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CLINICAL PRACTICE


GP practice teams affect community pharmacists, many of whom themselves have clinical roles far beyond the High Street?


‘I know there is anxiety amongst community pharmacists as to where this leaves them,’ says Aileen Bryson. Interim Director for the Royal Pharmaceutical Society in Scotland. ‘Actually, it is really important that the practice pharmacist works directly with the community pharmacist because there is huge amount that the community pharmacist can be doing, and knowledge they can share, and if they work well together locally they can capitalise on that.


‘There are some places where the role is a hybrid job where a pharmacist is working three days in the community and two days in the GP practice. Anecdotally, we are hearing this works really well and some people might suggest that that would be the best model.


‘I am hoping we get some sort of evaluation of all the different approaches and pilots and models as part of Prescription for Excellence. It is very much not ‘one size fits all’ but it would be good to know from the evidence what works.’


This view is mirrored by Community Pharmacy Scotland. Director of Operations, Matt Barclay, says the community pharmacy workforce is prepared to play its part in supporting the aims of the National Clinical Strategy and developing the framework to allow that to happen:


‘We acknowledge that pharmacists can - and should be - part of the solution within the new Community Health Service Vision currently being developed by Scottish Government under their new models of care. We would hope that pharmacists in these roles can facilitate continued strengthening of therapeutic partnerships within the wider primary care team.


‘We would also welcome innovative solutions bringing the community pharmacy network into helping provide improved patient care. In some areas this has involved community pharmacists sharing in the delivery of these new roles alongside their existing roles. We await with interest the evidence that comes from this type of model. Our initial understanding is that, for many pharmacy contractors, this has benefitted their employees and their business as expertise is


shared and relationships strengthened with other healthcare professionals.’


So what advanced skills are expected of General Practice Clinical Pharmacists? Rose Marie Parr says that, while the new posts are usually being filled by experienced pharmacists, there is a broad spectrum:


‘It is a bit of an evolution so that when people are up to speed they need to be working to the top of their licence. They’ll be patient facing and have their independent prescribing qualification in addition to some advanced or post graduate clinical training and skills, and consultation skills. We want people to be competent and confident clinically. They may not have all this from day one, but we would expect them to all be on that learning curve.’


expected to complete.


‘NES is fast tracking these pharmacists through independent prescribing and clinical skills courses, and working with the individuals and their line managers in health boards.


‘In parallel, NES is piloting a ‘Foundation Framework’ for early years pharmacists with core and specialist modules, one of the specialist modules relating to work in general practice.’


Late last year, the RPS published a joint statement with the Royal College of General Practitioners of guiding principles for the role of general practice based pharmacists.


‘We were very clear that the skills are very different at the same time as being very synergistic,’ says the RPS’


‘I SUPPOSE CHANGE IS SCARY,BUT IF YOU FEAR CHANGE IN THE NHS YOU ARE DOOMED BECAUSE IT CHANGES ALL THE TIME. FOR ME THERE IS NOTHING TO FEAR FOR PHARMACY: COMMUNITY OR PRIMARY OR WHATEVER. BUT THERE WILL BE CHANGE AND IT WON’T BE THE SAME IN THE NEXT FIVE YEARS


AS IT WAS IN THE LAST FIVE YEARS.’ ROSE MARIE PARR.


With this in mind, Anne Watson, Postgraduate Pharmacy Dean at NHS Education for Scotland, sets out how NES is supporting the education and training of these pharmacists.


‘There are three elements. The first is e-learning packages on the fundamentals of general practice, and therapeutics modules for common clinical conditions. The second is attendance at training camps supported by the general practice multi-professional team which includes training on telephone consultations, communication and clinical skills, and clinical decision making. The third is an advanced practice competency and capability framework, aligned to the RPS Faculty, which each person is


Aileen Bryson. ‘We need to have the pharmacists working in their own professional competency with their own professional autonomy in the same way as each GP works and the same way as the practice nurse works. Nobody is assisting the GP as such. They are all taking on roles where their skill mix is best used and knitting that together.


‘It is really important that they have one point of contact in their practice, somebody they can go to. But they also need an overall supervisor or mentor who is a pharmacist and that is the linchpin because they cannot be set adrift. There has to be a link with the wider primary care team, with the prescribing governance of their health


board, and they have to have the peer support of other pharmacists.’


Aileen Bryson says it is inevitable that pharmacists coming into new roles may take time to develop the role to its full potential. She says it goes deeper than just a division of tasks:


‘Pharmacists are very risk averse, GPs are not. GPs are trained to touch patients and talk to patients right from the start. Our training doesn’t do that yet but we are now asking pharmacists to test blood pressure or take blood samples. We have always said that some of our undergraduate training should be together and postgraduate training should be much more integrated, because that will get us the increased understanding between the two professions.’


‘I suppose change is scary,’ says Rose Marie Parr, ‘but if you fear change in the NHS you are doomed because it changes all the time. For me there is nothing to fear for pharmacy: community or primary or whatever. But there will be change and it won’t be the same in the next five years as it was in the last five years.’


So, what does this changed future look like from the perspective of an experienced practice-based pharmacist? Elaine Thomson believes it will see primary care realising the full potential of pharmacy:


‘I think our clinical skills will be being used much more. We will be seeing a lot more patients and we will be getting a lot more referrals from GPs, moving away from the prescribing support role even further. We will be much more patient facing; we will be taking on a wider caseload, managing more complex patients and developing more clinical skills to allow us to do that.


‘To do that the whole team is going to have to change. We’re going to have to bring in more junior pharmacists and pharmacy technicians and have a whole team approach to be able to do much more of this stuff. The pressures on general practice are huge at the moment so there is massive potential for us to use the clinical skills that we all learnt at university, and to use them to improve outcomes for patients.’


John Macgill is a Director of Ettrickburn, a communications consultancy specialising in Scottish health and care policy. www.ettrickburn.com


SCOTTISH PHARMACIST - 21


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