more support that is invested during this time, the quicker they will start to contribute to the delivery of these services. It may be helpful to consider a support timetable that provides the opportunity to check in regularly for advice and guidance (every day, initially). A really detailed induction and training programme covering the first 3-6 months can help with this.
If the pharmacist is being supported in one practice with one clinical supervisor initially, with the intention for them to work for other practices when they are ready, then the cost of providing this training and support should be acknowledged and resource agreed within the PCN.
To optimise your pharmacist’s time, network member practices should develop and agree a single protocol/procedure for each of the activities or areas of work that they are delivering. Developing shared templates within your clinical systems will help with this.
If your pharmacist is expected to do the same basic task several different ways depending upon which practice a patient is registered with, they will work slowly, get confused and make mistakes.
Bringing representatives from each practice together to discuss and agree clinical processes will require ongoing investment in terms of time, but the creation of shared ‘Operating Procedures’ can be developed gradually and should improve mutual support to identify and deliver best practice in medicines provision.
If practices can’t agree on a shared clinical pathway or a single way of completing a task, it is probably best not to share staff to undertake that task or patient appointment and focus their time on something that everyone can agree how to do and therefore optimise their contribution.
There are so many ways in which an experienced pharmacist can work within your practices that is can be really challenging to narrow it done to 37 hours of work per week but remember, you can recruit additional pharmacists in future years so it may be helpful to use 2019/20 to plan and learn how the integration of the pharmacist into your practice teams can be most effective.
As with all practices (or groups of practices), this really depends on the existing skills within the clinical team and the skills, experience and areas of expertise that each individual pharmacist brings with him/her. Once they have learned the basics of primary care delivery, either play to their strengths or train them to fill the weaknesses or gaps in your existing clinical team and support them to deliver services to a specific group of patients or across all the PCN.
Dr Paul Deffley is a GP partner in Brighton and Hove, and clinical director of not-for-profit primary care consultancy Practice Unbound
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