Clinical pharmacists within PCNs: another driver for collaborative practice?

Authors: Steve Williams (SW) is Senior Clinical Pharmacist, Poole Bay & Bournemouth Primary Care Network, and Honorary Clinical Lecturer, Manchester Pharmacy School, University of Manchester. Lawrence Brad (LB) is a partner and GP Prescribing Lead, Westbourne Medical Centre, Bournemouth. Jamie Hayes is Director, Welsh Medicines Resource Centre and Honorary Senior Lecturer, School of Medicine, Cardiff University, Cardiff

The prescribing of medicines is the commonest therapeutic intervention in healthcare and according to the World Health Organisation (WHO) ensuring safe medication use should be considered of central importance to countries working towards achieving universal health coverage.¹

The new GP contract in England now recognises the necessity for clinical pharmacists to ensure the optimal use of medicines for patients within all primary care networks. However, there has been much debate on the potential benefits of this national approach, as well as the clinical skills, therapeutics and knowledge & training required by clinical pharmacists to fulfil their role in the most meaningful and useful way. The benefits to patients are becoming clearer, but what about the benefits to the wider healthcare team within general practice?²

The interim NHS People Plan and NHS Patient Safety Strategy both highlight the different leadership challenge presented by the need for greater system collaboration and the call to think differently about the roles which multi-disciplinary team members will play. The RCGP has also highlighted the benefits of ‘Collaborative General Practice’ and suggests networks support the development of a coordinated and joined up approach to care for patients by focusing on the ten key building blocks of high-quality primary care.³

Through their training as problem solvers and critical thinkers, and a different perspective, clinical pharmacists score highly on several of these and there is already emerging evidence that clinical pharmacists’ contribution to practices goes beyond improving medicines and patient safety.⁴

“Leadership and vision”, “team-based care” and the “creating the future of care” blocks go hand-in-hand and some clinical pharmacists have already become Primary Care Network (PCN) Clinical Directors. Within Poole Bay & Bournemouth PCN the clinical pharmacist (SW) has helped the network see the virtues of placing holistic person-centred care at the heart of the treatment of long-term conditions and focussing on the right staff doing the right jobs. So, for example, linking with the “person centred care”, “population health management” and “data infrastructure & utilisation” building blocks SW used fresh interpretation to lead, with LB, major system changes for the recall of patients on chronic disease QOF registers.

Patients are now stratified by the administration team according to: a) metabolic results e.g. HbA1c/cholesterol/BP for diabetics or b) self-assessed disease exacerbation/dyspnoea scales for COPD patients. This then informs if patients need a clinician appointment, or not, and if so what length of appointment, and with which type of clinician e.g. standard appointment with nurse practitioner/GP or, if multi-morbid with polypharmacy, a longer appointment with the clinical pharmacist. This sophisticated model emerged as an evolution from the early adoption of the national polypharmacy prescribing comparators, which uses risk stratification tools to identify patients on multiple medicines or those on high-risk combinations and which recently won the 2019 HSJ Patient Safety Award.°

The clinical pharmacist also led the development of a new repeat prescription system across all practices within the PCN with a dedicated, trained and empowered non-clinical prescription team, a pharmacy technician to provide a safer, yet more effective and efficient system that has benefited patients, community pharmacists, practice staff and freed up GP time too.

In our current VUCA world (Volatile, Uncertain, Complex and Ambiguous) we urge more attention be devoted to the need to create and maintain a primary care network environment in which clinical pharmacists can truly make an impact and help catalyse learning organisations. In our collective experience we believe that this new cadre of health professionals in general practice can even help make working in primary care a more attractive choice for potential GP recruits by improving system resilience, personal resilience and wellbeing.

We previously suggested that clinical pharmacists should be used as “collision avoidance technology” to prevent problematic polypharmacy in older age.⁵ In keeping with the analogy of the rise of autonomous vehicles we call on GPs to embrace their other skills to help PCNs undergo the necessary ‘road redesign’ ( system change) and ‘improved battery life’ resilience) needed to safeguard the future of general practice.

 

References

1. Medication Safety in Polypharmacy. Geneva: World Health Organization; 2019 (WHO/UHC/SDS/2019.11)
2. Mann C, Anderson C, Avery AJ, Waring J ,Boyd MJ . Clinical Pharmacists in General Practice: Pilot Scheme. Independent Evaluation Report: Full Report. University of Nottingham 2018 https://www.nottingham.ac.uk/pharmacy/documents/generalpracticeyearfwdrev/clinical-pharmacists-in-general-practice-pilot-scheme-full-report.pdf
3. RCGP. Collaborative general practice initiative. London 2019 https://www.rcgp.org.uk/clinical-and-research/collaborative-general-practice.aspx
4. Bradley F, Seston E , Mannall C , Cutts C. Evolution of the general practice pharmacist’s role in England: a longitudinal study. British Journal of General Practice 2018; 68 (675): e727-e734. DOI: https://doi.org/10.3399/bjgp18X698849
5. Williams SD, Hayes J, Brad L. Clinical pharmacists in general practice: a necessity not a luxury? British Journal of General Practice 2018; 68 (667): 85. DOI: https://doi.org/10.3399/bjgp18X694697

 

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