Our GP practices is a very busy environment with nearly 55 000 patients registered. Our partners have always been open to new ways of working to improve accessibility and quality of care to the local community.
Prescribing safety has been the focus for primary care for a long time but only during last few years has received a boost with the introduction of NHS/CCG clinical pharmacists.
First steps that practice took was to recruit more pharmacists into their team as they have already employed pharmacists that has been involved at different stages of patients' care and proven to be valuable team members. With the introduction of national GP pharmacist pathway (CPPE) the role of the practice pharmacist become more understood.
At the same time, acknowledging the challenges ahead, the decision has been made to restructure and five practices joint to create partnership. With the difficulties in the recruitment of GPs in the local area, the role off additional healthcare professionals' roles grew to maintain best practice.
Advanced Nurse Practitioners, Urgent Care Practitioners and Pharmacists were utilised to deal with the patients' demand. Our partners have been happy to hand over the control to team leads for respective teams and I was honoured to be appointed lead pharmacist.
Pharmacists were very well placed to deal with medication reviews and prescriptions queries, enabling GPs to focus on acute presentations. We needed more structured and standardised model to establish what pharmacist can do and this lead to creation to clinical rota, few years ago this was quite novel for pharmacists in general practice. It included variety of activities: medication reviews, medication reconciliation, patients' queries, and support for other clinicians.
Once the pharmacists' role has embedded in our practices it became apparent that some improvement is required in practice's prescribing habits.
We have introduced number of measures to reduce inappropriate prescribing. At the time, pregabalin and gabapentin were classified as controlled drugs and intention was to ensure appropriate prescribing.
First point of action was treatment initiation, to ensure correct indication and that all alternatives' options were explored. In agreement with medical director, we have introduced a questionnaire/form that was triggered by prescribing of gabapentonoid. Clinicians were expected to complete 8 questions that were in line with current best practice.
In those early stages we have been able to use clinical system functionality to ensure safe prescribing and this was just the indication how clinical decision can be supported. Over the following months, Medicine Management Team working with the CGG has introduced similar warning system to alert prescribers when medicine optimisation triggers are identified. All clinicians have option to agree or disagree with the recommendation, however our acceptance levels are one of the highest in the regions few years into the project.
When we have looked at our prescribing data, we have identified that prescribing of the opioid-based pain killers is particularly high for our practices. It has to be recognised that opioids prescribing has become a national problem and most of the practices in our area has been struggling. We have recognised that volume of strong pain killers prescribing is closely related to depravation and unfortunately whole if the CCG has similar problem.
We have introduced number of measures to limit opioid prescribing. This included organisation wide educational sessions and individualised coaching sessions with clinicians. We have developed relationship with community chronic pain management clinic to offer patient more comprehensive support. We have proactively reached out to patient to offer review of their pain medications; we have been able to minimise the clinical risk. Our prescribing data has improved (see the link <https://openprescribing.net/practice/B81048/measures/?tags=opioids>)
Over the first few years we have been able to standardise repeat prescribing, but we still had high volume of acute requests from patients. Early 2020 has been become to be most challenging time for the NHS. Most of the routine activities' has been suspended to support the efforts to combat Covid-19 pandemic. NHS restrictions and population health directives caused a lot of pressure on primary care.
Through this period all acute medication queries and request has been assigned to the pharmacist' team which was an incredible challenge, but it has also allowed us to standardise our practice's non-repeat prescribing policy. Through the Covid-19 pandemic we were determined to ensure to maintain best standard of practice.
With some of the pressure of vaccination clinics easing off, our partners agreed to recruit pharmacy technician. Their role is to support clinicians by completing the record based activities and contacting patients when necessary.
Learning from first recruitment we recognised that patient's safety can be improved with the introduction of the technicians. As a practice all clinicians are very responsive to the complaints and errors, however the challenges of everyday GP practice life meant that some of the enthusiasm can be lost when challenged with the mounting workload.
Following a safeguarding Serious Event Analysis (SEA) that affected patient under parent/guardian care we have been able to conduct an audit of over 400 children and vulnerable adults that has not had their medications issued in last 6 months. The audit has led to several interventions where appropriate steps has been taken by clinicians.
Pharmacy technician role has great protentional and our practice has agreed to extend the team. In the meantime, we have received a notification the we will be a subject of the CQC visit in next 2 weeks. As we have already developed robust internal reporting system, we have been able to collate data for the CQC inspector for the visit.
I had a pleasure of spending some time with the inspector to present our efforts of proactive care. This has been acknowledged in the CQC which can be find in the follow in link
The cost savings of the pharmacists and pharmacy technician can be measured but the true impact in the functioning of our practice cannot. Our partners and senior mangers recognise the input from the team and value team's efforts to improve the safety of prescribing and existing processes. I'm confident that the future of the clinical pharmacist and pharmacy technician in general practice is bright and I'm committed to support colleagues across the local and national networks.
