Improving Efficiency and Reducing GP workload: Practice Pharmacists.

I am a practice pharmacist and very proud of that fact!

I am also proud of how many pharmacists have stepped up to the challenges set within the NHS Long-term Plan and have developed themselves to thrive in the General Practice arena. But I am also aware that not all the marriages between GP practices and Pharmacists have been made in heaven and I wanted to explore why that might be, as I truly believe that the RIGHT pharmacist in practice can fundamentally change the way that practice functions and most importantly, can be the answer to GPs dreams!

Well perhaps not quite the answer to your dreams but a good pharmacist can take so much of the workload off the GPs and easily prove themselves an indispensable member of the team within a concise period of time.

Practice Pharmacist: been there, done that.

Please don’t stop reading if you are thinking ‘been there’ or ‘done that’ and that it didn’t work for you. It might be that you didn’t find the right pharmacist or maybe that you didn’t have a clear enough focus as to what that pharmacist might do, to really make a positive impact in your practice.

Some of the problems with free money’ or ‘pockets of funding’ to spend are that we sometimes don’t really value what it is to be spent on and fail to invest time and energy into getting the most from that resource. I will also be the first to acknowledge that many pharmacists who plunged into funded Primary Care roles did so without really understanding what would be expected of them and without the necessary upskilling of themselves to meet the challenge.

However, things have now settled down, and I know there are many of you out there shouting from the rooftops about how well your practice pharmacist is doing. Those practices that thought through and embraced what a pharmacist might bring to the table have steamed ahead with much of their day-to-day workload being met by this resource. In fact, many practices are further building the capacity and may have more than one pharmacist on their clinical team. These same practices will be the ones who also gain the most from the PCN roles by understanding and trusting how the PCN pharmacist role stands to benefit them, and more importantly, their patients.

I could wax lyrical until the cows come home about the ‘types’ of pharmacist-led projects that are up and running and some of the fantastic work being undertaken across the country. Still, I want to focus, in this article, on efficiency.

Practice Pharmacists – How they can free up GP time

So, how might you free up GP time in practice by using a pharmacist, so that the practice runs more efficiently?

Let’s look at some of the day-to-day tasks contributing to the GP workload.

• Medication Reviews & Repeat Reauthorisations

I think this is where a pharmacist really comes into their own. After all, medication and pharmacists are joined at the hip from birth, so why wouldn’t this be an ideal task for a pharmacist to tackle? At the end of the day, if your pharmacist is clinically knowledgeable and up to date, they are working to the same guidelines as a GP so why wouldn’t they be able to carry out the task just as well as a GP?

With an agreed protocol in place, an understanding of monitoring requirements and good consultation skills (when required) a pharmacist can efficiently and accurately undertake all your medication reviews in practice, only referring to the GP if there is a concern. Many practices have taken this a step further. Also, they have mandated the pharmacist to undertake some of the long-term condition reviews simultaneously and set in place the foundations for a more efficient approach to review and reauthorisation in the future.

Imagine, in 12 months, every patient is now reviewed to birthdate, and all monitoring and recall activities are scheduled to be completed before that date! How efficient would that be? It is completely doable; it just needs someone to take the lead.

• Medication Queries and shortages

GP Moans

The greatest moan and the biggest gain for a GP revolve around handling med queries and drug shortages. How annoying is it when you see a whole list of queries to be dealt with at the end of the morning or afternoon session or when you are duty doctor?

Again – imagine that list gone for good! Well, it will be if you have a good pharmacist on board. They already know what medications are in short supply and more importantly, what is available in their place. They will pre-empt prescription issues and provide solutions, not problems. Even when I am not in practice, I will receive queries from the dispensary or one of the GPs asking for a solution to a shortage or concession problem. And I hope I give advice which saves the GP time and money as I will always have the most cost-efficient and profitable alternative to hand and make sure the practice team are aware.

• Hospital Discharges, Clinic Letters and Requests for Treatment from other clinicians

Efficient handling of clinical documents is key if patients are to remain safe. Such communications must be processed as quickly as possible, and in some cases, the patients are contacted to discuss any changes to their medications. In fact, if documents are completed within a day or so of receipt and the patient informed, it often prevents that patient from coming injust to check what is happening’ or ‘to let the GP know what happened at the clinic’.

Practice Pharmacist can ensure that documents are processed within 48 hours

Documents should ideally be processed within 48 hours and at most 72 hours to reduce risk to the patient. A pharmacist in practice can lessen this workload greatly and contribute to improved patient outcomes.

I know some practices will handle clinical mail via admin staff. This might improve efficiency as far as the job is done and coded, but who is overseeing medication changes? I have seen duplication of medicines where brand and generic have been added to patient records, and I have also seen speciality hospital medications being added without a shared care agreement in place and more importantly relevant monitoring considered and scheduled. One such patient had methotrexate tablets on their repeat while being injectable methotrexate at the hospital! Using a pharmacist, in part or fully, to complete this work is both efficient and safe. It also means the GPs can trust that the job is being done and that any mistakes will be picked up.

Three efficiencies

There we have three efficiencies that can be achieved with a good Clinical Pharmacist in practice. Of course, the list of GP tasks that a pharmacist can undertake is far longer, but I think this is a good illustration of how you could use a pharmacist to relieve GP workload and improve quality and safety.

I know that for some practices or PCNs it just hasn’t come together, and you are somewhat shell shocked from a failed pharmacist experience but if you are truthful, how much of the failure arose from the fact that you didn’t have the time to really work with the pharmacist to get the most out of them? It really is a chicken and egg situation. You are too busy to train or spend time with the pharmacist about how your practice works and what you want the pharmacist to tackle, and the pharmacist doesn’t know what you really want them to do!

Well, Pharmacists are here to stay, and if you want someone to relieve that ever-increasing GP workload, you may want to look again or even revisit what your existing pharmacist is doing, if you already have one on board.

If you require any further assistance or information on the alternatives to direct employment pharmacist services, please do not hesitate to ask: caroline@medacy.co.uk.