A new approach:
Extending the role of Pharmacy in
Primary Care
Workstream lead: Ramiz Bahnam
Contents
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Vision of the service
Scope
Service model
Care pathways
IMT solutions
Metrics
Governance and assurance
Training
Outstanding issues
Vision of the service
Pharmacists will have a key role to play supporting general practice to
manage the routine, non urgent case mix and those people who struggle
to access primary care in working hours.
Pharmacists will offer an enhanced service underpinned by access to the
patient’s medical record, PGDs, training and a robust clinical governance
framework.
There will be more opportunities for people to access this enhanced
service.
Ultimately by redirecting a proportion of routine case mix to Pharmacists it
will contribute to increased capacity within general practice to see more
complex or frail patients.
Vision for Pharmacy
• Incorporate Pharmacy as part of the first line
primary care team
• Provide appointments for patients in a familiar
and accessible environment
• Use Pharmacists to their full potential, upskilling and supporting them to work in an
extended role
• Work with Pharmacists to optimise use of
medicines in the city and reduce medicine waste
Scope
In scope:
• Extended Pharmacy primary care service (requires clear definition);
• Extended service will include minor ailments/illnesses underpinned by
PGDs and all repeat prescriptions documented within the medical
record.
• Access to the extended Pharmacy service will be via:
• GP triage (non urgent)
• NHS 111 or IC24
• Clear pathways for on going clinical areas.
Out of scope:
• Existing Pharmacy services;
• Patient does not meet referral criteria.
3 Levels of Service
EPiC Pharmacies
Level 1
Access to medical records. Pharmacist trained to use them
and answer medication queries
Level 2
Trained Pharmacist working with PGD’s. 3-4 trained
Pharmacist per module
Level 3
Independent Prescriber provides clinical consultations
Care pathways
People
Receptionist
Training and
support
Admin
GP Triage and
Booking
EPiC
Pharmacist
Self care
Management
and discharge
Access to medical
records
Refer to GP
Primary Care Modules
Participating GP Surgeries have been divided into 4 Primary Care Modules
Modules 1 and 2 are Fast Starters
Modules 3 and 4 are Early Adopters
Each Module will have several Pharmacies linked to them, based on geography
and the fact that they already provide services to those Practices
Primary Care Modules
IMT solutions
IM&T requirements for Pharmacies are:
• Access to a booking system with appointments made in real time;
• Access to the full patient record to support clinical decision making
• Two way feedback mechanism between GP and Pharmacist to be put
in place.
Progress to date:
• All Pharmacies have N3 and SMART cards.
• Pilot to Load System1 onto a Pharmacy system was successful but
connectivity centrally was not achieved probably because of firewall
issues.
• Ongoing challenges with EMIS, especially in relation to a two way
interaction between the GP and the Pharmacy system.
Metrics
Process outcomes:
• Service take up: No. people seen within Pharmacy service vs available slots
• No. people seen with service and discharged to self care or with management
• No. people referred back to GP
Person experience outcomes:
• Patient experience/satisfaction surveys
• GP/Nurse practitioner/Pharmacist experience surveys
Service effectiveness outcomes:
• Audit trail and tracking of PGDs
• Compliments and complaints
• Near miss and clinical incident reporting
Governance and assurance
General:
• All PGDs developed within local prescribing guidelines
• On going consultation with stakeholders including LPC, CCG etc.
Clinical
• Use of current national guidelines and evidence base to inform development of
the PGDs
• PGD sign off via EPiC clinical lead and project board
• Each pharmacist will sign each individual PGD accepting responsibility for
adherence to the PGD and that that they are clinically competent to deliver care
in line with the PGD
• Triaging GP to ensure that referral meets inclusion criteria for Pharmacy.
IM&T:
• Key issue around Pharmacist access to the medical record. Triaging GP will gain
consent at point of onward referral and again at patient appointment.
Training
Pharmacy training plan needs to be developed for Fast Starters to
include:
• IM&T:
• Booking system,
• Accessing the medical record,
• EPiC metrics
• Clinical:
• PGDs
• PGD tracking system
• Relationship building with GPs
• Learning from first wave will then inform on going training needs for
the Fast Starters as well as the Early Adopters.
DBS Checks
It is essential that all Pharmacists accessing
patient records hold an up to date DBS.
All Pharmacists will be asked to provide
relevant details.