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The first stop

for professional medicines advice

Choose your interests and networks including

Medicines Use and Safety Interest

Don’t forget to tick the box at the bottom of the

page to say you would like us to keep in touch!

You will then receive information and invitations

to events run by the MUS Network

Make sure you get updates from us by joining the SPS Website

You can register at www.sps.nhs.uk and once registered, you

can go to the top right hand of the registration page and ‘edit

your profile’.

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MEDICINES USE AND SAFETY WEBINAR

FEBRUARY 2020

• Welcome to this MUS Webinar – Clinical Prioritisation by GP

Practice Pharmacists

• The webinar itself will start at 1pm. Shortly before 1pm the SPS Webinar

Host will be doing sound checks so bear with us if you hear this more than

once!

• To join the audio call 0203 478 5289 Access code: 952 063 840#

• The webinar will be recorded and both recording and slide set will be

available on the SPS website – under Networks (you need to be logged

onto the SPS site with your .nhs email address to access the recording)

• If you want to make a comment or ask a question – please use the “chat”

function. (You need to choose to direct your question to “All Participants”

from the drop down box)

• The presenters will answer questions at the end of the presentation

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Upcoming MUS Events

WEBINARS:

8 April Advanced Therapy Medicinal Products (ATMPs) –

Anne Black

13 May Care of people who use illicit drugs in the hospital setting –

Jenny Scott and Magdalena Harris

FACE TO FACE EVENTS (held in London)

5 May Community Health Service Pharmacists

Prioritisation in GP PracticeRory Donnelly

GP Pharmacist, Bush Doctors

Principal Teaching Fellow, Kings College University

Introduction

• Background

• Role of a GP Pharmacist• How this has developed? How do roles differ?

• What are the key priorities• Issues that I face• Short-term versus longer-term• What are the challenges?

• Ideal day vs realistic day

• Curveballs

• Ideas for prioritisation

Background• How did I get into this role?

• Previous secondary care experience.

• Part of 10+ pharmacy team across our PCN in H&F serving >70,000 patients.

• Role now split with teaching at Kings.

Role of a GP Pharmacist

• The way I see it:

• Huge variety in GP pharmacy workforce:o Background/experience

o Knowledge skill sets

o Activities

o Clear structure lacking across the board

• General Practice more nuanced – different to very procedural sectors of community and secondary care

• Surgeries differ within locality as well as regionally and nationally

• Influx of PCN funding – increase in GP pharmacy workforce

Role of a GP Pharmacist

Role a GP Pharmacist

Governance

Education and Training

Management

Clinical

Role of a GP PharmacistClinical

• Repeat process management – pharmacists – specialists in medicines.

• Workflow and medicines reconciliation

• High risk drug monitoring

• Patient facing role - clinics – chronic illness, telephone triage, acute care.

• Telephone calls

• Home visits, care home visits

• Advanced roles – diagnostic clinics.

• Medicines information service – supply issues, drug interactions, formulation issues, liaising with community pharmacy, hospital, urgent medicines requests –pharmacy on-call service

Role of a GP Pharmacist

Governance• Medication safety

• Audits

• Protocol development - What is already in place? What needs to be developed?

• Projects

• Service improvement

• Integrated care work

• Virtual clinics

• Antibiotic stewardship

Role of a GP Pharmacist

Management• QoF disease lead – list management, recalls, financial targets

• Enhanced services delivery

• Area prescribing targets

• Staff development - junior pharmacy staff, pharmacy technicians, pre-reg pharmacists, pharmacy students

• Role progression – reviewing service provision – how can this be streamlined?

Role of a GP Pharmacist

Education and training• Further higher education – Diploma, IP, MSC, ACP, consultant pharmacy role

• MPharm students, medical students, pre-reg pharmacists

• Interprofessional teaching

• PCN/wider pharmacy workforce teaching

What are the key priorities?New to role• Take time to get settled – try not to take on too much

o Don't say yes to everythingo Review where you can have an impacto Are you stepping on anyone's toes?

• Ensure role is definedo Indemnity arrangements match JDo Appropriate training/experience to role - consciously competento Boundaries in placeo Recent PDA correspondenceo Practice supporto MDU – largest proportion of claims medicines related

• Need to get in front of patients - recognised as clinical member - rapport, respect within team

• Administrative support

What are the key priorities?

Day-to-day activities

• Medicines requests – urgent medicines – how do you determine what is urgent?

• Medicines reconciliation - How do you prioritise this? How is it built into work schedule?

• How do you get patient facing? Who are the key stakeholders?

What are the key priorities?

Long-term:

• Protocol development. - are there any in place? If so, are they fit for purpose? What can be streamlined? What are the priorities for your surgery?

• Systems review – take time to review services e.g. repeats, clinical assessments

• Medicines safety – how can this be built in.o High risk drug monitoring – DMARDso CQC focus on high risk drugs eg MTX -

o Blinkers on DOAC monitoring, PPIs with NSAIDs, interacting medicines

• Role development – expansion of team, integrated care, professional relationship building

What is an ideal day in GP practice?

Ideal day

• 9-10am – Workflow

• 10-11.00 - Governance

• 11.00am-12.00 - Repeats

• 12-1pm - Telephone calls

• 2-5pm - Afternoon clinic

Realistic day• 9-10am – Dealing with a few difficult hospital discharges which have multiple issues, liaising with multiple sectors.• 10-12 – Repeats, disturbed throughout by reception and GPs with queries• 12-1 – Resolve queries• 1pm – Rushed telephone calls• 2-5pm - Afternoon clinic – Multiple difficult patients. Potential acute issues.• 5pm+ - Time spent finishing up day's tasks

Challenges

• Workload

• Staffing

• Experience

• Stakeholder engagement

• Place of worko Resistance to change from some staff

o Relationships e.g lack of contact with a senior CP

o Egos – people with their own agenda

o Nottingham university report

Curveballs

• GP's off site

• Administrative sickness

• Staff turnover

• Flu season

Curveballs

• GP's off site• Work within competence. Don’t give in to pressure of workload. Safety

paramount – e.g. '"please sign x prescription"

• Administrative sickness• Prioritise 'urgent' medicines

• Staff turnover• Protocol development – ensure included as part of staff induction.

• Develop procedures/systems.

• Flu season• Other staff members available? Appropriate use of staffing?

Ideas for prioritisation

• Day-to-day:• Break down day to segmental chunks

• Blocking time to do certain tasks - don't end up pharmacist on call

• Urgent medicines list – develop and educate reception/administrative team Ensure all up to speed with process and limitations

• Allow headspaceo Time to review role – see what works and what doesn’t. Reflect on what you can change.

Where do you want role to go?

Ideas for prioritisation• Longer-term:

• Protocols/service provisiono Repeatso Clinical area e.g. spirometry, anticoagulation.

• Governance - How we build in safety - HFP:o High risk drugs searches:

o DMARDs, DOACs, Lithium monitoring etco Use of scheduled taskso Monthly automatic searches on S1.

o Antibiotic audito Reviewed antibiotic usage across clinicians and discussed at clinical meeting.

• Evidence based approach to dealing with errors – governance.• Projects – paediatric asthma, opioid audit.

Ideas for prioritisation

• Staffing/team development• Pharmacy technician. Protocol development for medicines reauthorisation

within defined parameters.

• Pre-registration pharmacists.

• Pharmacy students – aid projects, audits.

Take home messages

• Huge variety in workforce – how can this be standardised?

• Take time to get settled in role

• Work within competence – access to training/ support/ supervision /indemnity

• Create structure

• Build in safety

• Stakeholders

• Headspace crucial to develop

A SHORT INTERLUDE……

While we collate your questions, we would be really pleased if you could

complete a 1 minute poll which will appear on your screen. This will

help us know how we are doing! The questions are:

To what extent was this event useful to you?

If this webinar was repeated, would you recommend it to your

colleagues.

THANK YOU – NOW, ON TO YOUR QUESTIONS AND ANSWERS!

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Questions?

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www.sps.nhs.ukwww.sps.nhs.uk

The first stop

for professional medicines advice

Choose your interests and networks including

Medicines Use and Safety Interest

Don’t forget to tick the box at the bottom of the

page to say you would like us to keep in touch!

You will then receive information and invitations

to events run by the MUS Network

Make sure you get updates from us by joining the SPS Website

You can register at www.sps.nhs.uk and once registered, you

can go to the top right hand of the registration page and ‘edit

your profile’.