General Practice Pharmacy - Pharmacist in practice

What are the 2 ways pharmacists can be employed in GP?

Directly through the surgery or through integrated care boards (used to be known as PCN)

What are the general roles of pharmacists in GP practice?

Medication related, patient related, training and interprofessional relationships, paperwork-based

What is the medicine-related role of a pharmacists in GP?

• Medicines management - use, prescribing and storage of meds

• Medicines reconciliation following pt discharges from hospital, counsel on new medicines usage, ordering blood test and follow ups

• Help achieve care when pts move between care settings

• Conducting disease management clinics in area of competence

• Reauthorising repeat medications - can re authorise repeat cycle of medicines, can include clinical review

• Medicines optimisation

• Therapeutic management of high-risk medications, counsel on correct usage

What is the term to describe ensuring patients are only taking medication they need to take?

Medicines optimisation

What are the patient-related roles of a pharmacist in a GP practice?

• Respond to medication and prescription queries

• Undertaking telephone triage - can ask necessary questions to determine whether the patient needs to be seen/by who, can signpost to selfcare

• Assessing the patient clinically

What are the training and interprofessional relationships role of a pharmacist in a GP?

• provide education, training and support for the practice team - can be involved in developing and delivering training to practice team

• Assisting in medicine related queries from other healthcare professionals e.g., options for OOS medicines, suitable formulations foe special patient groups

What are the paperwork based roles of a pharmacist in a GP practice?

• Analysis of prescribing and other practice performance data

• Developing policies and guidelines, can include developing formularies

• MHRA alert monitoring - see if practice level intervention is needed

• Clinical audits - prescribing, monitoring or other areas of practice

What are examples of prescribing/practice performance data bases?

Prescribing analysis and cost tabulation (PACT), prescribing local improvement scheme (PLIS), quality improvement framework (QIF), quality outcomes framework (QOF)

What is the term used to describe an evidence based and comprehensive review of medication that takes a holistic approach to the health of the patient?

Structured medication reviews

What are SMRs required as part of?

GP network contract directed enhanced service

What questions should the SMR contain?

Ask about medications taking, as well as checking routine tests are completed, checking the medication they are taking is clinically and physically suitable, take patients ideas and expectations into account

What is the name of the voluntary scheme in the general medical contract that was designed to reward GP practices for delivering high quality services?

Quality outcomes framework

What is the aim of the quality outcomes framework service?

Reward GPs for high quality services and to reduce inequalities in reatment that patients receive

What are the 2 main domains in the quality outcomes framework?

Clinical, public health

What is the total income of the QOF based on?

Number of QOF points achieved and contractor population index

What is the term to describe the practice size list divided by NHS agreed average list size?

Contractor population index

What are the defined target population for clinical indicators determined by?

Predetermined clinical diagnosis or another patient attribute e.g., age, sex

What are some examples of clinical indicators?

Hypertension, stroke, transient ischaemic attack, diabetes

When can specific patients be excluded from QOF?

If it would unfairly disadvantage the practice e.g., patients who refuse to attend review appointments 3x, newly diagnosis patients, patients where treatment isn’t clinically appropriate

What is the prescribing analysis and cost tabulation data sourced from?

Prescriptions submitted to the NHSBSA by community pharmacies, dispensing GPs and appliance contractors

What does the PACT data show?

Primary care providers prescribing habits within the NHS and is measured in terms of the cost of drug peer treatment period or volumes prescribed

What does PACT allow practices to do?

See areas requiring audit, spending on medicines and adherence to local formularies and national prescribing guidelines