I am a partner and pharmacist at the Tamar Valley practice, a successful rural practice with two sites nestled in the beautiful Tamar Valley in east Cornwall. We are a large practice with 16,000 patients and have an excellent practice team. However, like many practices, we are now having difficulty recruiting GPs to be part of our clinical team.
The workforce issue facing general practice has been described as ‘fast approaching crisis point’. The GP clinical workload has increased by 16% and patient consultation rates are up by 12.4%, while the number of full-time equivalent GPs decreased by 1% between 2007 and 2014.1
There are a number of solutions to this pivotal crisis, from increasing investment in general practice to expanding GP training places. Another, is a move away from the doctor-centric model, by expanding the practice team with roles for different types of clinical support staff, such as pharmacists.
NHS England’s General Practice Forward View is aiming to bring more pharmacists into general practice and is partially-funding practices to employ a pharmacist.
Why should practices employ a pharmacist?
So, why should practices consider employing a pharmacist and what can they expect from this role?
Each GP practice will on average prescribe over 140,000 medicines each year. The prevalence of ‘poly-pharmacy’, those receiving 10 or more regular medicine for treatment of co-existing major diseases, is estimated to be nearly 6% of patients.2 The medicines management associated with this prescribing is a huge but important burden for practices.
This is where the role of a practice pharmacist, an expert in medicine, can support the clinical team. At Tamar Valley Health, we have successfully incorporated pharmacists into the structure of the practice.
The role we created, focuses the pharmacist on all of the medicine-related tasks that our doctors previously would have done: clinical medication reviews, prescription management, issuing medicines recommended by third party clinicians, updating medicine regimes after discharge, and any medicine-related queries or follow-up.
This saves our doctors around 1-1.5 hours per day. Our experience has also shown that patients value this new addition to the practice team and they actively seek the pharmacists’ support on medicine-related issues.
Recent evidence from a Cochrane systematic review has supported our own observations that a pharmacist prescribing can be safe, effective and improves patient outcomes.3
Taking on more responsibility
The pharmacist role in our practice has had to expand further than medicines because of the challenge posed by the increased patient demand for consultations. Our pharmacists now consult, diagnose and treat patients with common acute illnesses.
Initially this was a challenge for our pharmacists as their professional training focuses on self-limiting conditions, but with training on diagnosis, treatment and risk management they have been able to support the urgent, on-the-day appointment demands of general practice.
So, does every practice need a pharmacist? In our experience, choosing to bring in a pharmacist to the primary care team saves both time and money and significantly improves patient care.
At a time where other clinicians are becoming more scarce and, with increasing prevalence of patients with multi-morbidity and complex medicines regimes, those GP practices that do employ pharmacists will help ensure their future and the future of the NHS.
- Mark Stone is a partner at Tamar Valley Health Practices in Cornwall
- Hobbs FDR et al, on behalf of the National Institute for Health Research School for Primary Care Research. Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007–14. Lancet 2016; 387: 2323-30.
- Duerden M, Avery T, Payne R. Polypharmacy and medicines optimisation. Making it safe and sound. London: The King's Fund; 2013.
- Weeks G, et al. Non-medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care. Cochrane Database of Systematic Reviews 2016; 11: CD011227.