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Lived experience: PCN CD on clinical pharmacists

Clinical director of St John’s Wood and Maida Vale PCN, Dr Saul Kaufman, discusses the value of clinical pharmacists to his network of seven practice, covering 45,000 patients in Westminster.

Clinical pharmacists have been the leading light of the ARRS recruitment drive in general practice. I’ll admit that a couple of years ago I foolishly thought that GPs could do everything a pharmacist did, and I wasn’t convinced of the value they could add. How wrong I was. 

We are now fortunate enough to have an amazing pharmacist in our Westminster practice and I’m now an evangelical convert.

The difference a pharmacist has made is immeasurable. They prescribe more safely, have greater knowledge of interactions and in time this leads to fewer prescriptions and a smaller burden of prescription reviews.

The patients and staff can all see the benefits too. The patients who talk to her have time to ask and understand questions about their medication. That increased understanding, with the proper time investment, means they feel more empowered about ‘their’ medications and ‘their’ care. As our pharmacist does more comprehensive medication reviews over time the number of queries or requests which come through the reception team also goes down.

In Covid vaccine times, pharmacists were critical to the delivery of the programme. That also meant that practices who had gotten used to having them around really missed them when they were redeployed to the vaccine centres, where they were often diluting the Pfizer vaccines along with other mission-critical-roles.

Unfortunately, I’m not the only person who has realised the benefits of a pharmacist and they’re now (rightly) highly valued. I imagine all PCNs are looking for them. One way we’ve tried to combat this lack of workforce is to recruit, employ and train our pharmacists through our federation. It’s also easier to recruit at this scale as it’s already set up with staff. This leads to cross-pollination of good ideas and good practice across our PCNs, including safe use of inhalers and safe monitoring of many medicines.

Space is of course an issue, but practices are making sure to find rooms for our clinical pharmacists to work in, showing just how valued they are. 

We have a great team of 12 pharmacists shared in line with the weighted list size and we’re expanding to take on four more. We’re aiming for one clinical pharmacist per 8,000 patients: just over double what we currently have. We’ve based this target on ARRS money available and what we thought would be the right sort of amount although we’re learning as we go. 

To ensure we retain staff we are ensuring we make people feel part of the team. Truly, I don’t think a practice has far to go in incorporating our pharmacists as it’s pretty obvious once they’re here, they’re integral.

READERS' COMMENTS [2]

Vinci Ho 21 May, 2022 5:29 pm

(1)While I always say I am a PCN-sceptic even on the day when I stepped into the shoes of a PCN CD in 2019 and our size was just about 35,000) , I knew we needed the clinical pharmacists to survive. We subscribed to a company of clinical pharmacists ( which my own practice already did before I became CD) .
When Covid 19 and the subsequent CVP ( phase 1 and 2) hit , I worked so close with them I practically saw some of them everyday 10 hours 3 to 6 days in a row ( remember the painful three use-by days of Pfizer vaccines stored in fridge maintained at 4 to 8 degrees ?)
Deliveries of Pfizer under the jurisdiction of NHS England were unpredictable and chaotic that one received either too many or less vaccines in one week . Mixing , diluting and vaccinating all need time, space and workforce . The willingness, determination and flexibility offered by these clinical pharmacists outweighed any argument that they could not help GPs much , especially when you were given short notices to finish so many boxes of vaccines ( obviously, it was more straight forward with Astra-Zeneca vaccines ).
(2)Yes , we are officially now in recovery from the pandemic in this country but it is exactly the reason why we need these clinical pharmacists to get through hundreds of thousands of prescriptions everyday so as to free us to catch up and concentrate on all these leftover non-Covid workloads including an influx from an also struggling secondary care .
(3)I am conscious that there is an argument between employing, training your own PCN pharmacists in contrast to subscribing to a company . Our PCN, now disbanded after my resignation, was too small that I could not develop a healthy enough management infrastructure to train and supervise additional roles( I take full responsibility on this) . I would say , like every matter , there are advantages and disadvantages. It is down to sensible communication with reasonable and realistic expectations. Cost can be an issue as far as going beyond the highest ceiling of money PCNs can claim for full time equivalent (FTE) . Here comes the terms and conditions being agreed by both sides ( even for your own employed pharmacists). Sick and annual leaves can be covered in various ways but I suppose a good company can have enough pharmacists to cross-cover in short notice .
(3)Space is indeed a big issue but it simply reflects how poorly the government/system has taken GP premises issues seriously . Investments are disproportionate with inequity in different parts of the country . One can argue the bigger the PCN gets , the more likely solutions can be found . At the same time , the number of ARRS requiring rooms for face to face consultation(e.g. first contact physiotherapists(FCP) , Care Coordinators , mental health practitioners and even social prescribers ) goes up at least proportionally( so often not when development and expansion of a PCN is robust)
(4)There is also the issue of governance. Some standards especially on safety are essential but cannot be too rigid Again , it is down to sensibility and reality . Different practices in a PCN may have very different demands and expectations. The question on the difference between clinical pharmacist(s) employed by an individual practice and those by PCNs remains .
Flexibility and forming bridges to avoid ‘one size fits all’ is the key .
(5)Finally , the way the PCN DES and IIF is heading with more elusive targets add more complications. For example, Structured Meditation Reviews (SMRs) targets are now officially rubber-stamped by NHSE/I between 44%(lower threshold) to 62% ( higher threshold) . 53 points (I called them new QOF points) are maximum. Think about all these patients with severe frailty, in care homes , on repeat addictive including opioids ( even weaker ones), G-pentinoids , Z-drugs , benzos etc and poly-pharmacy . They are the candidates to be targeted annually . Nobody seems to know the difference between medication reviews and SMRs . It will be unrealistic and imbecile to set a fixed time required for each SMR .
Obviously , other medication issues like MDI inhaler usage, gastro-protective drugs for combination of anti-platelets with other drugs and the most extraordinary and impractical choice of Edoxaban as the specific DOAC for AF (CVD-15: UT: 60% LT: 40%). I am not going to talk about enhanced access here ( you are probably too bored of my negative energy by now😳😂)
Yes , you can opt out of PCN DES but you will lose the funding of the ARRS .
Guns are clearly held on our heads . Don’t tell me we don’t need our clinical pharmacists.

Paul O Reilly 23 May, 2022 7:41 am

Well done, Saul!