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The Deputy Chief Pharmaceutical Officer looks at the benefits of relaxing the current criteria for clinical pharmacists in general practice:
NHS England has committed to providing 2,000 clinical pharmacists in general practice by 2020-21.
There are already over 810 in post full time and the new entry criteria is aimed at encouraging even more into the NHS.
Practices, or groups of practices, working across a population of 15,000 will now be able to apply for funding; the aim being that those with a lower population, for example in more rural areas, will be able to employ a pharmacist for the first time under the NHS England scheme.
Pharmacists will also be able to work more flexibly which will enable more to choose to take up the posts, and we are streamlining the process of application so it is now quicker and easier for practices to gain approval from the programme.
The role of a clinical pharmacist in general practice has been developing for some time and is now an integral part of the transformation in GP services which involves making better use of the skills of the wider healthcare workforce.
According to a report in the British Journal of General Practice (BJGP) published in February 2018, a GP practice serving around 30,000 patients can expect to issue half a million prescriptions a year. It will have 1,000 patients on more than eight medicines, there is a potential prescription error rate of 5%, and they might reasonably expect around 300 medicines-related hospital admissions.
As the authors wrote in the article: “Subtlety and complexity of medicines and the increasing amount of NICE-endorsed and hospital specialist ‘silo prescribing’ means medication review by medicines experts in primary care is now essential. However, this type of work is currently difficult to achieve in general practice due to a lack of dedicated time and appropriate specialist skills. We believe such complex medication reviews should be the focus of practice-based clinical pharmacists.”
We know from the recent evaluation of practices which have employed a pharmacist that they are really proving their worth in delivering medicines optimisation, bringing multiple benefits to patients, relieving the pressures on GPs and reducing hospital admissions.
The evaluation found that:
- 70% of pharmacists reported clinical medication reviews being a major part of their role
- 63% of pharmacists reported doing hospital discharge medicines reviews every day.
A key benefit is their contribution to patient care through being able to undertake their own clinical caseload. It was estimated in the BJGP article that one clinical pharmacist post saves a practice 80 hours a month of GP time or the equivalent of two working weeks a month across the practice.
Pharmacists working in general practice play a key role in joining up patient care across primary and secondary care by working closely with other healthcare professionals such as community and hospital pharmacy teams.
When carrying out an in-depth clinical medication review, pharmacists are able to spend longer consulting with patients so any issues can be discussed in detail. Continuity of care can also be established which means the pharmacist can better understand their patients’ circumstances and needs with regards to their medicines.
It is often the case that clinical pharmacists treat those patients who already have a diagnosis, typically those with long term conditions such as asthma, diabetes, high blood pressure and arthritis. They can give individual advice about how medicines work, carry out monitoring and checks, and talk about side effects, providing much needed reassurance and clinical advice to patients. Many are already prescribers when they take up the role, and those who are not are being trained as part of the programme.
Clinical pharmacists can often step in where traditionally a GP appointment would have been needed. As independent prescribers they are able to monitor trends and interpret blood results to focus on reducing any potential harm that can come from the long-term use of medicines or poor compliance.
With the growing evidence that some patients are on some medicines for too long, or taking medicines which are no longer suitable, practice-based clinical pharmacists help to deliver better outcomes for patients, including stopping some medicines which are no longer needed.
The relaxation of the criteria for the clinical pharmacy programme aims to spread the net wider so many more GP practices can reap these benefits and more pharmacists can take up what is a really satisfying career choice.
We know that clinical pharmacists provide a valuable service for patients and contribute greatly to the smooth running of practices. What we need now is for more practices to take up the scheme; the end goal being more patients and GPs benefiting from the introduction of the pharmacy and medicines expertise which has been firmly established as a significant element of the general practice team.
To hear from the authors of the BJGP article, Dr Lawrence Brad and Steve Williams of the Westbourne Medical Centre in Bournemouth, see our short film: I’d like to see a clinical pharmacist:
For more information see: Clinical pharmacists in general practice: a necessity not a luxury? And University of Nottingham evaluation report