With much in the news about GP-pharmacy collaboration; we dug up this feature from the archives. Developing a diverse practice team has long been on the agenda and is one of the positive outcomes of collaboration in primary care and is a step towards patients receiving the care that they need locally. For a previous issue of Practice Business, Marie Cahalane spoke with Dr Carole Buckley, of Old School Surgery, Bristol, about how partnering with a pharmacist has helped their practice
At the heart of NHS care stands general practice as an integral part of population health care. The challenge is catering to an ever-changing population – at present an aging one with people who are living longer with long-term conditions and requiring local access to care that is focused on them. Multi-disciplinary teams have been promoted as the solution that will, ultimately, enable GP practices to broaden services and tailor the care provided.
Where there is a shortfall in GP and nurse numbers pharmacists occupy a unique position to offer support. GP-pharmacist collaborations can provide more patient-centric care, provide a more holistic approach to care and reduce prescribing and downstream care costs.
At the Old School Surgery, Bristol, this is something that has been strongly recognised. Here, Dr Carole Buckley, GP at The Old School Surgery, explains the benefits of on-site pharmaceutical expertise.
What led you to initially enlist a pharmacist at The Old School Surgery?
In 2001 Bristol clinical commissioning group (CCG) had a practice support pharmacist in every practice and it was through this that Rachel Hall joined us. She was an instant success; by 2003 she had brought our prescribing costs down to within budget – which was the first time we had ever achieved this – and she was well-liked by the practice team and patients alike.
Rachel is now both a clinical pharmacist and a partner. How did this come about?
She realised that she preferred clinical work so she trained up and, eventually, returned to our surgery. In 2006, we needed additional clinician time as our list size had increased dramatically. We considered our options; we were a poorly-funded practice and our available finances only facilitated four or five extra doctor sessions. Rachel had such a positive impact on the practice – she had lightened our workload, improved diabetic care and patients liked her – and cost significantly less than a doctor. We realised she was our solution and we offered her a permanent job. By 2013 she had earned her place as a partner; we’ve never looked back.
What does Rachel bring to the practice team?
Rachel runs additional services. She does our chronic, long-term conditions’ management, our hospital discharge medication, reconciliations and she has set up all of our prescribing protocols. Her workload is such that we’ve just taken on an another half-time pharmacist with the help of the recent pharmacy funding.
You mentioned that she offers additional services. Can you elaborate?
Rachel has 20-minute appointment slots and so offers a more holistic review of patients’ health. She conducts a more in-depth medication review and she’s giving more lifestyle advice to patients.
Plus, she is expert in her prescribing. Take her work on diabetic prescriptions; we were one of the first practices to take up the NOAC anticoagulants because, when we reviewed our atrial fibrillation patients, we were able to transfer those not considered suitable for Warfarin to the NOACs. If any new guidance comes out on prescribing she will summarise it for us.
We’ve got four nurse prescribers here as well – we’re very much in favour of multi-disciplinary teams, expanding people’s abilities and encouraging people to push themselves to achieve what they want to do and more.
Collaborative working disperses workloads more evenly across practice staff. Are there particular ways Rachel, as clinical pharmacist, aids this?
GPs are diagnosticians and Rachel, as well as holding her own, supports and reinforces what we do. She’s augmented our care structures; she’s set up a call and recall system for chronic disease management and supports our treatment room nurses who are now trained in all long-term conditions.
In addition, Rachel has organised a clinic for patients to attend annually that evaluates multiple conditions. So, if they’ve got kidney disease, hypertension, diabetes, they will get called for clinic ‘D’ and receptionists know that appointment will need an hour. This is incredibly efficient – we don’t waste appointments.
You also run co-located pharmacy. What has this meant for the practice?
We work in very close collaboration with our on-site pharmacy. We run what is called ‘pharmacy first’ where patients are directed by our staff into the pharmacy first if it is considered something that our pharmacy staff can deal with. Our pharmacy deals almost exclusively with smoking cessation, emergency hormonal contraception requirements, urgent repeat medication requests, minor ailments, etc.
Jonathan Campbell, our pharmacist, is an independent pharmacist and he’s inspirational. He won a national award for medicines optimisation for running a programme helping frail and vulnerable elderly people where he’ phones them once a month and optimises their treatment for us.
Sometimes it seems there’s reluctance to bring a pharmacist on board but this should not be the case – it’s a move where everybody wins.
This article first appeared in a previous issue of Practice Business