GP practices

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Working with clinical pharmacists

An increasing number of GP practices are recruiting clinical pharmacists to address different aspects of workforce need. While employment models and the roles and responsibilities vary, many practices have found that having a clinical pharmacist means GPs can focus their skills where they are most needed, e.g. on diagnosing and treating patients with complex conditions. This will help GPs manage the demands on their time.

 

Next phase of the Clinical Pharmacists in General Practice programme

Following the success of the 2016 pilot, NHS England invited GP practices to apply for funding to help recruit, train and develop more clinical pharmacists to meet its GP Forward View commitment of an additional 1,500 additional clinical pharmacists in general practice by 2020/21.

Practices participating in the programme receive funding for three years to recruit and establish clinical pharmacists in surgery teams. The first seven waves of applications have taken place with 1,834 surgeries in the country now having access to 810 whole time equivalent clinical pharmacists in patient-facing roles as part of the multi-disciplinary team.
See the list of successful sites.

The deadline for the ninth wave of applications is 31 May 2019. Visit the NHS England website for information on further opportunities to apply. Practices who been unsuccessful in previous waves will also be able to reapply. NHS England has published guidance for applicants on its programme web page.

Applicant sites that have already been accepted onto the programme will be sent the Enhanced Service Specification directly from NHS England. To complement this, the BMA has produced a template agreement which can be adapted to suit the needs of each particular provider site/collaborative arrangement. The adaptable nature of the template agreement means that any practices and providers who use it must take their own independent legal advice before it is signed by the relevant parties. Further advice on this process will be sent by NHS England to successful practices. 

In July 2015 NHS England launched a clinical pharmacists in general practice pilot.

Why employ a clinical pharmacist?

Feedback from practices involved in NHS England’s 2015 pilot suggests that by employing clinical pharmacists many practices have been able to reduce waiting times for appointments, increase access to healthcare, improve screenings and diagnosis of chronic and common ailments, reduce A&E admissions and attendances and reduce medicines wastage and overuse.

NHS Alliance and the Royal Pharmaceutical Society put together a list of functions a pharmacist can perform in a GP practice. These broadly break down into four areas:

  • Clinical services - working with GPs and patients to address medicine adherence, reviewing patients on complex medicine regimens, triaging and managing common ailments, responding to acute medicine requests and managing and prescribing for long-term conditions (often in conjunction with the practice nurse)
  • Prescription management - dealing with medication for patients recently discharged from hospital, supporting the practice to deliver on the QIPP and QOF agenda and enhanced services, delivering repeat prescription reviews, being the point of contact for all medicine-related queries and overseeing the practice’s repeat prescription policy
  • Audit and education
  • Medicines management

Pharmacists can hold minor ailment clinics, freeing up GP appointments and time. They can also be responsible for all prescription-related queries and clinical medicines reviews can be handed over from GPs to the pharmacist. Equally, in the case of a dispensing practice, a pharmacist can take responsibility for effective business management of the dispensary.

Employing a pharmacist can also save GP locum costs.

 

How to employ a clinical pharmacist

The Primary Care Pharmacists Association have produced a guide for GPs on employing a practice pharmacist, which includes a summary of what pharmacists can do for you, outlines of the different methods of recruitment available, sample job adverts and sample practice pharmacist job descriptions.

Their guidance also includes advice on the different methods of recruitment and for employing pharmacists. For instance, through:

  • Direct employment
  • Locum hire
  • Contract from CCG, CSU or a private contractor

The BMA has also produced a template agreement which can be adapted to suit the needs of each particular provider site / collaborative arrangement. The adaptable nature of the template agreement means that any practices and providers who use it must take their own independent legal advice before it is signed by the relevant parties. Further advice on this process will be sent by NHS England to successful practices.


Case study

Tamar Valley Health medical practices in Cornwall have recruited two primary care pharmacists. They have shared their experience with medeconomics.


What their pharmacists do

“The pharmacists’ job description has evolved over time: initially all the prescription queries were handled by them which freed up a good deal of GP’s time. Both pharmacists have completed the Independent Prescribing course (supported by the practice), so are able to prescribe in areas in which they are competent. I feel this qualification enhances the scope of a practice pharmacist and increases their job satisfaction.

Patient medication queries generated by patient requests for prescriptions, or prescribing recommendations from other health professionals, are dealt with by the pharmacist. Again, this saves our GPs valuable time each day – around half an hour a day per GP.

Medication recalls and safety alerts are dealt with promptly, since the pharmacist has immediate access to patients’ records, and can quickly carry out searches. For example, a recent NovoMix 30 patient-level recall was dealt with, and letters sent to patients within hours of receiving the alert.”


Working together

“Being a part of the primary care team means that professional relationships can also be formed with the auxiliary team, such as community nurses, community matron, diabetic specialist nurses. Pharmacists attend the practice monthly clinical cases meetings, where their input is valued, and participate in the regular clinical governance meetings. There has been a further change in our practice pharmacist’s role with the introduction of a new telephone triage appointment system. Patients are now directed to an appropriate professional to deal with their need, such as a practice nurse or a GP. This now includes the pharmacist since they are well able to deal with minor ailments, again freeing up GPs’ time and appointments.”


How much does it cost?

“The cost of employing a primary care pharmacist is between 35k and 45k per annum. However, the savings delivered as a result of their expertise have been beyond that. For example, part of the pharmacists’ role is to run the dispensary more efficiently. Changes that have been implemented have enhanced income and produced savings for the business totalling tens of thousands of pounds per annum.

In addition, though the practice doesn’t directly benefit from the savings, our prescribing budget in 2012/13 was £60,000 less than previously by targeting a number of prescribing switches. This is a significant saving for the NHS”.

 

Connecting doctors

Pharmacists begin to take the weight - Read Dr Mike Parks' blog.

 

Resources

NHS England information about the clinical pharmacists in General Practice initiative.

BMA/GPC guidance on working with community pharmacists.

BMA’s page on the clinical pharmacy pilot.

BMA template agreement for the provision of clinical pharmacist services

 



GPC would like to hear from you. You can contact us about these issues at [email protected]

Do you have an example where you've worked with clinical pharmacists in your surgery? Have you been a part of the NHS England trial? Tell us about what has worked and what could be done differently.

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