Patients at five GP Practices in Norwich are being helped to stay safe and well at home thanks to a new team of clinical pharmacists.
And, according to one local GP “they have added a whole new dimension to patient care.”
The clinical pharmacists are part of NPL, the consortium of GP practices that runs the walk-in centre and registered practice in Rouen Road. They work from Rouen Road and four other GP Practices as part of a national ‘pilot scheme’ set up NHS England and other national bodies, supported by NHS Norwich Clinical Commissioning Group (CCG).
Many patients at the five ‘pilot’ practices in Norwich are now able to see a clinical pharmacist rather than a GP, once their condition has been diagnosed. They do not dispense medicines like a community pharmacist on the High Street; their role is similar to that of any other GP practice clinician.
Clinical pharmacists can prescribe medicines after a patient has been diagnosed by a doctor, and they can offer specialist advice on using medicines or carry out one to one reviews to ensure a patient remains on the right doses.
It means people see the right clinician in the right place at the right time, a key ambition for Norwich’s new GP Alliance called “OneNorwich”.
One of the clinical pharmacists is John Higgins, who works from Norwich Practices Health Centre. He said: “It has been a big success so far. One of the major successes is that patients enjoy seeing us face to face.
“If a GP is unsure about anything they can send me a note and I will do the prescription via the electronic prescription service (EPS) within ten minutes.
“We don’t want anyone going to hospital over winter, no-one does,” he said. “We are helping prevent admissions by keeping people safe and well.”
As well as prescribe, the clinical pharmacists undertake medicine reviews, help manage discharge of people from hospitals to make sure they are taking the right medicines in the right dose and identify patients who might need ongoing support to stay safe and well.
John said: “For example, many people with long term conditions like asthma don’t understand the importance of attending annual reviews, which can lead to them not using their medication properly. Some end up going to hospital. We look for those who ‘do not attend’ and telephone them to offer advice.”
John’s clinical pharmacist colleagues in Norwich are Naomi Power, who works in Oak Street and St Stephens Gate Practices, and Graham Chapman who works in Woodcock Road and Taverham practices.
Both pro-actively reach out to patients who may benefit from additional medicines management as well as supporting colleagues in practices. Naomi is also developing a pain management clinic.
Naomi added: “I think having a clinical pharmacist to talk to directly, who has specialist knowledge and can advise on the latest guidelines, makes all the difference.”
Graham said: “We particularly help being involved in discharge management, being able to identify patients where additional care and support may be needed.”
Clinical pharmacists are highly trained members of the practice team. They have all spent four years at University, usually followed by at least two further years of specialist training.
Many then choose to specialise further, for example John Higgins has a particular interest in pre-diabetes and cardio-vascular medicines. It means they can bring added insights for the patients the whole clinical team cares for.
The pilot is an important part of NHS Norwich Clinical Commissioning Group’s ‘new model of care’ and is being watched very carefully by the interim leaders of Norwich’s new Alliance of GP Practices called ‘OneNorwich’. Helping patients to see the right clinicians in primary care, not just a GP, is a vital part of their planning.
GP Dr Chris Dent from Oak Street Medical Practice, who is also a member of the Governing Body of NHS Norwich CCG, said patient feedback demonstrated there had been a really positive experience.
He said: “Clinical pharmacists have added a whole new dimension to patient care by improving the quality and safety of prescribing and helping us make better use of resources.”
Donna Laws-Chapman, from NPL, added: “NPL is a consortium of GP Practices that exists to serve local people and improve primary care services. We are extremely proud that our clinical pharmacists are already making such a big difference to patients’ health care.”
Case study from one of the Norwich clinical pharmacists - a boy with poorly controlled asthma.
“I noticed he was ordering a lot of Ventolin to relieve his symptoms and suffering exacerbations of his asthma requiring antibiotics.
“He tended to be seen only when his asthma was bad, and not treated so that his asthma was more under control.
“Having had the patient brought to my attention due to the over ordering of his Ventolin,I was able to read through his medical records and speak to his parent. I invited them in for a face to face half hour review with me.
“Having that bit more time allowed me to gain some insight into his life. I was able to find out that he was losing many Ventolins due to accidently leaving them at his sports clubs. I was also able to find out that in fact the preventer inhaler that he had been on for years was no longer strong enough for a growing teenager.
“I wrote a prescription there and then for a ‘stronger asthma ‘preventer’ inhaler’. A month later I saw him and mum, to be told of a dramatic improvement. He was rarely breathless and not requiring is Ventolin so much, and able to do his sports better.”
About the national clinical pharmacist in general practice pilot scheme
NHS England, Health Education England (HEE), Royal College of General Practitioners (RCGP) and the British Medical Association’s (BMA’s) General Medical Council (GMC) are working with the Royal Pharmaceutical Society on this three year pilot to test the role of clinical pharmacists working in general practice.
The pilot was announced on 7 July 2015, when GP practices and groups of practices were invited to bid.
On 13 October 2016, NHS England announced an increase in the budget for this pilot. The budget has increased from £15 million to £31 million. This will part-fund 403 new clinical pharmacist posts across 73 sites, covering 698 practices in England, supporting over 7 million patients.