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How we reduced workload by working with pharmacists

Dr Farzana Hussain explains how her Newham practice reduced demand for appointments and improved outcomes for patients with chronic diseases

The problem

More than 50% of mortality among patients at our practice arises directly from diabetes. Only last month, a patient in his 40s with uncontrolled diabetes died of a heart attack, leaving a wife and a child. The one in 10 diabetes patients with an HbA1c of less than nine take up most of the GPs’ time and we felt better working relationships between GPs and pharmacists, as well as more preventive care and patient education, could improve outcomes for this group of patients.

Setting it up

We agreed to pilot EMIS’s new GP record viewer software alongside five local pharmacies. It enables pharmacists to exchange information directly with local GPs over EMIS Web and securely view clinical information from the GP record. This allows them to review medications, allergies and test results, and hopefully resolve adherence problems among diabetes patients.

What we did

It was relatively simple to set up the pilot. I had an initial phone call with my local pharmacist, then met a representative from the local pharmaceutical committee and the system supplier to talk it through.

I had an hour’s training on the software from the supplier, ticked a box on my clinical system and the GP record viewer system was up and running at my practice within two days.

The results

The system allows the pharmacist to access blood results and make a decision on improvements to treatment. He is able to let me know quickly what changes have been made via an electronic message on the system.

Some practices in the pilot initially found it troubling to share medical details with pharmacists, but we have strict protocols for patient confidentiality. Patients give verbal consent whenever the pharmacist needs to call the GP.

I haven’t cut back my chronic disease clinics yet, but with pharmacists’ input, I believe we could make significant cost savings by reducing GP sessions for these patients from 12 to 10 annually.

The new system has certainly reduced demand for appointments. It has also increased patient satisfaction.

Dr Farzana Hussain is a GP in Plaistow, east London

 

Readers' comments (5)

  • Thanks Farzana. Can you explain how you have got consent from patients for test results and other parts of the record to be shared with the pharmacy? How are you signing patients up? What information are you providing for them ?

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  • Great example of working with community pharmacists and IT to maximise patient care, well done!

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  • Fantastic work here and all quite common sense. I am working with my GP colleagues in Turriff, Aberdeenshire to do something similar. The only addition is the fact that I will actually make the asthma changes, step up or down, myself as I will be an independent prescriber by December.

    Try looking at using the community pharmacist to help with non attendance at chronic clinics. I create my list for my asthma clinics from the surgery non attenders. Everyone wins. I don't duplicate work and the practice gets the QOF benefits.

    The biggest winner in this approach is the patient. I am respectful though of the caution by some GPs, these things must be thoroughly thought out from an information and clinical governance point of view.

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  • so far it has been verbal consent as the patients have been physically present at the pharmacy and the pharmacist has called me while they are there or asked them if it's ok to call me their GP

    I would like to see a day when pharmacists came under the extended primary care team umbrella such as district nurses who don't need to obtain explicit consent as they are trying to clinically benefit the patient

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  • I do not think verbal consent would be considered a 'legal', ask the same patients 3 months later and they probably would even know what you were talking about and who would validate that they gave verbal consent in the first place?

    I shudder at the thought of any pharmacist being able to access my records and anything that requires a physical examination, no matter how minor, is a small room alone with a male pharmacist, would most certainly be a 'no go' area fro me.

    I already use a number of pharmacists to issue y medication to ensure no ongoing record is held by the. I know and trust my GP, not the stranger behind a counter in a shop!

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