PRACTICE-BASED PHARMACY
WITH PRACTICE-BASED PHARMACISTS IN POST ACROSS THE UK, JOHN MACGILL LOOKS AT THE DRIVE TO INCREASE ACCESS TO GP PRACTICE-BASED PHARMACY IN SCOTLAND, WALES AND NORTHERN IRELAND, AND EXAMINES WHETHER THAT AMBITION IS BEING ACHIEVED AT THE EXPENSE OF OTHER PHARMACY SERVICES.
THREE NATIONS: DOES ‘ONE SIZE FIT ALL’? G
ordon Rushworth is a lecturer, researcher and clinician working in the Scottish
Highlands. For half of the week, he is an advanced pharmacist practitioner working with patients at a GP practice. On the other days, he supports pharmacists in improving their consultation, clinical and prescribing skills; teaches undergraduate medical and pharmacy students; and undertakes practice research.
‘I’ve held a portfolio post for the majority of my career,’ he says, ‘and would highly recommend it to anyone. It’s refreshing to be able to hold key roles in multiple organisations or sectors of practice.’
As part of the local practice team, Gordon runs a polypharmacy clinic for every patient on a dozen medicines or more, making his own prescribing decisions. He is also contributing to a
6 - SCOTTISH PHARMACIST
redesign of medication review systems that has seen almost four in ten patients on a repeat medicine move onto a serial prescription.
‘I work within a team which also includes advanced nurse practitioners,’ he continues. ‘We now see all the on- the-day presentations instead of GPs and undertake the majority of house visits for acutely unwell patients. The patients I assess, from across the age and acuity spectrum, are undiagnosed and are not triaged. There is GP support available should we need it. I’m counted within the clinician numbers for any given day to ensure the practice has adequate cover, so my role is integral, rather than ancillary, to the operation of the practice.’
By April 2018, driven by £16 million of Scottish Government funding to recruit pharmacists into general practice teams, 201 whole time
equivalent pharmacists and 47 pharmacy technician posts had been filled. The advent of a new Scottish GP contract that removed responsibility for ‘pharmacotherapy services’ from doctors, has helped drive recognition of the expert role of pharmacy – and encouraged buy-in from doctors.
When she spoke to Scottish Pharmacist late last year, the question for Scotland’s Chief Pharmaceutical Officer, Professor Rose Marie Parr, was how best to grow the current 50 per cent of practices with input from a pharmacist or technician to 100 per cent over the coming three years. Often, newly-appointed practice pharmacists have come into the role by splitting their time with their existing community pharmacy work. Professor Parr is an enthusiast for a mixed economy, portfolio approach.
‘It is important that people are positive about their jobs and their futures,’ she told SP, ‘that they don’t feel stuck in silos, but can benefit from an integrated service to allow them to move between settings and, equally, to stay where they are and do new things.’
Matt Barclay, Director of Operations at Community Pharmacy Scotland recognises both benefits and challenges from meeting the broadening expectations of the pharmacy workforce.
‘Community pharmacy is experiencing a challenging period,’ he says, ‘as we are seeing the recognition of the importance of community pharmacy in primary care, while, at the same time, having some staff choose to work in general practice pharmacy instead. Our focus is on keeping community pharmacy an attractive career choice
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