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The idea of pharmacists working in GP surgeries isn't radical €“ it was on the radar over 10 years ago, says Lisa Jamieson. So why is it suddenly making news now?

Last month (March), the RCGP and RPS issued a joint statement revealing €radical proposals calling for pharmacists to work in GP surgeries€.^1,2 Whilst I welcome closer collaborative working between pharmacists and GPs, I couldn't help but raise an eyebrow when I saw it referred to as €radical€ in the news.

From studies in general practices and nursing homes, we have known since the 1990s that every £1 spent on employing pharmacists to review patients' medication resulted in £2 cost savings for the NHS.³

Outcomes evidence

Over a decade ago, I conducted a research project for my clinical pharmacy MSc, which provided outcomes evidence that a pharmacist-led antihypertensive clinic, delivered from within a GP practice, provided effective control of a long-term condition.^4,5 When I was conducting my research in 2001/02, I was also aware of other research showing beneficial outcomes of pharmacist-led medication review clinics based in general practice.⁶

The concluding paragraph of my MSc dissertation stated: €This study has provided a model for supplementary prescribing by pharmacists in the primary care setting.€ Then, in 2006, the way was paved for pharmacists to take on the autonomous management of long-term conditions from within general practice via the introduction of pharmacist independent prescriber regulations.

Tiny proportion

Yet in 2015, we still have only a tiny proportion of GP practices where pharmacists regularly see patients and work as members of the primary care team. So why is this initiative/campaign happening now?

My cynical view is that it is being borne out of necessity due to how stretched resources are in the NHS in these times of austerity. As if to illustrate this, one headline read: €Pharmacists 'should help ease GP pressure'€.⁷

However we still need some fairly significant changes to the NHS infrastructure before this proposed initiative can become a widespread reality.

Firstly, stating the obvious, budget/salary allocation, training, job descriptions, recruitment, retention, workforce planning, and access to NHS pension and employment conditions need to be considered. Will pharmacists be employed by the practice, or can they join the practice as an equity partner, which has already happened elsewhere?⁸

Having done this clinical role, I believe that pharmacists working in general practice should already have, or be working towards, a clinical diploma or MSc. As an employed pharmacist on Agenda for Change, this would be a minimum band 7 role, preferably minimum 8a, due to the level of autonomy and experience required.

Pharmacists will need access to the full GP practice patient records, in order to be able to practise safely. Many GPs will not have worked alongside primary care pharmacists before. Some GPs may be sceptical about the value that a pharmacist can bring.

It can take time to build up a level of trust. Before my MSc study commenced, I had already worked alongside the GPs for over two years. However some were more ready to accept my recommendations than others.

Ideally, pharmacists working in primary care need to be independent prescribers, so that they can action changes to prescribed medication without needing to refer to a doctor. Therefore, we need training and accreditation of an 'army' of pharmacist independent prescribers €“ and fast.

Gradual changes

Since the late 1990s there have been gradual changes to the infrastructure to allow pharmacists to work in general practice, yet it still isn't a widespread reality.

I don't want to see another decade pass by before pharmacists become well and truly embedded in the primary healthcare team. Let's hope that soon it will be commonplace for pharmacists to care for patients from within general practice... but there's still much to be done to make it a reality.

References

1. Pharmacists set to work in GP surgeries in radical move to ease pressures on general practice and improve patient care. Publication date: 17 March 2015 rcgp.org.uk/news/2015/march/
pharmacists-set-to-work-in-gp-surgeries.aspx [accessed 2.4.15]
2. Breaking down the barriers €“ how community pharmacists and GPs can work together to improve patient
care rpharms.com/public-affairs-pdfs/RPSRCGP jointstatement.pdf [accessed 2.4.15]
3. National Service Framework for Older People: Implementing medicines related aspects of the NSF for Older People, London, Department of Health; March 2001
4. Jamieson LH et al. IJPP 2004: Suppl
Sept; R36
5. Jamieson LH et al. JATR 2010: 7(3);73-86
6. Zermansky A et al; BMJ 2001: 323 (7325); 1340-1343
7. Pharmacists 'should help ease GP pressure' BBC News 17 March 2015 bbc.co.uk/news/health-31904812 [accessed 2.4.15]
8. Pharmacists in GP practices: an ideal partnership for providing patient care. Pharmaceutical Journal News 9 October 2013 pharmaceutical-journal.com/
news-and-analysis/news/pharmacists-
in-gp-practices-an-ideal-partnership-for-providing-patient-care/11128313.article [accessed 2.4.15]