A receptionist works in a general practitioners surgery in London. (Photo by Carl Court/Getty Images).

Most GPs are keen to maintain the services of GP pharmacists after funding has expired according to a study funded by NHS England (NHSE). But is this reason for the independent community pharmacy network to worry, asks Neil Trainis

 

From the perspective of patients’ health and wellbeing, it was heartening to read a study published by the University of Nottingham that claimed pharmacists based in GP surgeries are having a positive impact.

It revealed the introduction of GP pharmacists, or clinical pharmacists as NHSE provocatively and somewhat patronisingly terms them, has led to increased capacity in GP practices.

“Although the role requires financial commitment from practices, GPs believe the role to be sustainable, most will keep the one they are working with after the funding expires,” the report said.

Yet from that same perspective there was also something quite alarming to behold for pro-independent community pharmacy network advocates. And of course patients.

While the government appears intent on pushing as many pharmacists into GP surgeries as it can, it seems keen on dismantling the bricks and mortar community pharmacy network, those sanctuaries of health where people, many living in deprived localities, can go for healthcare treatment and advice.

Community pharmacies are much more than places you go to cure a cold. They play an important role in the illness prevention agenda through their healthy living expertise, care for people with long-term conditions, help the elderly live independently at home, provide a social function for individuals who feel isolated and have no-one to talk to. People in crisis.

Yet as the government ploughs on with investment in GP pharmacists whilst simultaneously slashing community pharmacy’s budget to the tune of £320 million over two years, endangering the existence of many independent pharmacies, it is pretty clear where the Conservatives’ priorities lie.

There were 4,798 independent pharmacies in England as of August 30, 2018 according to the General Pharmaceutical Council and that number is shrinking as they continue to contend with cuts and increasing prices of generic drugs. According to the  Department of Health and Social Care the number of bricks and mortar pharmacies fell by 134 between November 2016 and April 2018.

In contrast the prospects for GP pharmacists look rosier. The General Practice Forward View, published two years ago by NHSE, outlined an investment of £31 million to pilot 470 ‘clinical’ pharmacists in more than 700 practices. That is being supplemented by £112 million to extend the scheme, the aim being to secure 2,000 pharmacists in general practice by 2020.

“(Community pharmacists’) integration and availability in practice is important for continuity of care,” the study said.

“In order to be successful and feel part of the team, pharmacists need to be visible, communicate well and be flexible and innovative. (Community pharmacists) need to spend more than one day per week in post to feel a sense of belonging and the more time spent in role the faster the level of integration.”

Citing findings from the national survey of community pharmacists, the report claimed pharmacists working in practices “enjoy high levels of satisfaction.”

The survey found that 89% agreed or strongly agreed they enjoy working in their role, 89% agreed or strongly agreed they work autonomously in their role, 87% agreed or strongly agreed they work closely with others in the practice and 89% agreed or strongly agreed they are accepted by other professionals in the practice.

“This is underpinned by qualitative data. Pharmacists in the new (community pharmacist) role report that they enjoy the opportunity to work clinically, and in a (multi-disciplinary team), utilising their specialist skills in medicines,” the report said.

Those with a smidgen of knowledge of community pharmacy know of course that community pharmacists “work clinically” day in, day out. They do not need to be housed in a GP practice to do that.

What do the pharmacy bodies think?

“This positive independent research from the University of Nottingham continues to demonstrate the value that practice-based pharmacists bring to patients and to the healthcare professionals they work with. In light of this, we hope to see pharmacists remain embedded in GP practices on a large scale after the initial funding has ended,” said England Pharmacy Board chair Sandra Gidley.

“It’s clear that with 70% of pharmacists reporting that clinical medication reviews are a major part of the role, the profession’s skills and knowledge are being used appropriately to benefit patients, especially those with long term conditions.

“Having the consultation time to examine if individual patients are on the best treatment regimen, ensure they understand the benefits of their medicines, how to use them and cope with any side-effects improves patient safety and adherence to medicines.

“It also creates a more active patient engagement with their condition as they experience better health and personal support from the pharmacist, which in turn drives greater self-care and further health improvements.

“It’s heartening to see that over 60% of practice pharmacists are involved in the discharge of patients from hospitals back to home or care homes and are making a real difference by preventing hospital re-admissions.

“The impact of pharmacists’ prescribing expertise and support also enables GPs to understand their true value in terms of the professional support they offer. With 75% of pharmacists responding to colleague enquiries every day, it shows that sharing workloads means a better use of skill mix across the practice so patients get the right care from the right health professional.

“These benefits can of course also be achieved in community and hospital settings, and we support better use of pharmacists’ skills to benefit patient care wherever they work. The research clearly demonstrates overall how patient outcomes can be improved by thinking differently about how pharmacists integrate into the health care system.

“The new Secretary of State (Matt Hancock) has already shown that he is thinking differently and we are keen to work with him around how pharmacists in all settings can support patient care.”

Mandeep Mudhar, director of marketing at Numark, said he did not view the report as “another nail in the coffin” for independent community pharmacy.

“Community pharmacy plays a critical role at the front-line of managing patients, their prescription and medication needs, in giving invaluable healthcare advice and services that play a critical role in the health and wellbeing of everyone in the UK,” he told Pharmacy Business.

“Each day millions of prescriptions are dispensed safely and advice given to patients at the front end. And while they do this, clinical pharmacists in practice also play a vital role in further supporting patients in the GP practice through services and optimised prescribing.

“It is important that both community and practice-based pharmacists develop a good working relationship in conjunction with the GP and through this triage approach, identify and agree the best care plan for each patient.

“There is great opportunity for clinical pharmacists to refer patients where necessary or appropriate to community pharmacy for minor ailments, for health advice, for services like MURs and other healthcare services provided through the pharmacy.

“For the community pharmacist, there may be an opportunity to intervene in a patient’s medication plan and highlight concerns or issues that can be resolved for that patient by the pharmacist in the GP surgery.

“For example, changing a medication or dosage. It is vital that with the patient at the heart of everything they do, community and clinical practice pharmacists form a patient-centric partnership and agree how best to work with each other.”

PSNC chief executive Simon Dukes welcomed the study but insisted “community pharmacies remain for many people the gateway to NHS services.”

“PSNC is pleased but not surprised to see that pharmacists have had a positive impact on GP capacity and workload. Patients value spending time with pharmacists and there is much evidence that this interaction can improve people’s understanding and use of medicines,” he said.

“All pharmacists have the knowledge to offer extensive medicines support and advice to patients. We would like to see community pharmacists fully empowered to use their clinical skills in this way, working closely with pharmacists in all other settings.

“Community pharmacies remain for many people the gateway to NHS services and they can do much to improve patient safety and outcomes; PSNC’s aim is for this potential to be maximised so that all pharmacies have the opportunity to support the work being done by GPs and others in the best way possible.

“We were pleased to see that on some sites pharmacists in GP practices have actively engaged and met regularly with local community pharmacies – this collaborative working could bring great benefits in ensuring that patients receive joined up and consistent pharmaceutical care.

“We are keen to work with NHS England to explore how community pharmacies can be better integrated with general practice for the benefit of patients and the NHS.”

Helga Mangion, policy manager at the National Pharmacy Association, said: “It is good that the scheme is clearly demonstrating the value of pharmacist input and their clinical skills.

“Yet the truly transformational opportunity is within community pharmacy where the access is so much greater and the scalability is so much superior.”

Nobody should doubt the Conservatives’ desire to alleviate the pressure on the NHS and improve standards in healthcare. But we should certainly be concerned that they are veering off the road as they try to achieve that.


GP pharmacist report – conclusions

• Those undertaking the role enjoy high levels of satisfaction.
• 89% agree or strongly agree they enjoy working in their role.
• 89% agree or strongly agree they work autonomously in their role.
• 87% agree or strongly agree they work closely with others in the practice.
• 89% agree or strongly agree they are accepted by other professionals in the practice.

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