Case study summary
By placing a clinical pharmacist in GP surgeries it has reduced the need for patient GP appointments by 30%, making a significant impact on GP workloads and patient outcomes.
Karen Acott has been a clinical pharmacist at the Wallingbrook Health Group in Devon since 2004. She is a full partner in the group, which covers practices in Chulmleigh and Winkleigh.
As a prescribing pharmacist, she sees patients in clinics and delivers telephone consultations, handling all aspects of medication management. Over the years, her work has reduced the need for patient GP appointments by 30%, making a significant impact on GP workloads and patient outcomes. A 2016/17 audit of workload impact showed that having a pharmacist working four sessions a week resulted in over 400 hours of GP time was saved over the course of the year.
Karen explains: “My focus is on patients whose conditions and medication are reasonably well controlled and stable and our aim is to improve self-management. Within my consultations I also devote time to help patients learn how to self-care and give them confidence and information that empowers them.”
While the role of the clinical pharmacist in general practice has been developing for some time, it is now an integral part of a transformation in GP services by harnessing the skills of the wider workforce. Karen is able to support GPs by highlighting where, for example, NICE guidelines have changed, by looking at how best practice is integrated into care processes. She is also able to provide guidance on medicines’ optimisation and care for patients with long term conditions.
Karen works together with the local healthcare community to design more efficient and effective ways of working. “I also look at all the agencies and health professionals involved in that patient’s care and try to ensure we are all working in harmony. A patient might also be receiving cognitive behavioural therapy or treatment for glaucoma at the secondary care level and I will check if those agencies are still in contact, what treatment they have had, while ensuring their repeat prescription is up-to-date and integrated into their care plan.”
Previously, GPs would run joint clinics with nurses for chronic disease management where nurses would carry out initial observations, such as blood pressure and breathing tests, and the GP would finish the review amending medications if necessary. In the early days, Karen would step in where traditionally a GP appointment would have been needed. As a trained prescriber, she is able to monitor trends using blood results focusing on potential harm that can come from long-term use of medicines or poor compliance.
Having a prescribing role is crucial, she adds. “I was one of the first cohorts to qualify as a prescriber. Being a prescriber in my own right means I can look after a caseload and be totally accountable for what I do. I’ve always found it personally more rewarding to do more clinical work with patients than being in a traditional dispensary role; however, in future I believe I can work with my community pharmacist colleagues to support them in providing direct care to patients too.”
Dr Diana Wielink, senior partner at the practice, says “having a pharmacist in our organisation has enabled our health group to become safer and more cost effective prescribers. Our prescribing performance is always one of the best in Devon, with excellent clinical outcomes for patients”.
Ultimately, Karen has been able to make the role of group clinical pharmacist her own. She says: “I am a part of the primary care team and am recognised as an important part of the team. No GP would set up a practice without a nurse or a practice manager. In my view the same should now apply for a pharmacist. It’s about bringing these skill sets together to deliver safe and high quality care. All these health professionals working together can deliver the right outcomes for patients. My advice to others considering including a pharmacist within the practice team would be just do it, you won’t regret it!”
For further information please contact:
Karen Acott, FFRPS, FRPharmS, MIoD
Wallingbrook Health Group
Telephone: 01769 580295