1. Development of pharmacist prescribing clinics and promoting a positive image of pharmacists in primary care
Kerry Steel
Rowlands Pharmacy, 29 Mount Oliphant Crescent, Ayr, KA7 3EN
Aim
To provide an overview of pharmacist involvement in a wide range of primary care settings and ideas for future development
To demonstrate the development from one weekly clinic to being integrated into the GP healthcare team
To outline how these clinics have promoted and maintained a positive image of pharmacist and pharmacy.
Setting up and expanding clinics
Initial approach of all local surgeries
Collaboration with Ayrshire and Arran (A&A) health board
Expanding the role – undergoing training to provide phlebotomy & IM injections for vaccination services.
Analysing patient blood results to assess suitability and impact of medicines prescribed
Positive feedback to A&A health board from GP practices & interventions logged to support future claims for funding.
CPD and peer review for evaluation
Branching out to include 7 different GP surgeries 1
Development of clinics
Collaboration with GPs and practice manager to identify areas where pharmacist prescribing clinics may be useful – e.g. in those affected by GP workforce issues.
Developing the role – i.e. with the introduction of phlebotomy training, training to give IM injections.
Expanding the sphere of competency to include other specialities e.g. asthma, diabetes and other cardiovascular conditions then to prescribing in addictions, making use of skills to do polypharmacy review for the health board.
Prescribing for a cohort of hypertensives patients from the community pharmacy setting incorporating aims from the Prescription for Excellence guidelines.
Now working directly for Oxenward practice undertaking a wide variety of tasks, managing minor ailments, dealing with hospital IDL, special prescription request, medication queries and cost saving projects.
Impact
Training in phlebotomy and immunisation enables seamless care for the patient
GP time is saved by pharmacist intervention in uncontrolled hypertensive patients
Every month we have submitted 2 A4 pages of interventions to local health board including such issues as addressing side effects by adjusting therapy. Diagnosis of hypertension, diagnosis of diabetes or anaemia, initiation of appropriate medications, e.g. statins for diabetic patients.
Immediate access to primary care records allows me to make informed autonomous choices – directly benefiting the patient, the practice and the pharmacy.
Increased communication with local community pharmacies.
Peer review has shown that colleagues would be interested in providing these services.
Patient feedback has shown that the patients are delighted to have the pharmacist input into their long term health conditions. The image of the pharmacist is a positive one.
Future Recommendations
Pharmacists can offer real benefits in improving outcomes for long term conditions and can save patients making multiple appointments for GP, nurse, phlebotomists
Pharmacist independent prescribing clinics have promoted a positive image of pharmacists.
The ability to utilise the independent prescribing fund should be enhanced to include those services undertaken in GP practices.
Access to records for community pharmacists should be made a priority so we can provide excellent patient care and prescribe safely and autonomously with access to previous medical history, blood results etc.
The role could be expanded further to provide a prescribing role for minor illness in the community pharmacy or GP surgery, e.g. URTI, ear infections, wound management thus allowing a flexible, accessible and efficient service for the patient
Acknowledgements
Natalie Weir, Strathclyde University. Staff of and area manager, L McElroy,of Rowlands Pharmacy Forehill. Staff of the following GP practices: Fullarton Practice, Barns Medical Practice, The surgery at 9 Alloway plc, Tam's brig medical practice, Ayr. The Wards Medical Practice Kilmarnock. Maybole medical practice (Dr Sheward's). Oxenward medical practice, Kilwinning. A&A health board, A&A addiction services.