1. Primary Care Pharmacists Association
Practice Pharmacists Group Symposium 2016
10th March 2016 : The Studio, Birmingham
Clinical Pharmacists in General Practice Pilot Case Study : Florence Road Surgery Ealing GP Federation
Dr David Evans, Senior Partner & Dr Graham Stretch, Prescribing Lead
Florence Road Surgery, Ealing, London
@GrahamStretch

2. Overview Background Journey Current Service The Pilot in Ealing
Florence
Future Plans

3. Florence and Bramley Surgeries
Two sites
16,000
10 GP principles
5 Nurses (1 IP)
Teaching Practice: 2 GP Registrars

4. …if they can have clinical pharmacists, why can’t I?

5. 2005 – struggling nursing home ↑ joint local CP / GP working
2009 Nursing home study ↓ 91% Errors
Pharmacy, Nursing and Medical Press
National Daily Telegraph, Scotsman
Past
Future

6. 2010 – 91% Error reduction Half day ward round
‘most vulnerable : least likely to receive pharmaceutical care’ just a driver

7. 2005 – struggling nursing home ↑ joint local CP / GP working
Past
2005 – struggling nursing home
↑ joint local CP / GP working
2009 Nursing home study ↓ 91% Errors
Pharmacy, Nursing and Medical Press
National Daily Telegraph, Scotsman
2012 Medicines Management Sessions
Future

8. Meds Management QIPP Management of prescribing
CCG audits, targets and review work
Increasing information and clinical case load
Budget and targets met

9. Pharmacy team with full skill mix
Past
2005 – struggling nursing home
↑ joint local CP / GP working
2009 Nursing home study ↓ 91% Errors
Pharmacy, Nursing and Medical Press
National Daily Telegraph, Scotsman
2010Medicines Management Sessions
Pharmacy team with full skill mix
4 Pharmacy Techs, Pre-reg, Clinical Pharmacist, Pharmacist IP x3, Lead
Management of Prescribing & Clinical Sessions
Future

10. Protocol

12. Advantages Refer complex queries eg. Training for GP Registrars CQC
Premature infants
Trazodone titration
Training for GP Registrars
CQC
“Excellent – very impressed with pharmacy team”

13. Benefits Cost effective
Time effective > 95% of prescribing (Budget >£1.2m) GP
Savings = 45m – 60m / day / GP (x 10 GP!)
Reception
Time freed up ~ ‘para-legal’
‘PA’ to individual GP
Nurse
Chronic Disease Management
Polypharmacy
Information
PATIENTS – accessible, approachable, timely

14. Pharmacy team with full skill mix
Past
2005 – struggling nursing home
↑ joint local CP / GP working
2009 Nursing home study ↓ 91% Errors
Pharmacy, Nursing and Medical Press
National Daily Telegraph, Scotsman
2010Medicines Management Sessions
Pharmacy team with full skill mix
4 Pharmacy Techs, Pre-reg, Clinical Pharmacist, Pharmacist IP x3, Lead
Management of Prescribing & Clinical Sessions
Future
Full time equivalent clinical pharmacist role
Triage and Treat v
Medicines Optimisation & Polypharmacy
Chronic Disease Management
Integrated Case Coordination
Health and Social Care .

15. The Pilot - Ealing GP Federation
17 Practices – 131,000 population
6 Pharmacists
1 Senior Pharmacist
5 Clinical Pharmacists (WTE)
60 Sessions

16. KPIs
At least 60-70% of pharmacist time spent in direct contact with patients – face to face or telephone
A baseline of >60% of pharmacist appointments will release an equivalent GP appointment
95% of discharges or OP, medication reconciled 1/52. Readmission contact 1/52
Patients with diabetes stratified as high risk by the Out of Hospital Strategy reviewed every 6 months
Patients with uncontrolled hypertension (eg >150/90) reviewed each six months
Communications from other care settings reviewed within one week – current practice baseline.
Satisfaction feedback from community pharmacist (closest four)
All errors coded and 75% reported to NRLS online
Pharmacist satisfaction measurements exceed that of practice average
>60% uptake of EPS2

17. At Florence - development
Senior pharmacist and pilot pharmacist
Shadowing
GP/Nurse and pharmacist
Pharmacist and GP/Nurse
Debrief with Clinical Supervisor
Initially after each session
Less frequent with experience
Weekly lunch time meetings with other pilot pharmacists
Weekly clinical meetings / case discussion
PPG engagement

18. At Florence Clinics / Home visits Care Coordination
Complex Elderly / Palliative
Polypharmacy – Meds Optimisation – Meds Review
Chronic Disease
Diabetes
Respiratory
Cardiovascular
Care Coordination
Joint visits
Medication review

19. At Florence ‘Triage and Treat’ Afternoon sessions – 2 hours call back
2 Hours face to face to treat
Odyssey
“The clinical assessment stage allows the doctor or nurse to perform an in-depth clinical assessment with … telephone assessment … clinicians to practice according to the most up-to-date best practice guidelines, helping them to make informed decisions and deliver a consistently high quality service for every patient”
Murdoch J, Barnes R, Pooler J, et al.. BMJ Open 2014;4:e doi: /bmjopen

20. Triage Support Tool

21. Pharmacy Skill Mix Clinical Primary Care Prescribing Management in GP
Broad Church – 8,000 meets 11,000
What does each stakeholder bring to party?
Primary Care
GP - Prescribing
GP - Clinical
Primary Care CP
Tech IP
CCG
Prescribing Management in GP
Clinical
Diploma
RPS Faculty

22. The Future Joint Projects with Community Pharmacy Training for CP
Diabetes 6 Month Reviews in CP - Structured
Motivational Interviewing
Diet
Physical Activity
Medication Use (SCR)
Smoking/Alcohol
Flu Jab BP
BMI
Training for CP
Communication – coordination of Bloods (HbA1c, Lipids Urine ACR, Renal)

23. The Future Advanced Assessment Skills for Clinical Practice
LSBU Nursing School
Research – PhD Student for 3 years / Post Doc
Reading University
Faculty – Advanced/Fellow
Consultant Pharmacists – why not GPP?