The GP Forward View describes an expanding general practice workforce that includes 1,500 more clinical pharmacists. Every practice in England will have access to a clinical pharmacist.
These pharmacists, who are integral members of the practice team, can improve care and reduce GP workload by:
- streamlining prescription processes
- optimising medicines
- managing long-term conditions
The need for medication reviews
Medication is the most common medical intervention. One in four people has a long-term illness, and a consequence of our ageing population is that more people are using more than one medicine. However, between 30-50 per cent of medication for long-term conditions are not taken as intended.
Pharmacists are experts in medicines. Medication reviews make the best use of their clinical skills within the primary care team. These reviews are an opportunity to:
- Improve health outcomes
- Give patients a better understanding of their medicines, so they take them as intended
- Make sure prescriptions are still appropriate
- Reduce wastage (unused drugs cost the NHS around £300 million each year)
- Ensure monitoring for the medication, such as blood tests, is complete and within range
- Identify side effects and address them
- Reduce the risk of interactions and allergies, leading to fewer hospital admissions
Use of electronic records during reviews
Access to medical records is a critical aspect of medication reviews, but no one talks about it. Across the UK, there are different approaches to summary records:
- England has the Summary Care Record (SCR)
- Scotland has the Emergency Care Summary (ECS)
- In Wales, there's the Welsh GP Record
All these summary records give authorised medical staff access to electronic patient records. However, community pharmacists' ability to access these summary records is variable. Figures published by NHS Digital in September 2018 show that more than 70 per cent of pharmacies in England has yet to access an SCR. Scottish pharmacists can only obtain an ECS via NHS 24 for out-of-hours care. In Wales, community pharmacists can't access Welsh GP Records yet.
When a clinical pharmacist is part of the GP practice team, they have access to full records - not summaries. They have access to the core clinical system, which enables them to:
- Run searches to find patients that are most likely to benefit from a medication review. This list includes polypharmacy patients, the elderly and patients with recent hospital discharge.
- Reauthorise repeat prescriptions
- Add new medicines or stop a repeat item
- Provide advice
- Record details of interventions within the patient's medical record
Multiple GP practices
The GP Forward View commits to one clinical pharmacist for every 30,000 patients. So, each pharmacist will care for patients registered at between 3-4 GP practices. You don't need to share records though. It's much simpler to create a user account at each practice where the clinical pharmacist works.
This approach gets interesting when you use use Vision Anywhere during reviews. It's an innovative app that provides 24/7 access to patient records. There are apps for iPhone, iPad, Android and Windows, and typical uses include:
- GP home visits and nursing home rounds
- Federated GP services, such as extended hours appointments
- Remote access to medical records away from the GP practice
Vision Anywhere offers online and offline access to medical records. As well as viewing information, you can add data and update the patient’s record too.
The NHS Highland pharmacy team uses Vision Anywhere during medication reviews. Eighty per cent of their patients live in pockets of a remote and rural area that covers 12,500 square miles. Now, they can conduct the reviews from any location, such as a different GP practice or even the pharmacist’s home. They no longer need to travel to each GP practice to see their patients, saving vast amounts of time.
Download the case study to learn how NHS Highland's pharmacy team use telehealth and remote access to enable a new model of pharmaceutical care.
The way ahead
In the future, clinical pharmacists in GP practices will be the norm. They'll be a standard part of the team, as practices nurses are today. Innovative healthcare software that's easy to learn and use will help them to improve care and ease the pressure on GPs.