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Is the pharmacist in GP practice initiative the answer?


IN July 2015, a £15 million three-year scheme to fund, recruit and employ clinical pharmacists in GP surgeries was launched by NHS England. The initiative will see NHS England fund 60 per cent of the cost of pharmacists to the practices for the first 12 months of employment, which will decrease to 40 per cent for the second year and 20 per cent for the third year. The scheme will focus on areas of greatest need, where GPs are under the greatest pressure.

NHS England says that examples of work a clinical pharmacist may do in a GP practice could include:

  • Providing clinical advice and expertise on treatments.
  • Developing bespoke medicine plans for individual patients.
  • Establishing ongoing professional relationships with individual patients.
  • Assisting with communication across a patient’s care pathway, including with GPs, hospitals and social care.
  • Monitoring patients with complex long term conditions such as hypertension or diabetes.
  • Managing repeat prescription requests.
  • Increasing the uptake of new medicines.
  • Managing medicines shortages by suggesting suitable alternatives where appropriate.
  • Supporting innovation and clinical research where appropriate.
  • Mentoring newer pharmacists.

The NHS announcement comes just days after the employment of a part-time pharmacist was one of the factors that led Castle Medical Centre in Kenilworth, Warwickshire, to be rated outstanding by the Care Quality Commission (CQC).

Commenting on the inclusion of the one-day-a-week pharmacist, the CQC stated: “The practice team included a part-time pharmacist employed by the practice to support the clinicians in providing safe and effective medicines management. Their role included supporting the GPs and nurses with pharmacy advice, reviewing prescriptions and monitoring medication safety alerts to make sure these were acted on in a timely way.

“The practice told us that having a pharmacist had resulted in them being one of the most cost-effective prescribers within the CCG, and national data showed prescribing levels for specific types of medicines where caution should be exercised were lower than the national average.”

The pharmacist had also arranged an education session for staff with an external speaker, following which the practice produced an evidence-based and cost-effective list of inhaled medicines. The pharmacist had also worked with local care homes to improve stock control of medicines.

How many appointments?
A quick straw poll of practices employing pharmacists suggests up to 40 appointments a day can be diverted from GPs to pharmacists. While some patients will end up seeing a GP anyway and the pharmacist’s duties will mean they can’t see patients all day, every day, a sizeable number of GP appointments can still be freed up. Indeed, anecdotal evidence suggests that having a pharmacist on a practice team leads to reduced waiting times, improved patient health outcomes and reduced medicines wastage or overuse of medicines.

The funding barrier
While the NHS scheme will help a tiny number of practices part-fund pharmacists, there is certainly no set view on how GP practices can fund this pharmaceutical support (the £15 million pilot scheme won’t go far). Certainly plenty of questions remain over how to pay for the service and the level of prescribing savings that can be made, with many GPs still dubious about the real benefits that pharmacists can bring.

This is a major topic that we’ll no doubt be talking about once again in the near future. In the meantime, case studies and more information about pharmacists working in general practice are available on the Royal Pharmaceutical Society website. Finally, for more information on the NHS scheme head to the Clinical Pharmacists in General Practice Pilot webpage.

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