The role of a General Practice pharmacist

By Emily Bond, member of the RPS Primary Care Pharmacy Expert Advisory Group

I qualified as a pharmacist in 2005 and spent many years in hospital and community pharmacy roles. Inspired by a friend, I applied for a role in general practice. In January 2018 I started my post as Clinical Pharmacist for two surgeries in Portsmouth. This post had been created as a result of the Health Education England (HEE) /Centre for Professional Pharmacy Education (CPPE) ‘Clinical Pharmacists in General Practice’ Pathway. 

The training was intense but incredibly rewarding, and I completed my prescribing qualification in August 2019. I initially focused on hypertension and lipid management, but soon found opportunities to expand into areas such as heart failure, atrial fibrillation, and anticoagulant management.  

I moved to a newly created PCN Pharmacist role in Hampshire. This role focuses on the delivery of the Direct Enhanced Service (DES) Contract; a framework designed to improve quality of care by implementing additional roles such as pharmacists, pharmacy technicians, dieticians, and social prescribers. I was delivering the structured medication reviews (SMRs) to priority groups and supporting care homes. I also identified a need to develop my reach as a pharmacist further, into the management of diabetes mellitus, and osteoporosis. My particular interest is supporting patients living with the multimorbidity of cardiovascular, renal and metabolic (CVRM) disease. 

As COVID-19 changed things for many, I too had to adapt my working activities rapidly in accordance with my strengths as a pharmacist. I continued to review complex medication regimes with patients but also followed the recommendations of NHSE around offering appropriate patients the opportunity to switch from warfarin to direct oral anticoagulants (DOACs). It was really important to me that this project was as patient-centred as possible so that I could really ensure that they were making informed decisions and did not feel pressured in an already tense health climate. 

Later on, I became heavily involved in the roll-out of the COVID-19 vaccination programme. My experience using Outcomes4Health in community made me an ideal candidate to lead as the vaccination software superuser for our PCN site, and I provided advice on the quality control of the vaccination preparation and the legalities around the supply of the vaccinations. I also trained and worked as a vaccinator for the vaccination site, for care homes and housebound patients in the locality. I have the great privilege of working with other pharmacists in my PCN and together our roles include, but are not limited to: 

• Chronic disease reviews 

• Structured Medication Reviews 

• Same-day care triage and management 

• Patient education (eg insulin education groups) 

• Pain Management reviews 

• Clinical support of the Gold Standard Framework (GSF) around palliative and end of life care 

• General medication advice to patients and healthcare professionals 

• Planning and delivery of COVID-19 vaccination services 

• Prescribing quality improvement via audit, as well as the Investment and Impact Fund (IIF) and Locally Commissioned Services (LCS).  

• Dermatology services 

• Care Home Support 

• HCP training 

• Research  

• Support of the practice medicines management teams 

• Writing and reviewing prescribing protocols 

• Advice on managing clinical workflow around the COVID-19 pandemic 

• Medicines reconciliation around inpatient and outpatient secondary care delivery 

• Working in Advance Clinical Practice (ACP) roles  

• Working on projects to address health inequalities in patient populations 

• Working with community pharmacies to improve access to healthcare and improved care quality, e.g the Community Pharmacist Consultation Service (CPCS), the New Medicines Service (NMS) and local enhanced services provided by community pharmacy 

In addition to these current roles, we also have the opportunity for other areas as well: 

• Leading pharmacy services in dispensing practices and surgeries with on-site pharmacies 

• Training and mentoring pre-registration pharmacists, junior PCN pharmacists and pharmacy technicians 

• Development of business role as a Pharmacist Partner within General Practice 

• Development of role as Clinical Director of the PCN 

• Leading and supporting the wider Integrated Care System (ICS) across the locality in expert roles and service development in areas such as multimorbidity, Care of Older People and diabetes. 

Examples of specific pharmacy and pharmacist-led projects 

• Increasing uptake of electronic repeat dispensing 

• Supporting patient led decisions around anticoagulant choices 

• Using Therapeutic Carbohydrate Restriction (TCR) to help patients living with diabetes to manage their condition and even put their type 2 diabetes into remission 

• Review of Prolia monitoring and prescribing practice  

• Care home visits for diabetes review ward rounds 

• Supporting housebound patients living with diabetes (PLWD) during the COVID-19 pandemic 

Getting involved 

In order to work in a PCN role, pharmacists are required to enter via the CPPE/HEE ‘Primary Care Pharmacy Education’ pathway which has replaced the original ‘Clinical Pharmacists in General Practice’ pathway. There are exemptions and adjustments for the pathway depending on previous experience and qualifications.  

Find out more about the RPS Primary Care Pharmacy Expert Advisory Group.