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Pharmacists within general practice could help lift GP burden, says RCGP chair

Pharmacists should be employed by practices to perform tasks like medicine reviews and help relieve some of GPs’ workload until new trainees can enter the profession, the RCGP has said.

Speaking at the Best Practice conference in Birmingham yesterday, the college’s chair Dr Maureen Baker said she was very interested in new roles in general practice to increase its capacity.

Debating alongside representatives from practice nursing and pharmacy about whether the NHS needed 10,000 more GPs, Dr Baker said new roles were needed in the immediate future but increasing the number of GPs was still vital.

She told delegates: ‘I’m very interested, as well, in the potential of other new roles, like for instance pharmacists isn’t new, pharmacists in general practice probably is.

‘There are other new roles as well that we can explore, basically we’re not going to get a significant number of new GPs much before three or four years on, so we do need to consider that.’

She added: ‘I spent hours this week doing medication review for patients, somebody whose kidney functions are deteriorating, “what’s safe, what’s not safe? That’s hugely time consuming, and that’s just one example.

‘There are pharmacy skills out there, and let’s see quick, safe ways to get these skills into general practice. And let’s look to see what other roles we can design, that will support GPs, support nurses, and are quick to train.

‘We need to do this within the next year, 18 months, to keep general practice going until we get more GPs and other highly skilled professionals online.’

Earlier this month, Pulse revealed the college was lobbying ministers for a similar scheme to introduce ‘medical assistants’ who would help GPs with their administrative burden and free up more time to see patients.

In his keynote speech at the Best Practice conference, health secretary Jeremy Hunt revealed that the Department of Health were now working on the scheme with the RCGP.

He said: ‘Training a GP takes time, and we have to do things in the short term to improve capacity… being innovative in our use of physicians assistants or medical assistants - as is pretty standard practice for general practice in the United States - and we’re looking at it at the moment with the RCGP.

Yesterday, Pulse revealed that the workforce crisis was unlikely to abate anytime soon after Health Education England admitted 12% of GP training places remain unfilled, despite launching an unprecedented third round of GP recruitment.

Related images

  • Maureen Baker-RCGP 2014-Online-cropped-(c) Rachael Meyer

Readers' comments (66)

  • Surely more GPs and lower list sizes are what the RCGP should be promoting - Not other professions

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  • In response to Roger Boyle: Yes they ARE arguing for more GPs. But surely you can see that GPs are a very expensive resource and it makes sense for others to make a contribution (within their competencies of course)
    This blog on NHS Choices makes the point:

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  • I am sorry guys... But you are not the best at everything. Clinical pharmacists have been proven to imrove patients outcomes in long term conditions. We do better medication reviews than you. We reduced medicines related hospital admissions. Patients and GP comments of my work. I am a pharmacist presciber and i know I have made positive interventions for patients. I believe it is time for reflexion and embracing new ways of working. The old model is not sustainable. Let work together for patients benefit. In reference to community pharmacy i have to agree that the do not bring value for money because there remunarstion system is base in quantity rather than quality

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  • Get the CCG to pay - top-slice the prescribing budget to pay for the post and expect savings in return to at least cover this cost.

    If prescribing is safer, more cost-effective and the pharmacist becomes a valuable member of the team then consider options moving forward.

    If not, pull the plug. Simples!

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  • Having spent the last 20 years working with CLINICAL pharmacists, both in research and in practice, (not community pharmacists in their chemists' shops) I am familiar with their range of knowledge and skills. Their strengths lie in their knowledge of pharmacology and therapeutics, their comfort with detail (GPs tend to paint with a broad brush!), Their knowledge of drug hazards and interactions and their readiness to listen to and address patients' ideas about their therapy. They are particularly good at medication review of patients with chronic disease (and this is well evidenced). They are also team players and learn from and teach the rest of the team.

    Unfortunately they are is short supply, but the next generation of pharmacists who emerge from training with much more clinical skills are finding jobs in the retail industry fewer in number and less well remunerated (as they are replaced by dispensers). We should try and grab them whilst we can. If CCGs will allow practices to use savings on prescribing to employ them, this can be a win-win.

    "Who is wise? The one who learns from every person." (Simon Ben Zoma, 2nd Century Sage Ethics of the Fathers.)

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  • Clinical pharmacists that are good (and I have know 3) tend to be in post in general pracice as a stepping stone to higher management positions. This is good experience for them and they do some excellent work, however it is an expensive experiment on falling practice incomes.

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  • What amazes and disappoints are some of the "eminence" based comments here, aka "generalising from the particular"

    "Community pharmacists in their Chemist Shops" indeed. How very offensive and inappropriate. Community pharmacies are a highly-disseminated, easily-accessible public health asset with massive Social Capital. You would do well to recognize that.

    I hope you don't practice medicine based on an "N=1" model otherwise I'm sorry for your patients.

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  • I don't think that pharmacists will ever win over GPs. I work in a 'chemist shop' and must admit that I feel that our location is looked down upon by both GPs and even pharmacists who work in other settings and therefore decide that they are superior.

    We have invested well over £100,000 of our own money in our premises and have far more professional premises than many GP surgeries that I have been in (old houses, stair lifts etc).

    We are generally excellently positioned in the community and see patients on far more occasions than a doctor or nurse, so to not use us is simply a waste. Our relationship with our patients is also key to our survival so we do tend to build good relationships and trust is pivotal to this.

    I don't wish to be a doctor, but to simply dismiss a profession because it has been consistently overlooked and could be seen as being in competition is short-sighted.

    A GP that is happy to let a nurse prescribe after a short course cannot then belittle the ability of a pharmacist who has studied biology, physiology and pharmacology at degree level.

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  • I've practised as a community pharmacist, as a practice support pharmacist, worked with GP practices in a PCT developing meds management, in a prison and now as advisor to a health and social care provider. So I've seen primary care from all angles. The concerns voiced in the comments have some validity but it's wrong to assume that future engagement will be the same as past experience. I've always developed great relationships with GPs and it wasn't all about cutting cost, it was about effective rational prescribing and making systems efficient. GPs were happy to have the prescribing budget top-sliced by PCT to fund their practice pharmacist because of the benefits. I believe the CCG have continued this. Some of the pharmacists were from community, some hospital, some PCT and understanding what goes on in a GP practice is essential for any pharmacist providing support. Not all pharmacists will have the skills to do this in my view but don't dismiss it as there are many out there who can.

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  • Clinical pharmacy time is something as a practice that we are always asking our CCG for. In fact as a group it formed a substantial amount of what we wished to commission with our Five pounds per head. We are keen also to have a face and a physical person with whom to interact.. Unfortunately the CCG seems to be going for the faceless, distant, changing e-mail version which limits the effectiveness massively. The fact remains that at times of hugely reduced income it is a massive step to employ when time and again we have seen people moving on, moving to more regional or managerial posts because the skill level required to really benefit General Practice is too close to the skill level to earn much more money than we can afford.

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