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GPs: working with them, or for them?

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GPs: working with them, or for them?

This new scheme could provide the long-awaited missing link to allow us better integration and collaboration with our GP practices

Over 200 pharmacists will soon be employed by GP practices using government funding. Mukesh Lad considers the opportunities and challenges associated with this new initiative

The recent government announcement of £15m funding to integrate clinical pharmacists into GP practice is a positive development for the pharmacy profession as a whole. We’re being offered an unprecedented opportunity to show how our expertise in medicines management can add value to primary care through the optimal use of appropriate prescribing. This is the real meaning of pharmaceutical care.

Early details emerging from NHS England indicate co-funding for 250 pharmacists who, it seems, will be directly employed by a GP practice. The apparent aim is for the pharmacist to focus on patients with long-term conditions and assist them with use and adherence issues. Not only will the patient benefit from greater education about their condition and treatment, but the practice will gain enhanced capability and improved patient outcomes.

This new incentive pilot programme will provide 60 per cent of the necessary funding in year one to employ a pharmacist. Then, 40 per cent of the funding will be provided in year two and 20 per cent in year three. By the fourth year of what is currently a pilot scheme, the GP practice will be required to bear the full cost of employing the pharmacist.

It’s a ground-breaking initiative and it poses some interesting questions. What level of autonomy will be afforded to a GP-employed clinical pharmacist in order to work with community pharmacies? How will they ensure effective communication between clinical pharmacist, patient and community pharmacist?

The risk element

There’s a real risk that unless this programme is managed collaboratively at local level between GP practices and their pharmacy colleagues, the pharmacist operating from within the practice will simply become another cog in the wheel of process, adding further bureaucracy across the local healthcare economy. Aren’t we all – GPs and community pharmacists – already overburdened with paperwork?

Many patients with long-term conditions have multiple comorbidities creating issues around polypharmacy needs. Clarity of responsibility for the treatment of this type of patient will be imperative. How will the new scheme ensure patients, their healthcare professionals and personal carers are adequately informed of new care processes and their impact?

GP practices are being invited to bid for funding from Health Education England, with several professional bodies including the Royal College of GPs, the British Medical Association and the Royal Pharmaceutical Society helping commissioners to select pilot sites. It’s therefore important for community pharmacies, and particularly the independent members of our profession, to ensure they’re adequately informed about the processes being put in place for effective communication between them, the GPs and the practice pharmacist.

Training needed

Training and up-skilling in specific clinical areas will be a key component of the successful implementation of this initiative. The Centre for Pharmacy Postgraduate Education (CPPE) quickly confirmed its status as a delivery partner with NHSE and HEE for what they describe as a ‘new group’ of clinical pharmacists.

Whilst we are looking at a new generation of pharmacists based in general practice, we shouldn’t allow this to detract from the importance of the patient-facing services and medicines optimisation work already being undertaken in community pharmacy. The emphasis for those pharmacists chosen for the pilot sites must now be on training aligned with the specific GP surgery requirements. This doesn’t necessarily mean a clinical pharmacist programme.

From a community pharmacist perspective, this new scheme could provide the long-awaited missing link to allow us better integration and collaboration with our GP practices in delivering a more holistic package of primary care to patients. Furthermore, our prescription queries could be directed to the ‘practice pharmacist’ instead of the practice manager or receptionist, resulting in a quicker response and resolution of the problem.

Opportunity for independents

Even more important is the opportunity now on offer for us as independent pharmacies. We are more likely to have the same pharmacist on duty throughout the week compared to the changing face of the many duty pharmacists at the multiples. This means we’re far better placed to build relationships with our colleagues within the GP practice and foster a better understanding of each other’s professional capabilities and requirements.

Over the past 20 years successive policy changes have moved the pharmacist’s role ever more towards a provider of healthcare, advising patients on the use of their medicines, self-care and lifestyle. However, until now, this change in role seems to have been introduced in isolation from other primary care services, particularly without connection to general practice.

We are now seeing the creation of an opportunity to build successful relationships and break down old barriers. GPs now have the opportunity to better understand how community pharmacists deliver services into the local community. At the same time, they will be able to recognise our skills and experience in enhancing patient benefits.

I want to urge all independent pharmacists to embrace this new initiative as an incentive to prove to GPs the value of our profession in the new model of care now being proposed. If we support our fellow pharmacists, we’ll be helping to create a new career pathway for new entrants into our profession. The timing is perfect and I hope it will encourage a new generation of highly-trained, extremely motivated and openly welcomed new pharmacists.

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