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PRACTICE-BASED PHARMACY


and developing the services that we can provide.


‘The clear benefit of general practice pharmacy is taking pressure off GP time, and, to improve this further, we would like to see community pharmacy getting access to patient records so that we can further support prescribing and medicine review for patients.’


Russell Goodway, Chief Executive of Community Pharmacy Wales says his organisation welcomes the notion of greater collaboration between community pharmacists and general practitioners, either through local community-based arrangements or working together through the GP cluster model.


‘A ‘one size fits all’ approach, such as just employing community pharmacists in GP practices isn’t always the best solution, and isn’t what’s being asked for by the Welsh Government in terms of developing community pharmacy services in Wales. Indeed, when faced with increased recruitment pressures on community pharmacies in some parts of Wales, taking some of the potential workforce out of potential employment might actually worsen the situation in terms of accessing community pharmacy. It is often better to look at alternative models, such as secondment for one day a week, rather than direct employment.’


In late 2015, the Welsh government started a process towards recruiting primary care pharmacists to work across its 64 clusters, each cluster serving between 30 and 60,000 people depending on geography. At the same time, an increasing number of GP practices are directly employing a pharmacist as part of their team.


Lloyd Hambridge is a cluster pharmacist in Aneurin Bevan Health Board, working with another pharmacist across seven GP practices. He also now works two days a week embedded in a single practice. Portfolio working across different settings is, he says, common. In his Board, two colleagues split their time between cluster and community pharmacy jobs.


‘It was probably two thirds secondary care and a third community pharmacists moving into these roles,’ he says, ‘so we had to make sure that we weren’t losing too many pharmacists from hospital settings as opposed to community. I think


though that the Wales model means a lot of them have a multisector role and a portfolio career. Our Chief Pharmaceutical Officer is very forward thinking and innovative and he understands the value of community pharmacy, so a lot of community pharmacists want to stay there because they are seeing it become more interesting and varied, and quite clinical as well, with the roll-out of our Common Ailment Service and the ‘Choose Pharmacy’ campaign.’


Northern Ireland is currently suffering a crippling pharmacy workforce crisis, according to Adrienne Clugston, Operations Manager for the Ulster Chemists’ Association (UCA).


‘We’ve gone from a chronic oversupply of pharmacists to a situation where pharmacies are having to reduce opening hours through lack of pharmacist cover,’ she says. ‘The factors causing this are varied: many newly-qualified pharmacists left for Ireland or GB or further afield when they couldn’t get regular work, the number of graduates coming through has reduced, plus the recruitment of practice-based pharmacists has turned the situation 180 degrees in just a couple of years.’


Northern Ireland’s Department of Health is spending £15m to deliver practice based pharmacy support to all GP practices across Northern Ireland. Recruitment to these permanent posts is in six waves and, with the first four waves completed, 227 pharmacists – filling 189 WTE posts – have been appointed to GP practices across Northern Ireland.


Adrienne Clugston says there has been a price to pay.


‘New roles for pharmacists - especially within primary care - is a very welcome development and is recognition of the value they can bring to the NHS, but the fact is there are just not enough pharmacists in Northern Ireland to go around. All sectors in pharmacy are suffering.


‘UCA raised this issue more than a year ago with the Department of Health, who seemed to be oblivious, if not unsympathetic, to the unfolding situation. UCA was informed that an NHS-wide workforce review was getting underway and that pharmacy would be taken into consideration. Unfortunately, we have not seen the outcomes of that review yet and the


recruitment of practice pharmacists has continued unabated.’


As well as his day-to-day work as a community pharmacist, Jonathan Lloyd is Director of Integration for PACT – Primary Care and Community Together – a Northern Ireland community interest company, which was set up to look at how community pharmacy can integrate with other health and care providers in their communities. He says the recruitment of pharmacists into GP practices has been a mixed blessing:


‘Speaking personally as a community pharmacist, I suppose the positive would be that I now have somebody within the practice who understands what community pharmacy is talking about. We have advocates within the practices who, as they’ve generally been drawn from community pharmacy, know why we are asking things that may seem pedantic to a GP.


‘The problem is that they have been drawn from community pharmacy, so we are starting to see a crippling workforce crisis appearing. If you put an advert anywhere for a pharmacist, you are unlikely to get one. Locums too are becoming extremely difficult to find. We have gone from perhaps an oversupply of pharmacists to a situation where we are struggling.


‘I don’t think the Department did a workforce plan before they fired the gun on this and they are continuing to aggressively recruit into practices without taking any account of what is happening within community pharmacy.’


A spokesman for the Department of Health told SP that an ongoing review is underway of the pharmacy workforce, incorporating pharmacists, pharmacy technicians and pharmacy support staff. This review is intended to inform HSC workforce development needs for the next ten years and is expected to be completed by autumn 2019.


In the meantime, UCA and Community Pharmacy Northern Ireland have both proposed a pause on the recruitment of practice-based pharmacists to allow the workforce to replenish, but a spokesperson for Northern Ireland’s Health and Social Care Board says the fifth wave of pharmacists will take up post in the first quarter of the next financial year, with the final group taking up post


during 2020, filling approximately 294 WTE posts.


‘Practice-based pharmacists come from a broad range of backgrounds and sectors, including community and hospital pharmacy, academia and prescribing support roles,’ the spokesperson said. ‘The posts have attracted both local pharmacists and those who have been working in Great Britain and the Republic of Ireland.


‘The pharmacist workforce has responded very positively to calls for the new roles in general practice causing a short term pressure on other employers. This has been recognised and the Health and Social Care Board and Department of Health are working with stakeholders to help mitigate any negative impact particularly on community pharmacy staffing levels, over the final two waves of recruitment during 2019 and 2020.’


Scottish practice-based pharmacist, lecturer and researcher, Gordon Rushworth, wonders if there is a solution that’s about community pharmacy and not about practice- based or secondary roles:


‘Make the community pharmacist job more appealing,’ he says. ‘It sounds somewhat crass, but I think it’s true. People don’t tend to leave appealing jobs. Whether it’s pay and conditions, the lure of an NHS pension, the lack of weekend and evening working or a perceived workload reduction from a busy pharmacy dispensary – I’ve heard all these used, in part, to describe why community pharmacists have moved to another sector of practice.


‘However, the biggest driver that I’ve heard from community pharmacists/ GP pharmacists is the perception that the GP jobs will be far more clinical and patient-facing and, in many instances, community pharmacists are willing to take pay cuts to do this.


‘I think community pharmacy needs to listen to those leaving its ranks and think what changes it’s able to make to retain staff.’


SCOTTISH PHARMACIST - 7


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