Lecture 21a: The Pharmacy Workforce | Primary Care Pharmacy (GP Practice)

Primary Care

• NHS long term plan - collaborative working

• First point of contact for patients in healthcare system

• Main contact is GP. Also, community pharmacy, urgent care centres, dentists, opticians

• Primary Care Networks (PCNs)

Primary Care - General Practice

• GP practice roles (ARRS)

• Multidisciplinary Team working (MDT)

• Management:

  • Acute conditions

  • Long term conditions

  • Medication reviews

  • Referrals

  • Public health

  • Support services

Quality Outcomes Framework (QOF)

• Voluntary annual incentive and reward programme

• Various domains to support patient care

  • Clinical domain (437 points)

  • Public Health domain (127 points)

  • Quality improvement domain - now retired (April 2025)

General Practice Pharmacy

• Network Contact DES Specification

• Additional Roles Reimbursement Scheme - Clinical Pharmacist

• Must be enrolled in or have qualified from an accredited training pathway that equips the pharmacist to be able to practice and prescribe safely and effectively in a Primary Care setting

• CPPE Primary Care Pharmacy Education Pathway (PCPEP)

Responsibilities

• Medicines optimisation - doses, prescribing/deprescribing (SMRs)

• Medication reviews

• Long term conditions management

• Advice - patients and other HCPs

• Drug monitoring

• Medication safety

• Counselling

• Audit

• Medicines reconciliation

• Guidelines

• Medicines management (EBM)

• Cross-sector communication/collaboration

Independent prescribing

• Prescribing now embedded into MPharm

• GPhC professional standards

• Autonomy

• Within scope of practice - boundaries of clinical practice

• Indemnity insurance

GPhC standards

Local formulary

Typical day

Structured Medication Reviews (SMR)

• An evidence-based and comprehensive review of a patient’s medication, that would normally be carried out by a clinical pharmacist or doctor, taking into account all aspects of the patient’s health

• Medicines optimisation strategies for reducing polypharmacy, minimising risk of prescribing harm, reducing over-prescribing and managing risk of dependency on prescription drugs

• PCNs to use SMRs for high-risk cohorts

SMR outcomes

• Medicines optimisation

• Reduce hospital admissions related to medications

• Reduce medicines wastage

• Patient education

• Cost savings

Hypertension clinic

• Initiation clinic

• Dose optimisation

• Monitoring:

  • Blood pressure

  • Bloods

• Questions/infomation

• Follow up

• Escalation/referral

Care home ward round

• Weekly care home visit

• MDT - GP, pharmacist, paramedic, nurse, HCA, care co-ordinator

• Shared decision-making:

  • Patient

  • Parent/carers

  • Nurses

  • Best interest - mental capacity assessment

Diabetes MDT

• Monthly review of diabetes patients in care homes

• Clinical pharmacist and diabetes specialist nurse

• Consistent prescribe (particularly insulin)

• Regular monitoring (including QOF)

• Escalation to GP if needed

Tasks

• Medicines reconciliation - Docman

• Pharmacists advice - EMIS:

  • Alternatives

  • Interactions

  • Calculations

  • Formulation changes

  • Prescribing decisions

  • Dose adjustments

  • Drug warnings

  • Product recalls

Future

• Specialist in medication

• Patient centred care

• Shared decision making

• Holistic approach

• Improves patient access