Pharmacists working in General Practice – Utilising your community knowledge for the good of the Practice
Following on from our NHS England announcement and our contract to work with them to deliver In Practice Pharmacists across the country, we are finding out what it’s like for the pharmacists that are already working in Primary Care.
Yesterday we heard from Ida Osei on her experiences moving from community pharmacy to an in Practice role.
Today we talk to Cornwall-based Nick Kaye and find out about his story of running his own community pharmacy, to working in General Practice, and everything in between.
Why did you make the decision to practice pharmacy in Primary Care?
“I’d worked in a busy community pharmacy for 20 years, which was based in the same building as a GP Practice. I really enjoyed having my own autonomy as a health care professional, whilst having a close relationship with the health care team. I felt that my clinical skills were used well, and the GPs, nurses and receptionists would often ask for advice.
“After my time there I worked in a variety of pharmacies in areas where these relationships were not so well established, which felt quite isolating at times.
“The opportunity then came about to work for the Clinical Commissioning Group (CCG) for 3 months offering advice to 4 GP Practices. I did this part-time and felt like I was much more part of the team again, but this role was very processed driven and I missed the face to face contact with patients. When this funding from the CCG came to an end one to the Practices I was working for offered me a role.
“This was a new step for me and the Practice, but it also meant we could craft a role that worked for us both, offering a mixture of process and face to face roles. This was great as I felt that the clinical skills I’d gained as a community pharmacist were being used, and being part of a wider team was key to me.”
Did you see any familiarities in General Practice to Community Pharmacy?
“The thing about being a community pharmacist is that I absolutely understand Primary Care and the pressures it brings. It can be challenging, and the workload can be intense and needs to be managed within the right timings. While you may want to take 30 minutes or more on a single patient appointment, it’s not an effective use of your time, nor indeed how Primary Care works, whether in community pharmacy or in General Practice.
“I was already very familiar with administering vaccines, such as the flu jab at scale, and worked well with the Practice nurses in delivering this service. As a community pharmacist, I had also been involved with prescriptions, e-prescribing (EPS) and repeat dispensing, as well as being very comfortable with most of the drugs that are prescribed in primary care.
“Coming from a retail environment that concentrates on patient and customer needs, I feel it’s natural for a community pharmacist to offer a great patient experience, and managed within the time pressures of General Practice.
“Many community pharmacists are commercially minded, which meant I was not scared of seeing the Practice as a business. I understood the need to maximise efficiencies within the team to deliver great patient care whilst making sure the Practice was sustainable and viable moving forward.
“Community Pharmacists are used to doing medicines use reviews and the new medicines service, so talking to patients about their medicines was very familiar. I believe that community pharmacist also understands the processes of things like compliance aids and medicines being out of stock so because you have seen it operational from the ‘other side’ of primary care you can understand what is needed to achieve great patient care.”
Did you need to learn any new skills to step into a Primary Care role?
“The main thing I had to learn was how the Practice functioned and how its work was managed or flowed between clinical and non-clinical team members, to make sure great patient outcomes were maximized.
“Using the various IT systems was a challenge, EMIS, Docman, and ICE – the training and having someone to answer my questions was critical for me.
“Having access to full patient notes was really useful but also overwhelming to start with. It was understanding what was important and not to get lost in the notes, although I do always try and look at them for 30 seconds before I call my next patient. I feel this offers a much more personal service.
“Although I had done a 6-month placement at a hospital, it was 20 years ago, and I needed to understand discharge prescriptions and medication initiation from secondary care.
“Some of the medicines having shared care guidelines was a new concept to me. Although I had heard of shared care guidelines before, understanding the clinical and financial responsibilities of both the secondary care institution and primary care was something I needed to understand.
“One of the things that felt uncomfortable for me was the reviewing of blood tests. I have been on a day course for this and it has benefited me greatly. I am also nearly through my Non-Medical Prescribing (NMP) course and this has been useful, mainly in some of the basic tests that I have been trained in such as manual blood pressure and chest exams as a community pharmacist it is very odd to ‘touch’ patients.
What value do you think you bring to General Practice and the patients you see there?
“As a Pharmacist, I bring value in GP time, which is the most costly resource within General Practice, as well as:
• Medicines expertise.
• Commercial thinking.
• Horizon scanning on new models of working and being the link between GP Practice and community pharmacy.
• I can free GP time in general appointments for long term conditions (LTC), medicine reviews and minor ailments.
“As a pharmacist, I am the expert on medicines and I can bring value in the form of better prescribing. A lot of the CCG work for prescribing targets comes to me, which results in freeing GP time as well as being a great resource for the Practice team to draw on.
“Commercially have had input into the buying of products such as flu vaccines, which results in a good return for the Practice.
“As the first point of call for community pharmacy I have been able to help with all queries, and sometimes conflicts around commercial sensitive areas such as flu jabs, while ensuring professional relationships are maintained. We are also looking at expanding joint working with community pharmacy, such as extended assess schemes, and health checks, making better use of the community Practice teams in a mutually beneficial way to all our patients.”
Are there any challenges you have had to overcome when working as an in practice pharmacist?
“The main challenge was figuring out how to integrate into the Practice team, making sure I understood where I fitted in, and how the Practice used me best. How this is worked out will be different for every Practice.
“It was also hard but refreshing to be able to ask another clinician for help. In a community pharmacy, all the responsibility for decision making ends with you. This is both a blessing and a challenge to refer to someone else, within your working environment.
“The last challenge to overcome, which doesn’t happen that often, has been the patient’s perception of my role. I have had three people say to me that they don’t want to see the pharmacist, they want to see a GP. When I have explained that I will try to help, but if not then they can see a GP, I have been able to help every signal one and had some great feedback.
“I feel that these appointments, although they are the most challenging, are sometimes the most rewarding.”
Nick Kaye is an in practice pharmacist based in Newquay, Chair of Peninsula LPF and media spokesperson for the National Pharmacy Association (NPA). Nick has also won Entrepreneur 2012 and Alphega pharmacy of the year 2013 and starred in Omega Pharma’s hayfever products advertising campaign.
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