The ultimate guide for pharmacists working in GP practices

The Royal Pharmaceutical Society believes that primary care patients should have the benefit of a pharmacist’s clinical expertise similar to that currently experienced by patients in hospital, helping patients to make the best use of their medicines and reducing hospital admissions as a result.

There are a growing number of pharmacists across England, Scotland and Wales in clinical roles within GP practices. We support the closer working of pharmacists with GPs and have been encouraging more of these roles to be developed.
Find out more about our Pharmacists and GP surgeries campaign in England and RPS in Scotland joint policy statement with RCGP Scotland.

We have developed this online ultimate guide to support pharmacists working in or with GP Practices. It will be useful for pharmacists thinking of a clinical career in general practice or starting work in a GP practice for the first time. This guide could be useful for pharmacists already supporting GPs and may also be relevant to colleagues in primary care roles.

About the role

Person specifications and job descriptions Person specifications & job descriptions

The Primary Care Pharmacists Association has published a guide for general practices considering employing a practice pharmacist


This guide has been endorsed by the Royal Pharmaceutical Society and the Royal College of General Practitioners. It describes the activities that pharmacists may be involved in when working in general practice, and also includes a detailed breakdown of the job roles of entry level and advanced level practice pharmacists.

Applying for jobs Applying for jobs

New positions for clinical pharmacists working in GP practices or primary care clusters are expected to be created across England, Scotland and Wales.

In England, an NHS England pilot should create over 250 positions, with pharmacists expected in these posts by early 2016. In Scotland, the Scottish Government has announced £16.2 million of funding to recruit 140 pharmacist independent prescribers over three years.

Practice pharmacist posts are often advertised on the NHS Jobs website for England and Wales, or the NHS Scotland Recruitment site.

Roles may also be advertised on:

You may also be able to enquire with your local GP practice about any vacancies.

Business cases Business cases

We are currently developing economic models to underpin the benefit of pharmacists working in GP practices. These will be published here when available.

The Haxby group, a provider of community healthcare services across 10 GPs in the York and Hull area, have published a summary of the positive impact of employing a practice pharmacist.

Practical guidance

Indemnity and insurance Indemnity & insurance

It is a regulatory requirement for all registered pharmacists to "make sure that all your work, or work that you are responsible for, is covered by appropriate professional indemnity insurance".

The RPS is not regulated by the Financial Conduct Authority and cannot recommend professional indemnity insurance providers, however NHS employers have published guidance and a series of questions and answers regarding professional indemnity insurance, including for employees of GP practices.

NHS England is likely to provide information about indemnity requirements for practice pharmacists taking part in the national pilot scheme.

Using systems such as EMIS, E-PACT, SYSTEM ONE and VISION Using systems such as EMIS, E-PACT, SYSTEM ONE & VISION

Practice pharmacists with expertise of using these systems advise that day to day access is essential to become fully competent using these applications. A colleauge in the practice with prior experience may be able to help. The following resources may be helpful:

The Department of Health in collaboration with the Royal College of General Practitioners and the British Medication Association have also published comprehensive good practice guidelines for GP electronic patient records

Snomed-CT codes and the NHS dm+d database Snomed-CT codes and the NHS dm+d database

Snomed-CT is an international coding standard, and the NHS dictionary of medicines and devices (dm+d) database is a dictionary of the codes used for medicines and medical devices. These are both used in general practice. The Health and Social Care Information Centre (HSCIC) have published a webinar which provides an introduction to dm+d and the Snomed-CT UK Drug extension.

Further information about Snomed CT is available from HSCIC.

Quality improvement and audit Quality improvement & audit

One role of a general practice based pharmacist is to increase the quality and safety of prescribing through mechanisms such as practice based audit and improvement cycles.

The following quality improvement toolkits and resources may be useful:

The Royal College of General Practitioners has also produced resources for clinical audits, including clinical audit guidance.

Responding to medicines related questions in practice Responding to medicines related questions in practice

Pharmacists will need to respond to requests for information on medicines from colleagues and patients

CPPE, NES and WCPPE, together with UKMI, have produced learning programmes to support pharmacists responding to medicines-related questions.

Consultation skills Consultation skills

You will be taking an increasingly patient-facing role as you support medicines optimisation and the public health agenda. The Royal Pharmaceutical Society report, Now or never: shaping pharmacy for the future, outlines the need for pharmacy to be proactive in patient care.

The Consultation Skills for Pharmacy Practice website has been developed to support when speaking and consulting with patients and people about their medicines and lifestyle choices. The practice standards for consultation skills set out the knowledge, skills, behaviours and attitudes you need when communicating and consulting with patients.

WCPPE have also produced a learning programme to support development of consultation skills.

Legal and regulatory framework

CQC inspection CQC inspection

The Care Quality Commission (CQC) have produced a range of support tools to help practices prepare for an inspection, including a handbook and an explanation of their approach to inspection and what to expect. There are also examples of outstanding practice.

Additionally, the British Medication Association have produced a practical guide for GP practices preparing for their inspection by the CQC.

GP NHS contract GP NHS contract

Pharmacists working in general practice may need to be familiar with how services are funded, how incentives work and understand the contractual arrangements between the NHS and the practice.

In England, the General Medical Services (GMS) contract is agreed between NHS employers and the British Medical Association (BMA).

In Scotland, the BMA’s Scottish GP committee agree a contract with the Scottish Government. A similar arrangement is in place in Wales.

Quality outcomes framework Quality outcomes framework

The quality outcomes framework is part of the GP contract in England, Scotland and Wales. It is a voluntary incentive programme but is a major source of potential income. Funding awards are dependent upon the practice meeting certain quality outcomes.  

NHS Employers have also published a guide to the quality outcomes framework.

The General Practice – the fundamentals of working with GPs e-course from CPPE contains support to help pharmacists start using clinical systems, GP NHS contract and the quality and outcomes framework.

GP patient survey GP patient survey

In England, the GP patient survey is managed by Ipsos MORI under contract with NHS England. Information about the survey, and data resulting from past surveys can be found on the GP patient survey website.

NHS England publish annual results of the GP patient survey on their website, as well as further information how they use the results.

In Wales, information about the GP Patient survey can be found on the NHS Wales website.

Each GP practice or group of practices in England will need to have a patient participation group (PPG). Information about PPGs has been published by the National Association for Patient Participation. It will be important to engage with the PPG and for the role of clinical pharmacists to be explained and understood.

NHS complaints procedure NHS complaints procedure

The British Medication Association (BMA) has published information and guides on the NHS complaints procedure in England, Scotland and Wales.

Managing and optimising medicines

NHS repeat dispensing and Chronic Medication Service NHS repeat dispensing & Chronic Medication Service

The roles of general practice pharmacists may include promoting NHS repeat dispensing (England and Wales) and the Chronic Medication Service (Scotland). Practice pharmacists may be involved in developing and improving repeat prescribing systems, training staff to identify safety issues and processes to reduce medicines waste.

Guidance for the implementation of NHS repeat dispensing has been jointly published by PSNC, NHS Employers and the General Practitioner Committee of the BMA. The guidance provide background to the service, patient selection, benefits of using repeat dispensing and top ten tips for successful implementation. NHS England have also published Electronic Repeat Dispensing Guidance which could be useful to GP practice teams.

Other resources include:

WCPPE have produced a distance learning pack that explains the NHS Repeat Dispensing arrangements in Wales. NES have resources to support pharmacists with the Chronic Medication Service.

Prescribing guidance Prescribing guidance

Becoming a prescriber

There are many ways a pharmacist can support the work of GP surgeries and it isn’t mandatory to be a pharmacist prescriber before starting work in a GP surgery. However being able to prescribe does increase the range of clinical activities the pharmacist can offer to patients. Find out more about becoming a pharmacist prescriber.


Competency framework for prescribers

We have worked with other Royal Colleges to develop a revised single competency framework for prescribers, published in 2016. This work is based upon the single prescribing framework for all prescribers published in 2012 by the National Prescribing Centre.


Antimicrobial stewardship

RCGP is offering a free e-learning course about antibiotic resistance about antibiotic resistance for all primary care health professionals in the UK.

We have worked with University College London to create an online resource, www.AMSportal.org, which signposts resources and information to promote learning about microbiology and antimicrobial stewardship.

 

Medicines optimisation Medicines optimisation

NICE guidelines describe medicines optimisation as “the safe and effective use of medicines to enable the best possible outcomes.

We have created a wide range of resources on medicines optimisation; including good practice guidance, a patient leaflet, and briefings on optimising medicines for a number of conditions.

NICE have also developed a medicines optimisation pathway, covering the decision making processes used to help optimise a person’s medicines; including medicines reconciliation and medication review.

NHS England have developed a Medicines Optimisation Dashboard, which is designed to further understanding of how patients are being supported with medicines use locally.

Medicines reconciliation Medicines reconciliation

NICE describes medicines reconciliation as accurately listing the all of a person’s medicines including prescribed, over-the-counter, and complementary medicines. Pharmacists working in general practice may be involved in reconciling medicines following hospital discharge and will need to work with patients and community pharmacists to ensure patients receive the medicines they need post-discharge.

You might find our Medication history quick reference guide helpful when conducting a medicines reconciliation.

Clinical medication reviews Clinical medication reviews

Pharmacists working in general practice will need to be able to provide level 3 clinical medicines reviews.

Comprehensive information about medication review (including level 3) can be found in the document, A guide to clinical medication review 2008, published by the National Prescribing Centre.

You might find our Medicines adherence quick reference guide helpful when conducting a clinical medication review.

Drug alerts Drug alelrts

The role of a general practice based pharmacist is likely to involve leading and implement changes as a result of drug withdrawals, medicine indications changes and alerts. Changes would be aimed at improving medicines and patient safety across a population.
Information about drug alerts are available from

Polypharmacy Polypharmacy

One of the roles of a GP based pharmacist is to reduce inappropriate polypharmacy. This could be through clinical medication review.

The Scottish Government has created polypharmacy guidance to address the issues resulting from the use of multiple medicines in the frail and elderly population.

The King’s Fund published a report on medicines optimisation and polypharmacy. Exploring systems for managing polypharmacy and offering recommendations for improving care for older people and those who have two or more chronic medical conditions.

WCPPE have produced a learning programme to help pharmacy professionals understand the impact of polypharmacy and reducing medicines wastage.

Professional guidance and ethical issues

Consent and confidentiality Consent & confidentiality

The need to protect patient confidentiality and obtain patient consent is layered through legislation, regulation and contractual frameworks.

Resources useful in the context of general practice include:

Registered pharmacists also need to be aware of GPhC regulatory guidance for consent and confidentiality:

Safeguarding Safeguarding

The Royal College of Paediatrics and Child Health has worked with 19 different bodies to produce Safeguarding children and young people: roles and competencies for health care staff; a framework for healthcare staff, which describes the level of competency and training required for different roles.

Clinical Pharmacists working in GP Practices would be expected to achieve Level 3 training for safeguarding as they will contribute to assessing, planning, intervening and evaluating the needs of children, young people, vulnerable adults and in assessing parenting capacity.

Appropriate training will normally be provided by the practice to all staff working in a GP practice

Other sources of information include:

Prescription direction Prescription direction

Prescription direction is defined by PSNC as the sending of prescriptions to a pharmacy other than the one which the patient wanted them to go to. The British Medication Association (BMA), PharmacyVoice and PSNC have published a statement regarding prescription direction, including a list of activities to avoid in order to maintain good practice.

In October 2015, NHS England produced a poster on prescription direction highlighting patient choice.

Working with a multi-disciplinary team Working with a multi-disciplinary team

Pharmacists working in general practice will work with other healthcare professionals as part of a multi-disciplinary team. This may involve training or mentoring multi-disciplinary colleagues, in prescribing and medicines optimisation.

We have developed a leadership framework and tools which includes a section on engaging your team which may be helpful. We have also created mentoring support tools to help train and mentor colleagues.

Other resources which may be useful include:

Clinical guidance and support tools

NICE guidelines and pathways NICE guidelines & pathways

One role of a general practice based pharmacist is to implement NICE and other evidence-based clinical guidelines.

Hepatic Hepatic

NICE have developed a clinical pathway for patients with liver conditions.

You may also find Drugs and the Liver: A guide to drug handling in liver dysfunction (Pharmaceutical Press, £34.99, £26.25 for RPS members) a useful resource.

The United Kingdom Clinical Pharmacy Association (UKCPA), a partnership group of the Royal Pharmaceutical Society and a member association for clinical pharmacy practitioners, have a special interest group for hepatology.

Renal Renal

NICE have developed a clinical pathway for patients with kidney conditions.

The UK Renal Pharmacy Group have identified a list of useful references for healthcare professionals.

CPPE has launched an Acute Kidney Injury (AKI) campaign with the Think Kidneys programme to highlight the risk of acute kidney injury.

High risk medicines High risk medicines

Patient Safety First have published a guide to reducing harm from high risk medicines whilst CPPE run a distance learning programme linked to medicines use reviews and high risk medicines.

Substance misuse Substance misuse

The key UK guideline for the clinical management of drug misuse and dependence is published by the National Treatment Agency and endorsed by the Department of Health, Welsh Assembly Government and Scottish Government.

The Royal College of GPs has also published a factsheet about medicines misuse and dependence.

Older people Older people

NICE have published a range of guidance and clinical pathways to help with the care of older people.

The United Kingdom Clinical Pharmacy Association (UKCPA), a partnership group of the Royal Pharmaceutical Society and a member association for clinical pharmacy practitioners, have a special interest group for care of the elderly.

CPPE have published an older people learning programme to highlight health and medicines use and polypharmacy in older people. The consulting with older people workshop is part of the consultations skills for pharmacy practice programme and helps you support the older person in making decisions about their medicines.

WCPPE Have published Older people: managing medicines (Level 1) an online course which will provide you with the key issues affecting medicines management and older people.

Minor ailments Minor ailments

Part of the role of a general practice based pharmacist might be to undertake minor ailments triage, dealing with minor ailments and triaging patients appropriately. RCGP offers free online training for self-care for minor ailments.

It could also be useful to understand how minor ailments services work within community pharmacy. PSNC have published a service specification. Similarly, Community Pharmacy Scotland have published information about the core service in Scotland.

Understanding pathology results Understanding pathology results

One role of a general practice based pharmacist is to review pathology results for patients on known medicines. Pharmaceutical Press have published a clinical pharmacy practice resource ‘Pathology and therapeutics for pharmacists’ (£50, £37.50 for RPS members) which can help pharmacists to understand these results.

Avoiding hospital admissions Avoiding hospital admissions

An important role of a general practice based pharmacist is to contribute to reductions in medicine related hospital admissions and re-admissions. The King’s Fund has examined the research evidence around avoiding hospital admissions and prepared a report which includes recommendations for how general practice can help.  

 The British Medication Association (BMA) have produced a step by step guide to avoiding unplanned admissions as part of an Enhanced Service introduced in England last year.

Using the Foundation framework to prepare for working in a GP surgery

We recommend that pharmacists interested in embarking on a career working in GP practices complete the RPS Foundation programme

The Foundation Programme supports pharmacists through your first 1000 days of practice, enabling you to develop essential knowledge, skills, and values to be a safe and effective pharmacist. It also provides you with the tools and resources to become a more independent learner so you can identify gaps in your development and take necessary steps to address these.

By working your way through the Programme and associated workplace based tools, you will learn how to apply the knowledge and skills you’ve acquired during your undergraduate studies and pre-registration training to patient scenarios and day to day practice.

Over time, this will empower you to effectively manage more complex patients/cases and pharmaceutical care issues, which will be crucial to your role as a pharmacist working in GP practices.
 

Building your Faculty portfolio while working in a GP practice

Working in general practice presents an ideal opportunity to develop and to build your Advanced Practice Portfolio, submit for assessment and become a Faculty member.

Joining the RPS Faculty gives you the opportunity to benchmark and perhaps distinguish yourself from your peers; gaining a post-nominal to reflect your stage of advanced practice as you do so. You also receive access to a library of tools and resources to support your professional development.

Building a portfolio could be an effective way of developing your practice, supporting your career progression and may help prepare you for revalidation in the future.
 

Access to clinical training and support

CPPE (England) CPPE (England)

CPPE run an online course to introduce pharmacists to working in GP practices at multiple times throughout the year.

CPPE have also developed a periodic 18 month clinical training pathway programme to train pharmacists taking part in the NHS England pilot encouraging clinical pharmacists to work in GP practices.

NES (Scotland) NES (Scotland)

Content for this section is being developed.

wCPPE (Wales) wCPPE (Wales)

Content for this section is being developed.

Affiliated groups Affiliated groups

The United Kingdom Clinical Pharmacy Association (UKCPA), is a partnership group of the Royal Pharmaceutical Society, and a member association for clinical pharmacy practitioners for sharing knowledge, research and experiences in providing clinical care for patients.

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