REPORT


“We have been highlighting for many years the pressures faced by general practice including ever increasing workloads from both patient demand and from work being shifted into the community from Trusts, the chronic under-funding of Out of Hours services as well as the need to address the recruitment and retention of GPs”


shoulder some of the workload which GPs are unable to carry at present,” he said.


“I would strongly be in support of Pharmacist representation on any working group as allied healthcare professionals.”


Radical proposals calling for pharmacists to work in GP surgeries were unveiled at a summit in London in March of this year.


The Royal College of General Practitioners (RCGP) and the Royal Pharmaceutical Society (RPS) came up with the plans in a bid to ease current pressures in general practice and address the severe shortage of GPs across England.


Many GP surgeries already work closely with pharmacists. The proposals would see pharmacists working as part of the general practice team, much in the same way as practice nurses.


They would work closely with GPs and other colleagues to resolve day to day medicine issues, particularly for patients with long term conditions and who are taking a number of different medications. They would also liaise with hospitals, community pharmacists and care homes to ensure seamless care for patients.


With many GPs approaching retirement age, and insufficient numbers of medical graduates going into general practice to replace them, practices are struggling to meet patient demand and waiting times to see a GP are getting longer.


Dr John O’Kelly, Chair of the RCGP Council for Northern Ireland, said such


an initiative would work well here. “Waiting times for a GP appointment are now a national talking point – and a national cause for concern, not least amongst GPs themselves.


“But, even if we were to get an urgent influx of extra funding and more GPs, we could not turn around the situation overnight due to the length of time it takes to train a GP.


“Practice -based pharmacists, working as part of the clinical team, would relieve the pressure on GPs and make a huge difference to patient care.


“This isn’t about having a pharmacy premises within a surgery, but about making full use of the pharmacist’s clinical skills to help patients and the over-stretched GP workforce.


“Patients with long term conditions such as asthma or diabetes with complex medicine needs would particularly benefit from having a pharmacist to help them navigate the conflicting and confusing information they sometimes receive about their treatment as they move between hospital and community care.


“Practice teams can also benefit from a pharmacist’s advice to help avoid medicines waste, improve the management of medicines and rationalise costs at this time of a squeeze on NHS finances.


“The health needs of the population are changing and we need to be adaptable and flexible enough to accommodate this without losing the unique strengths of general practice such as continuity of care.”


As part of the multidisciplinary team, pharmacists can advise other


professionals about medicines, resolve problems with prescriptions and reduce prescribing errors.


Pharmacists can also work with GPs to resolve day-to-day medicine issues and with practice teams to provide advice on medicines to care homes, as well as visiting patients in their own homes when needed.


Many believe it is a win-win situation for everyone concerned.


One Tyrone Pharmacist told Pharmacy in Focus, “I think there is tremendous potential in shifting some services left and making better use of community pharmacy as part of the wider GP team.


“Obviously there would need to be a strong referral policy in the process where if there was any doubt they would be referred straight away to a doctor. But it would take a huge amount of pressure off where GP level intervention is not necessarily required.”


“We would also, however, need to be very black and white and very obvious so that we would feel confident in doing what we would be doing. There would be issues in terms of staff and, we would have to work out a new fee structure.


“The exact logistics of it could be done through negotiation but there would have to be something there as it would take up more of our time and reduce our front of shop availability otherwise. There is no point shifting the pressure from one place to the other, you want to actually do something positive about it.”


UCA Vice President Stephen Slaine adds, “I am concerned about the long term sustainability of General Practice and the consequent impact on community pharmacy.


“I'm concerned both as a patient and a contractor. GP numbers need to be addressed in Northern Ireland and it's going to get worse before it gets better. Pharmacy can help but it's still going to need resolved.


“We have a real opportunity here to build and forge new relationships to help lessen the knock-on impact of this problem.”


Belfast Pharmacist Helene Buchanan said that any official additional workload requirements would have to be funded and resourced properly.


“Any scheme like this is, first of all, is going to have to be properly funded,” she said.


“There have to be incentives as this kind of work is time consuming.”


But, with adequate support and resources, she says that there is a


Dr John O’Kelly, Chair, RCGP Council, NI


willingness for pharmacists to increase their responsibilities for the benefit of the health system.


She pointed to recent research from the UK Royal College of General Practitioners (RAGP) and the College of Emergency Medicine, which found that one in seven GP visits and one in 12 visits in the ED could be dealt with by the pharmacist.


She also believes that the recent proposal for pharmacists to work alongside GPs in general practice teams, which was made by the RCGP and the Royal Pharmaceutical Society is viable.


As part of the team, they would share responsibility with GPs for day-to-day medicine issues, particularly for patients with long term conditions and those taking a large number of different medications.


It is believed that the Department of Health is currently examining how the sector can most valuably and cost effectively contribute to the health and wellbeing of patients in Northern Ireland healthcare.


The manpower issues facing general practice cannot be ignored and pharmacists are ready and able to do their part to contribute to a solution.


Meanwhile, as Pharmacy in Focus was going to press, it was announced that GP quality targets look set to stay in Northern Ireland, despite calls for their abolition from doctors leaders.


The Department of Health, Social Services and Public Safety said it had no plans to suspend or abolish QOF (quality and outcomes framework) in Northern Ireland.


BMA Northern Ireland said the step would help overstretched GPs to manage their workload. BMA Northern Ireland GPs committee chair Tom Black said the committee would continue to strive to cut bureaucracy in the GP contract to allow GPs more time on patient care.


“This is particularly pertinent in Northern Ireland due to the huge shift of work from secondary care [owing to] long hospital waiting lists,” he said. n


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