NEW POSITIONS
at their local surgery,’ Sean told PiF. ‘At the beginning however, there’s no question that the PBP will have to educate both the practice team and the patients about the role of the PBP in general, as many of the general public and many healthcare professionals are unaware of this role and how they could benefit from it.
‘I think one of the most successful aspects of working in this way is that it provides both the PBP and the community pharmacist with an interprofessional relationship, which allows everyone to utilise their healthcare scales to optimum effect.
‘Through the PBP, the community pharmacist has a point of contact with the GP surgery which goes way beyond the contact he or she may previously have had and can therefore work collaboratively. Even for the most minor of issues, having a PBP in place means that the community pharmacist only has to pick up the phone, or pop into the surgery to speak to a fellow professional and this allows problems to be resolved much more quickly and satisfactorily than was previously possible.
‘I had one instance, for example, where a patient was ordering medication from the GP four times a month. On consultation with the community pharmacist, I was able to ‘sync’ the whole process and produce a monthly script that obviously only needed to be ordered once a month. This made the whole system much more streamlined.
‘Risk management is another area
where collaboration between the PBP and the community pharmacy will be vitally important. Many patients, particularly the elderly, are faced with taking multiple medications and these can often change mid- cycle, leading to confusion and uncertainty in the patient. With fellow professional pharmacists working together and collaborating, the PBP can keep the community pharmacist up to date regarding the medication changes, which is preferable to relating changes to the GP surgery receptionist[ . By working in tandem, we can contribute greatly to risk management.’
If evidence was needed of the valuable work that PBPs can undertake, you only have to look at an initiative, which Sean ran in June of last year!
‘As a result of historical issues relating to this particular area,’ Sean said, ‘we had many issues with benzodiazepine prescribing, and it was very evident that much of the GPs’ time was taken up with patients coming in for prescriptions. This was not only impacting GPs’ workload, but there was obviously concern about the amount of benzodiazepines that were being prescribed in this community. Something had to be done – and quickly.’
Sean immediately set about organising appointments for 200 patients, who were on benzodiazepines.
‘These appointments provided me with the opportunity to talk to each
BACKGROUND
In December 2015, the then Health Minister Simon Hamilton announced a five-year initiative that would see additional investment in 2016/17 of up to £2.6million, rising to £14million per year in 2020/21, to provide for pharmacists to work alongside GPs.
‘We know our GP services face rising demand for appointments and prescriptions,’ the minister said. ‘We also know that patients are not getting the optimal benefits from their medicines and that there is a high level of non-adherence and waste across the UK, with up to six per cent of hospital admissions due to the adverse effects of medication.
‘GPs delivered 875,000 more consultations with patients in 2013/14 than in 2010/11. Alongside the growth in consultations has been a growth in prescribing with a 42 per cent increase in repeat prescriptions in the ten year period since 2003/4. While the cost of prescribing has fallen by 18 per cent in real terms since 2006, the volume of prescriptions continues to rise significantly – from 23 million items in 2000 to almost 39 million in 2013.
‘We have a great resource in our pharmacists whom we want to better utilise to work directly alongside GPs and nurses. Not only will this approach deliver a better service for patients, it is also common sense to ensure we make the most effective use of the skills and experience we have in health and social care.’
patient at some length and to focus on specific issues,’ Sean continued. ‘Obviously social reasons were behind much of this particular demograph’s reason for needing the medication, so we supported patients through Cognitive Behavioural Therapy (CBT) sessions, so that they could access this service as an additional support. Obviously with some patients there are clinical reasons for taking benzodiazepines, but many patients become so reliant on them that they begin to view them as a crutch. The CBT sessions meant that they could talk about their problems and this certainly helped to reduce anxiety levels in many patients.’
‘THE GREAT THING ABOUT THESE NEW ROLES, IS THAT THEY WILL ALL BE SO DIFFERENT. EACH PBP WILL PROBABLY GO INTO THEIR PRACTICES AND CARRY OUT MEDICATION REVIEWS. THIS COULD FLAG UP ANYTHING – FROM MEDICINES RECONCILIATION ISSUES TO PRESCRIBING SYSTEMS MANAGEMENT - SO THERE’LL BE A WIDE VARIATION IN THE JOB DESCRIPTION BETWEEN TWO PBPS.’
Sean’s initiative was so successful that over a three-month period Vere Foster experienced a ten per cent reduction in benzodiazepine prescribing.
‘I think that once the PBPs are up and running,’ Sean concluded, ‘both healthcare professionals and the patients will very quickly see the added value that these roles bring to pharmacy, and no one will benefit more than the community pharmacist, who will be involved in an interprofessional relationship that can only bring benefits to patients.’
Sean does, however, sound a note of caution.
‘The initiative will only really work if PBPs continue to embed within their individual practices and become a valued part of the practice team. A setup in which each federation has a group of PBPs and moves them
PHARMACY IN FOCUS - 17 WHAT CAN A
PBP PROVIDE? Expertise in clinical medicines reviews and helping to address both public health and patients’ social care needs
Medicines reconciliation following hospital discharge
Managing repeat prescribing reauthorisation procedures by reviewing requests for repeat prescriptions
Screening, diagnosis and initiation of treatment and follow-up appointments in patients with long- term conditions
Reviewing pathology results for patients on known medicines
Triaging patients to appropriate practice services and/or healthcare professionals
around surgeries just wouldn’t have the same impact. Also, there are many pharmacists who have been working within their practices for years and have already become a crucial part of the practice team. Losing these PBPs from these surgeries would be a major blow for both the practices and the PBPs involved.’ •
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