Staffordshire's GPs are being encouraged to recruit extra pharmacists to work in their surgeries. Why would that be a good idea? Let’s find out from Dr Muni Hussain of the Pharmacy Local Professional Network.
SG: Thanks very much for coming in. How can pharmacists be beneficial to have around the corner from their doctor in the same building?”
MH: Well, we all know about the community pharmacy and the pharmacists working in the community pharmacy but it’s actually not a new idea. Pharmacists have been working in GP practices for a number of years. So, for example, I still do sessions in general practice and the first time I worked in a GP surgery was 10 years ago. It’s a national drive to actually have GPs working with lots of other health professionals. We know nurses work with GPs and it’s a national drive to actually get the pharmacists working with the GP and the nurse so that they can utilise their skills around medicines and help patients.
SG: To the point where the GP may pop out and have a word with the pharmacist to decide which drugs are best to treat a certain patient, then?
MH: Absolutely but we’re also looking at pharmacists who are actually trained prescribers. So pharmacists are now able to actually see the patient, looking at the medicines that they’re on and actually, if needs be, adjusting the dose so that the patient gets a better outcome and actually prescribing the medicine themselves.
SG: So, you could have an appointment at your surgery but it’s an appointment with a pharmacist rather than a doctor or a practice nurse or whoever?
MH: Absolutely. So, for example, there are some pharmacists who are looking after long-term conditions. They might be running an asthma clinic so if you’re on asthma inhalers, you might pop down to see your pharmacist who will go through your inhalers and make sure that first, you’re taking them properly, check the doses, check they’re the right inhalers and, if needs be, tweak your medication. So, that might be actually prescribing you a new inhaler or stopping a particular inhaler or increasing the dose.
SG: Given the amount of training that pharmacists have, which is lots, are they a bit underutilised by the health service?
MH: I personally think they are. As you’ve highlighted, to qualify are a pharmacist, you’re looking at five years minimum training, which is one year less than a doctor. So, you’ve got highly trained professionals who know a lot about medicines. What we’re doing is, we’re taking that training and giving more training, so that they can clinically assess people so that they can, in many cases, diagnose conditions which they’re trained to diagnose and then actually prescribe the treatments for those conditions.
SG: Given that there are some practices, two I’ve used in North Staffordshire, one in Madeley and one in Cheadle, both have a pharmacy, a big cupboard, a hole in the wall; they’ve got pharmacies onsite. Is there evidence that those kind of places are working better than the ones that have to send you around the corner to a community pharmacy or to the supermarket?
MH: We’re talking about the same people. We’re talking about pharmacists. It doesn’t really matter if you’re a pharmacist working in a hospital or a pharmacist working in the local community, we’re talking about, rather than the dispensing function, we’re talking about the pharmacists using their clinical skills to actually intervene with the patient’s medicines and actually change the medicines. So, rather than focusing on the dispensing and making sure it’s safe to dispense, actually intervening at an earlier stage.
SG: So, the Medicines Use Review scheme that’s being going on for the last four or five years or so. It’s taking that much earlier by the sound of it. So you almost do that from day one.
MH: Absolutely. I mean, the Medicine Use Review will still carry on with community pharmacies but you’re right, so; I call it a Clinical Medication Review. It’s more-or-less the same thing but you’re sat there in the GP surgery, you’ve got the patient’s records in front of you, you’ve got the blood results, you’ve got the patient in front of you, so you can possibly do a more thorough in-depth job.
SG: Would it be fair to say GPs are very good at spotting illnesses and spotting what’s wrong with people and actually the pharmacists are possibly the ones who know which medications are better to treat it?
MH: Well I’m pretty biased as a pharmacist. *the two laugh*
SG: So if I had a GP next you, I’d get a different answer here, I’m guessing.
MH: The reality is that GPs are absolutely great. They are generalists and they are absolutely great at diagnosing and they are actually very good at actually making sure that you are on the right treatment. But, as a pharmacist, we receive extra training on the medicine side of things. So, once the GPs diagnoses, knows exactly what’s wrong with you, especially with long-term conditions, it makes sense having a pharmacist who is a specialist in medicine to actually tweak your medicines such that you get the most out of them.
SG: What’s driving this? Is it patient care? Is it money? Is it a bit of both?
MH: I personally think it’s a bit of both. I mean, NHS England have committed over £100m to this initiative. They did a pilot last year and it was really successful so this year they’ve committed a lot of money behind it. They’re expecting 15,000 pharmacists to work in GP practices. Part of that is because there’s good evidence that when you’ve got a multidisciplinary team looking after a patient, then the patient gets better care. We know that. But there is an element of actually, as a pharmacist, we’re pretty prudent on looking at the medicines and making sure that we get best value for money. Not that I’m saying GPs aren’t. But it’s also linked with that there is currently a GP crisis and a nurse crisis as well. We have practices which have difficulty in recruiting GPs, we have practices who have difficulty in recruiting nurses. So we’ve now got another health professional, which we’ve got plenty of, thankfully in pharmacy, we don’t have a shortage, who have the skills and, with further training, can help general practice treat their patients.”
SG: How much training would it take?
MH: Well, as I said, the basic training for a pharmacist is five years anyway. If you’re selected as part of the national programme, then there’s an additional 18 months of training to help you understand the general practice, to give you the clinical assessment skills, or, if you’ve got plenty of experience in general practice, you might go on a six-month enhanced course to give you the qualification. We are talking pharmacists who have the expertise that are undergoing additional training so that they are absolutely competent so they can do the job.
SG: And, of course, they understand how that bit of the NHS works, which is probably what most of the training will be but it’s a complicated beast, the health service, as you know.
MH: Absolutely. Working in a clinic room in general practice is different to working behind a counter in a pharmacy. So you’re absolutely right, a lot of training will be needed to understand the nuances of general practice.