By Brendon Jiang, English Pharmacy Board member
My introduction to general practice
My background is in community pharmacy. I registered in 2004, and in 2006 I emigrated from New Zealand to register as an overseas-qualified pharmacist here in the UK. My career ranged from store-based, relief, and locum roles, to service development, management, leadership, and superintendent. In 2016, I joined one of the first NHS-funded clinical pharmacists in GP practice pilot sites in the Southwest. I completed the CPPE training pathway and became an independent prescriber in 2018.
That first role in general practice was formative. As a GP pharmacist, your job is to bring your expertise as a medicines expert to bear as part of the multi-disciplinary team. Naturally, this aligns with medication reviews and reconciliation, high-risk drug monitoring, audits, queries, and quality improvement through systems, processes, and audits. As you progress, you can expand your skills and extend into more specific areas and clinics, but all pharmacy professionals bring transferable skills that can be utilised from day one.
An explosion in primary care
There have long been pioneering pharmacists practising in general practice but NHS funding accelerated an expansion that continues today. The GP Forward View 2016 had an ambition of 450 clinical pharmacists in general practice. By September 2021, 2774 pharmacists were employed in Primary Care Networks and by 2024 this is expected to more than double to 7000. These figures only include NHS-funded posts, there is an existing workforce that has also expanded as employers realise and appreciate the potential of pharmacists. I will not be surprised if 20% of registered pharmacists in England work in general practice come 2024.
A day in the life of…
I now lead a team of four pharmacists, three pharmacy technicians, and a pre-registration trainee pharmacy technician across a Primary Care Network (PCN) of five GP surgeries. We have a weekly morning meeting to check-in and catch up on the latest developments, review how we are progressing against our work plan and take turns presenting a CPD topic. I then have a three or four-hour structured medication review (SMR) clinic which focuses on some of the more challenging target groups:
- Patients with complex and problematic polypharmacy, specifically those on 10 or more medications
- using one or more potentially addictive medications from the following groups: opioids, gabapentinoids, benzodiazepines and z-drugs
- patients using inhalers for which there is a more environmentally friendly alternative
My SMR clinics rotate through all five member practices, while the rest of team cover only one or two practices to better embed and facilitate relationships. We work with a fifty/fifty split between PCN and practice priorities in order to deliver the outcomes of both the PCN and GMS contracts.
After lunch, my afternoons are often structured more flexibly to deliver other requirements of my role: education, support, service development, quality improvement and delivery. Each week I spend one session supervising a pharmacist, but otherwise I work on projects; preparing presentations, meeting stakeholders, developing and implementing a plan. I might have a care home visit at one of our thirteen homes or be needed to support vaccinations, and there are always emergencies that crop up from time to time. This all provides for a varied and fulfilling role where I can help patients directly, but also shape and affect the care of a large number of patients across a wide area. It brings together clinical and pharmaceutical expertise, with management, leadership and research. It is a job with limitless potential and opportunity. I love it, and highly recommend it to others.
How do I get into primary care?
- The best place to find a job is through www.jobs.nhs.uk, when I wrote this blog there were over 1300 listings.
- Apply! In 2016, there was a requirement for a minimum of two years post-registration. That has carried through to many of the current job descriptions but is no longer a requirement in the contract. While experience may play a role at interview, don’t let that discourage you.
- Find out about the business and ask questions to determine if they are the right fit for you. GP practices are independent businesses and like community pharmacies, can be independent, small groups or large multiples with different cultures and values.
- Understand the difference between a GP and a PCN role and ascertain the expectations of the employer. While all PCNs share the same contract, there can be great variation in implementation and the expectations of their teams.
- Ask about training. PCN roles have mandatory training requirements as part of the contract, but what, if any, training is available and how is it organised?
- Find a mentor with primary care experience. Contact your local PCN/GP pharmacist to arrange a shadowing session.
- Research the practice and PCN.
Find out more about primary care from the RPS Primary Care Pharmacy Expert Advisory Group.