What to expect from your clinical pharmacist

Understanding the competencies of a fellow professional can be a challenge so Central London Community Healthcare NHS Trust (CLCH), the largest of its kind across 11 London boroughs and Hertfordshire, has developed a structured workplan to help PCNs work with clinical pharmacists.

The role of clinical pharmacists in primary care has been evolving since NHS England announced the clinical pharmacists in general practice scheme. This was followed by the establishment of PCNs in 2019 which allowed for pharmacists and technicians to be funded as part of the additional roles reimbursement scheme (ARRS).

This led to an expansion of the pharmacy workforce within primary care; creating numerous opportunities for pharmacists and technicians looking to work within a clinical role and acquire new skills.

However, a report published by The King’s Fund, highlights some of the key challenges facing PCNs. There is a lack of consensus within PCNs and practices about whether the roles are to deliver the requirements of the PCN contract or to undertake the ‘core’ work of the practice, and what the minimum and maximum responsibilities of the roles are.

Clinical supervision is a key requirement within the PCN Directed Enhanced Service (DES), and peer support is critical to the effective integration of ARRS roles within general practice.

In 2019, CLCH was approached by a PCN in Northwest London to discuss whether the Trust could provide clinical pharmacists for the PCN. Since then, the service has evolved and CLCH is currently working with seven PCNs across London.

Challenges facing PCNs with employing roles are recognised, and the pharmacy team at CLCH have developed a structured workplan which includes supervision, training, development, and senior leadership to support the professional working relationship required for integration within the practices making up the PCNs.

Recruitment and induction  

At CLCH, the following has been developed and implemented: 

• Standardised band 7 and band 8a job descriptions and person specifications, in line with the national profile for pharmacy. This helps to streamline the shortlisting process.
• Standardised interview process which includes ‘real’ case studies 
• Induction programme and checklist 
• PCN knowledge gap analysis on induction, with ongoing review. 

The induction programme and checklist includes:

1. Induction and onboarding
2. Access to clinical resources and training on relevant clinical systems
3. Introduction to GP practice
4. Introduction to systems and processes in the practice.

Banding structure

The PCN DES describes the ‘clinical pharmacist’ as a band of 7 or 8a, a term regularly used within NHS trusts but new to the GP landscape. The National Profiles for Pharmacy are nationally evaluated profiles based on information from job descriptions, person specifications and additional information.

A newly qualified pharmacist, after completing their training year, will start as a band 6 pharmacist and progress through the banding with national and local training and experience. A band 8a pharmacist will provide and lead specialist pharmacy services, undertake risk management, provide expert advice, teach and supervise junior staff.

Below is a description of a list of duties that a band7/8a pharmacist working in a PCN could undertake. This is a guide only and is not intended to be exhaustive. Duties and responsibilities need to be adapted to the needs of the PCN.

Band 7

Role adapted as they proceed through the CPPE and IP pathway.

 (Supervised until assessed as competent to conduct independently)

• Medicine tasks/queries increasing complexity as the individual progresses through the CPPE pathway.
• Medicines reconciliation from clinical and discharge letters.
• High risk drug monitoring.
• Localised incentive schemes e.g., audits, medicine switches, ICB medicine priorities
• Actioning CAS Alerts
• Long term condition-based reviews utilising a template.
• Structured medication reviews.
• Supervises less experienced pharmacists and technicians.
• Advises junior medical staff and nurses on pharmacy matters.

Band 8a (duties as above and including below)

• Responsible for leading, delivering and providing specialist pharmacy services. For example, medicines information or medicines management; undertaking risk management and ensuring compliance with medicines legislation.
• Highly developed specialist knowledge and able to interpret complex facts or situations requiring analysis.
• Provide expert advice on pharmaceutical matters in specialist field.
• Lead and develop clinical audit.
• Provide day to day, clinical supervision/management.
• Oversee the teaching, training, and development of junior staff.

Development and retention 

CLCH recognises that there is no ready-made workforce; staff are recruited from a variety of backgrounds such as community pharmacy, hospital pharmacy and integrated care boards (ICBs), and have varying skills and knowledge in delivering clinical pharmacy services. As a result of this, pharmacists employed by ARRS funding are required to enrol onto the Centre for Pharmacy Postgraduate Education Primary Care Pharmacy education pathway to equip them with the skills and knowledge to undertake activities within a PCN.

Alongside the programme, CLCH ensures tasks provided fit the ability of the team member, adapting as necessary. An in-house competency assessment is used to identify work-based gaps and inform training for individuals, so the staff member can continue their professional development while in these positions.

Supervision and mentorship 

Supervision is a process of professional learning and development that enables individuals to reflect on and develop their knowledge, skills, and competence, through regular support from another professional. It underpins good and safe patient care. Supervision is also a regulatory requirement; the Care Quality Commission (CQC) expects primary care providers to assure the capability, scope of practice and competency of their staff.

To support practices to meet the required supervision as stated in the PCN DES contract, CLCH has implemented the following:

• 30-minute time slot at the end of the clinical session with the GP to talk through interventions and recommendations.
• Attendance at clinical meetings or practice-based multi-disciplinary team meetings to discuss any complex patients.
• Twice weekly (junior) or monthly (senior) clinical professional supervision sessions with a senior member of the CLCH pharmacy team, using the CLCH PCN developed clinical supervision proforma.

All the PCN pharmacists are on a joint telegram communication group for sharing good practice, troubleshooting, or to ask any medicine related questions. No patient details are shared on this platform, and it is moderated by the CLCH pharmacy team. Each week the pharmacists participate in CPD training covering various primary care focussed topics to enhance learning. All PCN pharmacists are required to deliver a training session to aid their development.

A staff satisfaction survey was sent to all the PCN pharmacists employed by CLCH. Eight out of 15 staff members completed the survey and results revealed 100% were satisfied with their job, felt supported in their role, and felt they had adequate supervision, mentorship, and opportunities to develop within their current role. The PCN pharmacy team recruited by CLCH currently has a 93% retention rate.

Conclusion

Having a clear structure in place regarding workplan, training, competency assessment, career progression, peer support and mentorship helps to make the PCN clinical pharmacist role a success.  

By Krupa Dave and Devinder Kalsi lead medicines optimisation pharmacists at Central London Community Healthcare Trust