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Pharmacy support


monitoring and review by a healthcare professional? Are there likely to be sufficient volume of patients to justify a dedicated clinic? Can a pharmacist free medical consultant time and therefore provide an economic benefit to the service (as pharmacists generally have lower staff time costs than medical consultants)? If the answer to these questions is yes, then a business case can be made for a pharmacist-led clinic.


Practical operation of pharmacist- led clinics


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Pharmacist-led clinics are often developed to run alongside consultant clinics. This model allows patients to be reviewed by a healthcare professional with the appropriate level of skill to manage their condition. The consultant can concentrate on more complex patients where their expertise may be better utilised and the pharmacist can review a specific cohort of patients for whom it is felt that consultant input is not required at each visit. By setting up the parallel clinics in this way, clinic capacity is increased and a more experienced colleague is available if needed to support the pharmacist. This has proven to be a useful model to develop pharmacists starting out in


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clinic as an independent practitioner. It also allows the gradual expansion of range and type of patients that can be seen as the clinical experience and confidence of the pharmacist develops. Having a medical consultant as a mentor is very useful when a pharmacist first starts in such a role.


Direct integration into the clinical


team, often working in conjunction with consultants, specialist registrars and specialist nursing colleagues allows pharmacists to review their own case load of patients. They are also ideally placed to answer queries and have input into more complex cases to manage a patient’s treatment and condition as part of the multidisciplinary team in the clinic setting.


Clinic models


Pharmacists can undertake non- prescribing medication review clinics that aim to optimise patient treatment and manage toxicity. For example, near patient clinics have been developed to allow verification of chemotherapy prescriptions at the point of prescribing by a pharmacist who has direct access to the patient in clinic with their notes. This allows input into toxicity management, supportive care


assessment and counselling. Pharmacists who have gained an independent prescribing qualification can have a specific cohort of patients under review in their own clinic. It is good practice for this to be protocol led to clearly define the nature of patients they should be reviewing, along with acceptable clinical parameters and criteria for when it is appropriate to refer the patient back to the consultant clinic. By acting in this manner, the pharmacist can independently assess patients who are established on regular chemotherapy treatment. The clinic appointment is used to review patient blood results, assess toxicity and make dose adjustments as needed.


The model utilised in Northumbria Healthcare NHS Foundation Trust is the provision of a pharmacist-led clinic to review patients with MPD. Once established on therapy, which mainly involves oral chemotherapy agents, this group of patients are seen in clinic every three months. Numbers of patients being reviewed mean that once-weekly clinics run at the three main hospital sites in the Trust. The clinic protocol developed clearly states monitoring parameters, referral criteria to both the pharmacist- led clinic and for re-referral to the


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