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Pharmacy professionals are already well-established within PCNs, but further recruitment is expected. So what can PCNs do to support their integration into primary care? Ayorinde Balogun, medicines optimisation pharmacist at Wandsworth PCN and Central London Community Healthcare NHS Trust, makes some suggestions.
Pharmacy professionals bring many benefits to PCNs. As well as reducing the burden on GPs, their input can ensure patients get the maximum benefit of medicines safely. But to get the most from this valuable professional, PCNs must acknowledge that pharmacists have diverse backgrounds. When PCNs do this – and accommodate individuals’ strengths and development needs – the impact of their pharmacists will be even more significant.
The current utilisation of pharmacy professionals within PCNs can vary widely. For example, while the medication-related indicators of the PCN Investment and Impact Fund (IIF) highlight the national priorities, many PCN pharmacy professionals go beyond this.
Some will provide specific patient advice to clinicians, medicines reconciliation and give support with prescriptions. They may also review shared care prescribing requests and the associated monitoring of high-risk drugs. Some could be running specialist disease-related clinics such as diabetes, hypertension, anticoagulation, asthma, COPD, or pain management. They can support practices to establish new processes of working to embed medicines optimisation. (1)
The smart PCN will take a look at the work undertaken by pharmacists in their former sectors. That way, they can maximise the pharmacist’s clinical activity and improve retention and job satisfaction.
Most UK-trained pharmacists will follow their four-year Master of Pharmacy degree with a year as a trainee pharmacist prior to registration. They will subsequently work within community or hospital pharmacy or both. (2) There are few variations to this.
The most common type of pharmacists are those in the community, and GP practices will have regular contact with them. Community pharmacists are responsible for the supply of medications as well as routinely providing advice to patients for minor ailments. Their clinical activity has expanded throughout the current community pharmacy contractual framework. They deliver clinical services such as the New Medicines Service, NHS community pharmacy consultation service and hypertension case-finding. (4) Some community pharmacists are trained to deliver warfarin clinics, travel clinics and seasonal vaccinations.
Hospital pharmacy professionals vary widely depending on experience and background. Newly registered pharmacists start as junior pharmacists and progress clinically to seniors, leads, and then further into management and divisional leads through their careers. Those in clinical roles must be clinically competent in the management of patients with multiple conditions. They are familiar with working within a multidisciplinary team and make critical interventions as part of their routine practice. Some may run outpatient clinics in a clinical speciality.
Pharmacy technicians, who work closely with pharmacists in all sectors to support procedural activities, are also regulated professionals. They will have completed an accredited course whilst working within a community or hospital pharmacy, demonstrating the required knowledge, competency, and skills set out by the General Pharmaceutical Council. (3) They support pharmacists to engage in more clinical activities by undertaking clearly defined activities that pharmacists would otherwise perform.
PCNs can help pharmacy professionals make the transition into primary care. That starts at the interview and continues through induction, initial work plan, reviews, and subsequent appraisals.
The fundamental pharmacy need for each PCN must be medicines optimisation. (1) So, at interview, PCNs should explore how the pharmacy professionals’ previous experience can fit their needs. An example question could be: ‘This PCN requires pharmacy professionals to engage with medicines optimisation because it supports patients in achieving their treatment aims and ensures ongoing safety and appropriate use of medications. What are your prior experiences of supporting patients with medicines optimisation, and how can you support us?’
When it comes to induction, some elements will apply to all pharmacy professionals, but PCNs should also prioritise the developmental needs of the individual.
Irrespective of background, each new starter must learn how to use the clinical system, understand the flow of work and the role of each team member. In addition, they should receive an induction on the local formulary and prescribing guidelines from the ICB prescribing advisor and be encouraged to meet with local community pharmacies.
But, while community pharmacy professionals will already be aware of the mechanism of medicines supply within primary care, this could be a gap for some hospital professionals. On the flip side, hospital pharmacists may be confident in clinically reviewing patients alongside their bloods and physical parameters, and recommending medication changes, whilst some community pharmacists might need support with this. All professionals need to be aware of the risks associated with ill-founded assumptions of competence, particularly those who are non-medical prescribers. (5)
Pharmacy professionals should be encouraged to seek support, particularly early on. They should have a designated clinical supervisor as well as an on-shift clinical supervisor for urgent advice or support. In addition, there should be scheduled end-of-the-week reviews – or more frequent reviews, if necessary – with their designated clinical supervisor to share successes and/or areas of concern.
After induction, the initial work plan should target their strengths, focusing on what they can do competently and safely. This should be built upon as their confidence and experience grow. Higher-risk activities for pharmacists, such as Structured Medication Reviews (SMRs) or long-term disease reviews, may need competency assessments or case reviews to confirm competence.
Once pharmacists have settled into their new role and their work plan has been expanded, the PCN can make greater use of their expertise. Pharmacy professionals can provide a unique insight from their training and background that may not be currently available within practice teams. For example, they should be encouraged to critically evaluate current processes or medicines-related incidents for quality improvement.
To support best practice, professional support and networking, pharmacists should be encouraged to join or establish a peer group or forum. And their appraisals should consider the development of their roles into clinicians with specialist interests or becoming advanced practitioners.
By taking the steps outlined above – acknowledging and accommodating the diversity of backgrounds, and providing support – PCNs can support pharmacists to thrive. And when they thrive, pharmacy professionals’ expertise has a significant impact. Effective pharmacy teams can reduce the burden of medicines-related activity for clinicians at practices whilst maximising the benefits for the patients and the wider NHS.
1. NHS England » Medicines optimisation [Internet]. NHS England. [cited 2022 Dec 31]. Available from: https://www.england.nhs.uk/medicines-2/medicines-optimisation/
2. What does a pharmacist do? | General Pharmaceutical Council [Internet]. [cited 2022 Dec 27]. Available from: https://www.pharmacyregulation.org/raising-concerns/raising-concerns-about-pharmacy-professional/what-expect-your-pharmacy/what-does-0
3. Criteria for registration as a pharmacy technician in Great Britain [Internet]. 2021 [cited 2022 Dec 31]. Available from: https://www.pharmacyregulation.org/sites/default/files/document/criteria-for-registration-as-a-pharmacy-technician-in-great-britain-jan-2021.pdf
4. NHS England » Pharmacy Integration Programme [Internet]. NHS England. [cited 2022 Dec 28]. Available from: https://www.england.nhs.uk/primary-care/pharmacy/pharmacy-integration-fund/
5. PDA issues urgent warning to GP-based pharmacists after serious incidents – Pulse Today [Internet]. Pulse. 2019 [cited 2022 Dec 31]. Available from: https://www.pulsetoday.co.uk/news/uncategorised/pda-issues-urgent-warning-to-gp-based-pharmacists-after-serious-incidents/
Ayorinde Balogun is a medicines optimisation pharmacist at Wandsworth PCN at Central London Community Healthcare NHS Trust.