Clinical Pharmacist at the front line in providing healthcare to homeless

Case study summary

Marianne Tucker-Martin had always wanted to be a pharmacist and worked for a retail pharmacy for 21 years before embarking on her next step as a clinical pharmacist, through wave one of the National Programme of Clinical Pharmacists in General Practice in 2015.

To Marianne the benefits of being a clinical pharmacist working at the interface of primary care are clear; as a clinical pharmacist she is able to utilise a wide range of clinical consultation skills including health assessment, diagnostic intervention and care management planning including medicine optimisation to really allow the role of a clinical pharmacists in a practice to shine and demonstrate how pharmacists can be used as an additional clinician for the GP practice. Benefits such as extended appointment availability, creating same day access to emergency appointments, providing an increased access of care in an accessible format; all of which resulting in improved health outcomes and timely health interventions that can ultimately prove to be lifesaving.


In 2014, after 21 years of working for a retail pharmacy chain, Marianne was provided with an opportunity to demonstrate to a GP federation the skill a clinical pharmacist could provide to General Practice. In the autumn of 2015 a bid was submitted to NHSE for consideration of the roll out of the programme – this resulted in England’s largest bid site in wave one in the National Programme of Clinical Pharmacists in General Practice.

Since the roll out of the programme Marianne has led and mentored up to 28 clinical pharmacists locally, whilst retaining 18 hours each week within a GP Practice in a patient facing role.  Marianne believes passionately that clinical pharmacists are a real asset to General Practice and with commitment and dedication to an excellent NHSE sponsored programme of education delivered by CPPE and some clinical determination to demonstrate professional worth, opportunities can be identified, created, harnessed and delivered to support guidance in the General Practice Forward View.

Clinical Pharmacist in action

Using the NHSE Programme as a springboard, Marianne has been able to access further local Health Education England funding to build on her certificate in Independent Prescribing gained via the pilot pathway to that of an Advanced Clinical Practitioner which has led to the completion of a Masters in Advanced Clinical Practice. Marianne now works as a same day triage clinical pharmacist which has led to many clinical opportunities.

Working closely with a clinical mentor who has really engaged and understood the investment and outcomes of the structured educational pathway and development of a clinical skill set has allowed Marianne’s role to evolve.

Marianne notes that ‘At times this has stretched my personal confidence but once put in to practice has resulted in some amazing clinical gains, patient experience and job satisfaction. For one thing, I now provide a weekly in reach clinic to the homeless shelter in Worcester. For the first time this has led to some clinical relationships with patients who have historically found it difficult to obtain primary care services due the erratic nature of homelessness and the often associated drug dependence and illicit drug use that is commonly encountered’

The weekly in reach clinic has now developed to allow same day access to a clinical pharmacist for assessment, treatment and triage with a GP available if required. This has resulted in patients being empowered to make health care decision choices such as symptoms of suspected DVT that allow timely D-Dimer and Ultra Sound Diagnosis and the subsequent skill set of the clinical pharmacist for treatment, medication counselling, and improved access to medicine often working with community pharmacy for weekly or supervised consumption to aid compliance. It is a simple intervention but one that is utilised and being rapidly recognised by other hostels and shelters as a work towards model for improving care in the patient population.


Running the in reach clinic to provide healthcare to the homeless, whilst adopting the principles of evidence based medicine poses challenges for the clinical pharmacist, for one – never truly knowing when you will encounter the patient again or whether you can even make contact with the patient with their nomadic vulnerability. The clinical pharmacist has been crucial in creating an accessible service that is easy to understand and delivers a one stop shop principle, delivered by clinicians whom are able to relate and understand their patients challenges and whom are not afraid of working with the wider Multi-Disciplinary Team to deliver and optimise care.

The impacts made by the service are clear:

  • The service provides improved access to patients and creates a diverse allied work force fully utilising the skill set of a clinical pharmacist. Working with the advanced skill set of a clinical pharmacist is useful in patients with disease requiring medicine optimisation or medicine related complications
  • Increased appointment availability allowing for personal and tailored care to the patient. Allowing care to be delivered timely and closer to the patient and over a period of time develops a culture of ownership of health to a patient population that has historically been a challenge to the traditional model of primary care services
  • Reduced operating costs within the practice thus delivering effective and optimal care
  • Practice staff feel supported with GP’s having a further clinician to provide clinical support, through to a receptionist being able to offer immediate appointments.
  • Creates development opportunity for the clinical pharmacist role to be used wider than the confines of the practice. The clinical pharmacist is exposed to substance misuse managementand prescribing whilst utilising all skill sets developed over the 3 year programme.

Lessons Learnt

Marianne says of the clinical pharmacist role ‘At times the role can feel like very new territory, but with experience you soon realise this provides a huge opportunity for the profession. Primary Care is evolving and it is essential that clinical pharmacists are part of this new pathway to create a role that firmly embeds the profession for years to come bringing the skill set of the pharmacist ever closer to the patient’.

Whilst determination and passion are crucial to the success of the clinical pharmacist role, Marianne also believes more can be done to tackle barriers that may arise such as the need to develop internal self-belief and professional leadership.  Marianne believes that ‘In the early days I anticipated that local services would have been developed to include the emerging role of the clinical pharmacist but this has not been the case. It requires determination and persistence of the individual to show case your skill set and to demonstrate and sing its benefits both loud and proud. Personally this has been about recognising this has been a once in a life time career opportunity and the determination to create a local legacy that will allow other professional peers to walk my career pathway in years to come allowing them to experience the immense clinical reward I am able to experience each day’.

Key Contacts

Marianne Tucker-Martin
Lead Pharmacist, SW Healthcare GP Federation