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Thursday 24 January 2019
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Case study: ‘Our pharmacist is invaluable – we couldn’t do without her’

Practice manager Val Denton discusses the positive difference employing a clinical pharmacist has made to patients and staff at Hillview Family Practice in Hartcliffe, Bristol.

Practice manager Val Denton discusses the positive difference employing a clinical pharmacist has made to patients and staff at Hillview Family Practice in Hartcliffe, Bristol.
 
The employment of clinical pharmacists in general practice is the focus of a recent programme run by NHS England – the Clinical Pharmacists in General Practice programme – but the benefits of such an initiative are something practice manager Val Denton began to realise as early as nine years ago.
 
At the time, Denton was working at a practice in Weston-super-Mare and had built up a relationship with Alison Grant, a medicines management pharmacist ‘who wanted to branch out’ from her role at what was then the local Primary Care Trust.
 
‘I suggested to the partners that we employ her to replace a partner who was leaving – they were quite shocked and reluctant at the time,’ Ms Denton says.
 
But they did agree - and Grant has followed Denton ‘from practice to practice since’, with the two now working together at Hillview Family Practice, in Hartcliffe, Bristol.
 
‘I got her here as soon as the NHS programme came to Hartcliffe - I persuaded the CCG that they would be missing a trick if I didn’t employ her,’ Ms Denton says.
 
Streamlining systems
 
The NHS programme launched as a pilot in July 2015, and was expanded following a funding commitment in the 2016 General Practice Forward View to support an extra 1,500 pharmacists into practices by 2020. Participating practices receive decreasing funding over a three-year period to help cover salary costs. 
 
‘The money runs out next year [2019] for us but we’ll be keeping Alison on because she’s just invaluable to the practice, we couldn’t do without her, Ms Denton says. 
 
She adds that when the pharmacist took up her post in April 2017, the practice’s prescribing spend was ‘through the roof’, and there were no real processes for synchronising medication, completing reviews or handling discharge letters. 
 
Her main responsibility has therefore been to take charge of medicine management, ensuring the practice is efficient and that ‘patient care doesn’t suffer as a result of trying to switch, stop or review any medications,’ Denton says. 
 
Freeing up time
 
This has involved looking at patient care and streamlining the over-ordering of medication, as well as training up a prescription clerk to handle the bulk of medicine management queries that come through to the practice’s reception. 
 
‘It has evolved so much and has removed a huge workload from the partners,’ Ms Denton explains. ‘Our doctors don’t even have to look at the prescriptions they are signing electronically now because they have complete confidence in the system.’
 
The doctors now work a nine-hour day instead of a 12-hour one, Ms Denton says. Having a pharmacist as part of the team has also brought additional expertise into the practice, and means patients can benefit from a longer consultation, lasting around 15-20 minutes. 
 
‘GPs are generalists, at the end of the day. They admit that themselves, and patients like having someone within the practice who can actually spend time with them,’ says Ms Denton. 
 
‘There was some negative feedback at first but within a few months that became very positive and now she’s always booked up - she never has any gaps.’
 
Regional recognition
 
Another area where Ms Grant has brought about significant improvements, Denton says, is the management of the practice’s diabetes patients and their medication. 
 
‘Our diabetics were really poorly managed when she came on board because we had no one here with the skills to deal with that work – the nurse had left,’ she says.
 
‘Alison can initiate insulin and has built up her knowledge over the years – she’s a diabetes expert in her own right and has completely turned our diabetic list around.’
 
This was reflected in recent figures from the NHS Digital National Diabetes Audit, Denton adds, which showed that 100% of Hillview’s diabetes patients had a diabetes review completed in 2017-18, compared with just 40% the previous year. 
 
‘We are among the 20 most-deprived practices in the UK and these patients are difficult to manage, so it’s really great to see that improvement,’ she says.
 
Hillview was also recognised as GP Practice of the Year at the 2018 Bristol and Bath Health and Care Awards – a win Denton says was in part due to the reduction in their prescribing spend, something that has been achieved through the pharmacist’s work. 
 
‘We didn’t actively set out to reduce it but we made a huge effort and have saved in the region of £85,000, which is just amazing in one year,’ she comments. 
 
Integral team member
 
When asked what advice she would offer other practices looking to employ a pharmacist, Denton says that, firstly, they should not ‘get caught up in the word pharmacist’. Instead, they should look at what that person can do, including whether they have a specialism. 
 
‘If they are interested in a specialism then take that on board – it’s better to [have] an expert in one field and to take those patients away from the GP.'
 
She adds that practices should think about what they are struggling with the most and work with the pharmacist to develop a plan to address that, while ensuring that the pharmacist becomes an integral part both of the team and ‘hands-on patient care’.
 
‘There’s no across-the-board model but once our team got to know Alison and realised her knowledge was so great and that they could rely on her, it just grew. 
 
‘If you place the pharmacist at the heart of your team then you can’t lose really.’