Case study summary
Steve worked in hospital pharmacy for 25 years but was keen for a lifestyle change and to use his medicines expertise in primary care. Moving to this role has meant a move to live by Dorset coast, creating opportunities for both Steve and his family, for example dog walking, fishing, kayaking and swimming.
Making the move to clinical pharmacy has also allowed Steve to use his wealth of experience to try and reduce some of the medicines-related harm that causes avoidable hospital admissions. When the National Clinical Pharmacists in General Practice launched Steve was one of the first to apply for wave one, applying for a senior post on the Dorset coast.
Clinical Pharmacist in action
Since taking up his post of Clinical Pharmacists for Westbourne Medical Centre, Steve:
- Has introduced a new repeat medication policy, ensuring more patients have a medicines review, and reducing prescription queries.
- Provides daily telephone consultations for patients with medicines related questions.
- Runs medication review clinics for people on multiple medicines which include Quality and Outcomes Framework reviews for patients with long term conditions.
- Provides a care homes prescription management service for 300 residents.
- Helps the practice fully achieve its annual medicines optimisation incentive payments, including improving prescribing of antibiotics and blood thinning agents.
Steve is part of a team at Westbourne Medical Centre and works alongside GPs, a community pharmacist, a pharmacy technician, a nurse practitioner, a practice business manager, clinical governance and quality manager and a receptionist. They are all part of a high performing, integrated, multidisciplinary team dealing with complexity in primary care, centred on clinical pharmacy helping to contribute to team capability within the GP surgery allowing “the unit to deliver care”
For Dr Lawrence Brad, partner and practice prescribing lead, having Steve in the team was a learning opportunity, the ability to go to the next level of prescribing expertise and a door into specialist knowledge for the practice and local health system. Steve is able to provide advice relating to the increasing number of patients with complex issues and their medication needs, help follow up on patients with one or more long-term conditions, as well as helping the practice manage everyday prescription queries.
For nurse practitioner Janine Foy, Steve added the benefit of sharing professional knowledge both ways; a productive working relationship and key point of contact for medicines queries.
From a patients perspective, ‘Mrs G’ is taking multiple medicines. She received a letter inviting her for a clinical medication review. She met with Steve to have her medicines reviewed, and left feeling better and more confident as a result of changes to her medicines made by Steve resulting in an improved quality of life – so much so her friends are asking, when might they have access to a clinical pharmacist in their GP practice? ‘Mrs G’ now understands her medicines better.
Since NHS England’s pilot scheme for clinical pharmacists started, Westbourne Medical Centre has been very aware of the need to prove the worth of clinical pharmacists and has been collecting both process and patient outcome measures. They record all pharmacist activities that directly relate to patients (telephone consultations, face-to-face consultations for patients with polypharmacy, prescription queries, clinical tasks from clinicians, and medicines reconciliations post-hospital discharge) using a template on the practice software.
The team use metrics to assess all changes in general practice giving them relevant, objective and easy to collect data. The practice collectively agreed an average time needed to perform regular activities, which otherwise would have been done by a GP, and have estimated that one post saves GPs 80 hours a month, excluding indirect patient activities, the equivalent to two working weeks a month across the practice.
Identifying outcome measures has been much more challenging. In the absence of any other reliably sensitive and specific quality measures, the practice are using the new national medicines optimisation polypharmacy comparators.
Steve describes his biggest success to date as ‘getting two other general practices in the area to employ a pharmacist within the national pilot scheme. The practices had been considering it for a while but, having me in the role, and my passion for pharmacists improving patient care, demonstrated to them just how important these roles are going to be in general practice’.
Recognising the move from a senior role in the NHS to a new role that is emerging for clinical pharmacy, Steve recognises that this leaves him ‘feeling as though I’m new again and left to go back to basics!’.
Switching from a hospital to a GP setting has allowed Steve to help more patients who take too many medicines, and grow his understanding about how things work in general practice, as well as educating GPs on how useful the role of a clinical pharmacist can be.
Steve says ‘If you’re considering a career in pharmacy, or wanting a change from hospital or community pharmacy, I’d say you’ll never look back! You’ll be able to fully realise your potential as a medicines expert and the practice and the patients will be astonished about how much you know and how irreplaceable you are’.
Clinical Pharmacist, Westbourne Medical Centre