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Why we appointed pharmacist as our new partner

Dr Chris Bowman explains why his practice decided

to appoint a pharmacist

to partnership status

The Government's

NHS reforms are rewriting the role of GP practices in the provision of health care. Under the new contract we will find ourselves competing with an ever-expanding range of primary and community care providers.

In my practice, the partners recognised the need to extend the range of skills and services we were offering patients. This was so as to capitalise on the opportunities available under the new contract in an increasingly competitive market. To drive this change, new forms of partnership were judged the best solution.

We are a rural PMS dispensing practice, located in the little town of Chulmleigh in north Devon. For many patients access to medical care is limited by a lack of money and by isolation. In 2000 the local pharmacist retired and the Chulmleigh Pharmacy closed, making it even harder for the locals to access the full range of health care services.

Filling a vacuum

Our current dispensing status makes it financially unappealing for a pharmacy to set up in town, and no one seemed keen. To fill the vacuum the partnership formed a limited company and obtained outline approval for the pharmacy contract. We were told full approval required the appointment of a pharmacist.

We had developed a good working relationship with the PCO pharmaceutical adviser Karen Acott, and our requirements coincided with her wish for a new challenge. Karen is an exceptionally skilled and experienced pharmacist keen to develop new ways of delivering patient-centred care and to explore the extended role of the pharmacist within primary care. We decided she was the ideal person to be our new partner.

The benefits are many. Dispensing makes good business sense for us as well as providing a key service for our patients. Fortunately Karen has a good understanding of business matters. (This is important, and should be borne in mind by any practice thinking of following our course of action.) We are now able to register the pharmacy to sell both OTC and prescription medicines providing easier and more appropriate access to advice and treatment for minor ailments.

Karen's experience will ensure we secure high medicines management scores under the quality and outcomes framework. There may be the potential to link our PMS to the new local pharmacy services contract and blend the two to provide a more sensitive service to our patients.

With the increased emphasis in general practice on chronic disease management, an appropriately skilled multidisciplinary team that works well together is essential. A pharmacist is a most desirable addition to this team, especially one qualified as a supplementary prescriber. This will allow reviews to be managed by pharmacist and practice nurse, freeing up time for the GP to focus on patients with complex multiple needs.

In addition, we envisage improved concordance with the tailoring of formulations and packaging to individual patient needs, including the provision of compliance aids such as NOMADS. Karen will also oversee medication changes following hospital discharge, an area where mistakes can be made and patient care compromised.

Profit shares

As well as the improved target achievements, increased range of services, and external sources of income through teaching and consultancy work that Karen brings, appointing her as a partner will enable us to capitalise on the flexibility within the PMS contract to fund services. Individual profit shares may reduce over the short-term, but in the long-term what we've done will make good business sense too.

Karen has been a partner for more than a month and our new partnership agreement is still a work in progress. With the benefit of legal advice, the current agreement is being rewritten to address the different professional issues and the needs of our PMS contract.

This may be a unique opportunity but the new contract and the Government's desire for plurality of service provision will ensure other opportunities exist for service development and delivery of PCO-based additional and enhanced services. New partnership arrangements support that development by providing enthusiasm, ownership and commitment to drive forward change to the benefit of all.

These are challenging times where innovation is likely to hold the key to success. With Karen on board as an equal partner we are better equipped to meet that challenge.

Advantages of having a pharmacist partner

lGood income generation for our rural PMS dispensing practice

lImproved service to patients

lAbility to secure higher medicines management scores under Q&O framework

lImaginative development of a multi-disciplined practice team

lImproved concordance with tailoring of formulations

lAbility for us to oversee medication changes following hospital discharge

Chris Bowman

is a GP in Chulmleigh, Devon

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