What we did
We are an inner-city practice in Croydon, south London, with a degree of deprivation and a large black and minority ethnic community. We look after approximately 17,500 patients.
In 2003, with the contract changes and the advent of the QOF, we decided that we needed support to administer the changes and maximise the benefits, so we employed a clinical pharmacist. She had a background in hospital medicine and the local primary care organisation, which meant she already understood local organisational issues from working alongside NHS managers. As the need for medicines management and chronic disease management increased, she became so valuable to us that we appointed her a partner in 2006.
Her current role is wide ranging and involves implementing and monitoring the QOF, LESs, DESs, and local incentive and prescribing schemes. In addition, she carries out medication reviews, optimises repeat prescribing and medicines reconciliation with patients and hospitals, manages long-term conditions and implements clinical trials in the practice. She is also an independent prescriber.
On a typical day she will undertake a hypertension and diabetes clinic independently, seeing 12 patients with 15-minute appointment times. This will be followed by repeat prescribing, including signing the scripts and sending them via EPS. The rest of her day will be spent on clinical organisational concerns.
She has reduced workload for the GPs, as we do not spend so long on repeat prescribing and she independently runs our chronic disease management programme.
Without her our QOF scores would not be so high. She has been with us since the QOF’s inception, and from the beginning we received scores of around 1,050, while other practices near us received around 800.
We also have high-quality medicines management, with onsite medication reviews from a pharmacist’s perspective. Everyone on repeat medicine has an annual review. If they are on four or more medications they have a six-monthly review. We no longer prescribe specials and we robustly adhere to local and national guidelines. We also meet local prescribing incentives every year and use our repeat prescribing process to recall patients for the QOF and LESs. Most importantly, we now have a same-day turnaround for repeat prescriptions – usually around six hours.
Without our pharmacist we would not be involved in so many enhanced services. She set up the unplanned admissions DES and looks after our care home services.
We have applied for funding through the NHS England pilot scheme for clinical pharmacists in general practice, which would give us the opportunity to delegate further services to new clinical pharmacists – for instance, a minor ailments service. In anticipation, we recently employed two further clinical pharmacists on a part-time basis. With the current recruitment and retention crisis, we envisage such developments will lessen the burden for GPs.
You may argue that some of these developments could be supported by other healthcare professionals, but our experience is that the skills of our clinical pharmacist are well suited to such a wide range of functions and roles. She also has a corporate mindset, which has been hugely important with the changes of the past 12 years. We have never come across anyone else with such a broad range of skills, both clinical and organisational, who was not medically qualified.
Dr Dev Malhotra is a GP in Croydon, south London