What is your role as a practice-based pharmacist?
Ravi I am a practice-based pharmacist employed directly by the GP practice, on a full-time basis.
I work alongside the GPs and nurses as part of the clinical team. The role makes full use of my clinical skills to help the team deliver high-quality care to patients.
Being in general practice, you have to be flexible, so my timetable can change on a day-to-day basis if patients would like to see me or if other work, such as audits or CQC preparation, needs to be done (see page 37 for an illustration of my typical working day).
I am heavily involved in the way the GP practice runs day-to-day. Some days, I have the capacity to see up to 40 patients. This helps to free up a lot of GP time, which in turn allows the GPs to spend more time with patients and to see more patients daily, reducing waiting times for appointments.
What are the successes and challenges of this set-up?
Ravi The healthcare teams have been very forthcoming and excited about the introduction of a pharmacist to the team.
One small challenge at the beginning was educating the team and patients about the role of the pharmacist in general practice.
Most of the general public and many healthcare professionals are unaware of the role and how they could potentially benefit from it.
I think the most successful aspect of working this way is that you really notice how the skills of pharmacists, nurses and GPs complement each other.
We have shown that by having a pharmacist as part of the practice team, we can all work together in collaboration to improve patient health outcomes and deliver higher-quality care.
Jane This way of working is the future of general practice, allowing all healthcare professionals to work together in teams, sharing their knowledge, skills and expertise, to help improve patient care.
I think the main challenge, initially, was understanding what a pharmacist could offer the general practice team.
The benefits are numerous - by having a pharmacist on our team, we have been able to reduce waiting times for appointments, improve patient health outcomes, increase access to healthcare, improve screening and diagnosis of chronic and common ailments, reduce A&E admissions and attendances, reduce medicines wastage and overuse, and overall, improve patient safety regarding use of their medicines.
The pharmacist's skills and knowledge are a huge benefit to the team and the patients.
Our patients have been extremely pleased with the contribution our practice-based pharmacist has made to their healthcare.
Should this model now be rolled out nationwide?
Ravi There is a real shortage of GPs at present. Although more GPs are being trained, we really have to think differently about how we provide healthcare.
Demand is rising fast as the population ages. Rather than piling more pressure on hospitals and A&E, we want to provide care close to where people live, through GP surgeries.
By expanding the practice team to include pharmacists, with their skills and knowledge, we will increase GP practices' capacity to see and help more patients. With pharmacists working alongside GPs, we can make sure that patients receive the best care in the most effective way.
What clinical skills can a pharmacist provide?
Ravi I am an independently prescribing pharmacist. Some of the clinical skills a pharmacist can bring to the practice and its patients include:
- Providing expertise in clinical medicines reviews and addressing public health and patients' social care needs.
- Ensuring safe, effective, rational use of medicines.
- Monitoring patients taking high-risk medicines or those with a narrow therapeutic index.
- Reconciling medicines following hospital discharge and working with patients and community pharmacists to ensure patients receive the medicines they need following discharge.
- Managing repeat prescribing reauthorisation procedures by reviewing requests for repeat prescriptions and medicines reaching review dates.
- Managing medicines queries from patients and healthcare professionals.
- Implementing drug alerts and withdrawals, for example, MHRA alerts.
- Developing and running pharmacist-led clinics, such as medicines use reviews and chronic condition management.
- Screening, diagnosis and initiation of treatment and follow-up appointments in patients with long-term conditions.
- Monitoring long-term conditions and identifying any early deterioration.
- Providing medicines information and training to practice healthcare professionals and other staff.
- Reviewing pathology results for patients on known medicines.
- Triaging patients to appropriate practice services and/or healthcare professionals.
- Conducting home visits.
- Helping prepare for CQC visits.
I also provide child and adult immunisations, spirometry, phlebotomy, diabetic foot checks, cardiovascular risk assessments, NHS health checks, dementia screening and falls risk assessments, among other services.
What is the impact on GP workloads and prescribing?
Jane Ravi is solely responsible for the repeat prescribing process in the practice. He has been able to streamline it and improve its efficiency.
By having him manage the repeat prescribing process, we have been able to identify prescribing errors and make improvements to our prescribing, which in turn improves patient safety concerning use of their medicines.
Ravi also manages all medicines-related queries that come into the practice.
Many GPs would agree that matters relating to medicines, especially repeat prescribing, can be very time-consuming. What used to take me an hour a day to do now only takes 10-20 minutes. This means I can focus on other areas of general practice and offer more appointments to our patients.
Pharmacists bring other skills and attributes to the team, which can also reduce GP workload.
Ravi sees a substantial number of patients every day. Many of these appointments would normally be allocated to a GP. This has massively reduced the pressure on the GPs in our practice.
- Mr Sharma is a practice-based pharmacist and Dr Muir-Taylor is a GP clinical lead in Stratford, east London