ROUTINE
OVER IN THE SPRINGFIELD ROAD SURGERY IN BELFAST, MEANWHILE, ANNA FAY HAS BEEN WORKING AS A PBP FOR ALMOST TEN YEARS. AS AN ACTIVE, QUALIFIED PRESCRIBER SINCE 2008, ANNA FEELS THAT A 'TYPICAL DAY' IN HER POST CLEARLY SHOWS THE VARIATION AND MULTI- FACETED BENEFITS THAT THIS ROLE CAN PROVIDE IN PRIMARY CARE....
8.30am - My day usually starts with a quick discussion with Practice Manager which can either be about ongoing issues or specific queries raised by a GP, patient or the community pharmacist. This is usually followed by a review with the reception staff of any urgent issues that need addressed before clinic starts.
9.00-12.30 - On the days that I'm seeing patients in clinic, time is spent setting equipment up and ensuring everything is ready for when patients arrive. I primarily run respiratory clinics, however, over time, I've developed skills, knowledge and competence in other areas, including hypertension and diabetes, so I also manage patients with these long-term conditions. Many patients with long-term conditions unfortunately have more than one, so it is important their medicines are managed holistically. This is an area where pharmacists excel, as pharmacists are the experts in medicines use and management.
30 - PHARMACY IN FOCUS
Time is spent with patients assessing their symptoms, medicines use and developing a care plan with them. As a prescriber, I will then amend prescriptions as needed. This may be starting new treatments, changing doses, changing inhaler device, or stopping treatment as needed. This is all done with the patient during the clinic and the benefit of this is reduced workload within the practice, ie, requests no longer have to be addressed by the GP. Follow up and referral to other services is also organised during clinic time. If time allows, I will address medicine requests from that morning.
13.30 - Once clinics are completed, it's time to move on to the practice notes, which are specific queries attached to patients' notes. A patient may need perhaps a medicines review or may require an appointment for a check-up or clinic review. Sometimes it will be the GP, who requests that I make an appointment for a particular patient. Equally, it may be the community pharmacist who will phone through to the practice reception regarding prescribing queries and these will be forwarded on to me. There may, for example, be a recurrent problem with the blister packs of a care home or nursing home patient. It's all a matter of 'open door' communication.
Often, I'll also be called upon to make suggestions for potential treatments following blood monitoring tests.
The community pharmacy MUR scheme has been useful in identifying patients that need further management and often patients tell me it is their community pharmacist that suggested they attend for review.
Over recent years it has also become clear that the numbers of prescriptions being requested has risen dramatically. Patients are using more medicines and there are increased risks associated with this. Everyone involved in the process of prescription generation and dispensing has a role in minimising these risks, It is for that reason that I always place great emphasis on the fact that the community pharmacist has direct access to me and can simply pick up the phone to discuss issues and, together, we can get it sorted as soon as possible.
2.30pm - Once the practice notes have been addressed, I spend time on the practice specific formulary. This helps ensure the practice is prescribing within clinical and professional guidelines to ensure the best outcomes for patients.
3pm - Medication review of patients recently discharged from hospital and of those at higher risk of medicines related adverse events including frail, elderly and those on multiple medicines (polypharmacy). Being an Independent Prescriber, any issues that arise can be dealt with directly and prescriptions issued or
amended as needed. This helps the patient access medicines in a timely fashion and also ensures a thorough clinical check is done at the high-risk interface.
I also undertake clinical audits that identify specific patients needing review, and develop and maintain practice protocols to ensure high standards of clinical governance.
I definitely feel that the PBPs, who will be coming in in September, might find this work particularly useful and I hope that many will want to work in this area.
3.30pm - Mid-afternoon, I'll start to look at audit issues that may have come up, such as duplicated medicines, patients ordering medication processes and potential errors in the prescribing process.
5.00-5.30pm - Follow up any outstanding issues from earlier in the day.
I firmly believe that the appointment of the first tranche of PBPs in September will bring nothing but benefit to the whole primary care system. There are already about 60 PBPs working in GP surgeries across Northern Ireland and the appointment of more will only streamline systems and improve collaborative processes between PBPs and community pharmacists. •
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