The Clinical Pharmacist in General Practice programme announced the successful wave 1 sites this week and this offers pharmacists a fantastic opportunity to realise a proportion of their potential within the primary care team. However, I have huge concerns about funding levels. An investment of £112 million following the pilot studies investment of £31 million sounds like a fortune but the money is being spread too thinly. How do I know? I know because I was heavily involved in a pre-pilot, pilot study in 2015/16.
For our study based in North Yorkshire, was based the number of FTE pharmacists was calculated on a ratio of one FTE pharmacist per 10,000 and that ratio allowed pharmacists to complete medication reviews, process hospital discharges and out-patient treatment requests and also see patients in clinics, real, practice changing stuff. One pharmacist per 30,000 won’t allow that to happen and that worries me.
If you listen to some commentators and the left-leaning media, the NHS is in crisis. I don’t agree, yet. It will be soon, as many GPs and practice nurses accelerate towards retirement and this will leave an aging population with an increasing number of co-morbidities with fewer healthcare professionals to support them. Chuck the negative impact of Brexit into the staff retention cauldron too and things don’t look good further down the line.
The Clinical Pharmacist in GP practices programme has the potential to really change the way primary care operates. At Medacy we say that once a patient has been diagnosed by a GP then every other medication related aspect of their care should be managed by the practice pharmacist. GPs are an expensive and increasingly rare resource, so they should be left to the work only they can do – diagnosis and overall care management with most of their time spent in patient facing activities. The rest of the existing workload should be shared by other healthcare professionals. One FTE pharmacists per 30,000 patient aren’t enough to allow pharmacists to realise their full potential and although a £150 million investment is welcome, it isn’t enough. Further investment will deliver directly proportional benefits to practices and the wider NHS and it needs to be done now before the looming crisis hits.
To illustrate, a 10,000 patient surgery is well above average and would get just over 12 hours of pharmacist cover per week. No pharmacists would spread 12 hours over five days so the only option is to provide cover over 2-3 days. The reality of that is that a practice can’t hand over the responsibility of any one task to their practice pharmacist as that task won’t be completed when the practice pharmacist is not on site. One per 30,000 might be OK for CCG type medicines optimisation work but that doesn’t deliver benefits to the practice just the CCG. To deliver real change and benefits to both the practice and wider NHS, investment needs to triple to a ratio of 1:10, 000 and at that level, pharmacists can deliver on their potential and fundamentally change primary care.
