JOB DESCRIPTION. The post holder will support the Lead Prescribing Support Pharmacist with the aim of:

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1 JOB DESCRIPTION 1. JOB IDENTIFICATION Job Title: Responsible to: Department & Base: Prescribing Support Pharmacist Lead Prescribing Support Pharmacist Borders General Hospital Pharmacy Dept Base Date this JD written/updated: 16th January 2007/June 2 nd 2011 Job Reference Number: PHAR JOB PURPOSE The post holder will support the Lead Prescribing Support Pharmacist with the aim of: Managing the 19M primary care prescribing budget of NHS Borders to ensure budgetary control Directly influencing individual prescribing budgets for their allocated practices (normal allocation = 3 to 5 practices) Clinical audit, review, monitoring and instigating change in primary care prescribing for NHS Borders Acting as a credible and independent source of expert pharmaceutical advice to promote high quality evidence based cost-effective prescribing within safe management systems in primary care Contributing to the development of, and responsible for leading, delivering and implementing the prescribing and medicines management strategy through provision of specialised prescribing support services within their allocated practices (normal allocation = 3 to 5 practices) Developing and leading individual practice prescribing policies following analysis of prescribing data and planning and organising projects to effect change Ensuring the implementation of local therapeutic and prescribing guidelines and compliance with the Borders Prescribing Joint Formulary and national prescribing directives e.g. Scottish Intercollegiate Guideline Network (SIGN), Scottish Medicines Consortium (SMC) through audit and review of prescribing practice Developing an integrated approach to Pharmaceutical Care between practices, community pharmacy and secondary care, to address individual patient and practice needs

2 3. ORGANISATIONAL STRUCTURE- Senior Pharmacist Medicines Management Lead prescribing Support Pharmacist Other Prescribing Support Pharmacists and Technicians Prescribing Support Pharmacist This Post 4. SCOPE AND RANGE The post holder: is responsible for pharmaceutical support to a range of GP practices across NHS Borders. This involves regular liaison with the prescribing lead in each practice and holding at least quarterly meetings with all prescribers. will influence the primary care prescribing budget of NHS Borders of just under 19 million for 2006/07 which supports a population of 112,000 cared for by 24 medical practices and 106 GPs. will directly influence the prescribing budget for their individual practices. These will vary with the specific practice attachments but no practices have an annual budget less than approximately 250,000 and several have budgets of over 1m with 2 practices having individual budgets of > 2m. acts as a credible and independent source of professional pharmaceutical advice to promote high quality evidence based cost-effective prescribing within safe management systems negotiates with the practice prescribing team to facilitate and implement changes to prescribing practice; this is an essential component of this post. 5. MAIN DUTIES/RESPONSIBILITIES a) Patient/client care To act as a credible and independent source of highly specialised, up to date, pharmaceutical advice to promote high quality evidence based cost-effective prescribing to GPs, community services, care homes, and other healthcare colleagues and the public. This advice involves obtaining, interpreting and evaluating medical research and other technical information in order to promote the clinical and

3 cost-effective use of medicines within safe management systems. This also involves practical interpretation of the evidence, summarising in order for decisions to be made, and identifying where evidence is lacking or controversial. To advise prescribers in order to optimise patients medicines to maximise treatment outcomes and minimise medicines-related risk and waste, through medication review and clinical audit within agreed protocols. This involves reviewing: drug choice and dosage drug interactions appropriateness of therapy, including identification of therapeutic duplications or omissions formulary issues patients requiring monitoring for medicine efficacy or toxicity e.g. blood pressure, blood tests medicines administration issues e.g. poor compliance patient concomitant medical problems social issues. To organise and action drug changes in practices for quality and cost reasons arising from work, communicating changes in medicines to patients either by letter, telephone, or in person and documenting changes made To advise on legal and ethical aspects of prescribing and the clarity and accuracy of prescriptions. (e.g. legal requirements for controlled drugs) To promote compliance with medicines legislation and related NHS Borders policies e.g. use of unlicensed drugs. To report adverse drug reactions (ADR) to the Committee on the Safety of Medicines. To advise and support the practices on safety warnings and relevant licence changes relating to medicines, including discussion with the relevant medical staff and informing patients as necessary. It is expected where necessary and appropriate that the post holder will work as a supplementary prescriber (once qualified) and in so doing follow individual care plans agreed with the GP and patient The post holder may also work under this job description as fully independent pharmacist prescriber (once qualified) in an agreed area of competency to meet the local needs of patients and other health professionals and the Health Board b) Policy/service development To be directly responsible for prescribing support to designated GP practices (3-5, depending on contracted hours) To assist the Lead Prescribing Support Pharmacist with the development, planning and organisation of the primary care prescribing and medicines management strategy, policies and work programme, ensuring that these comply with the Medicines Act and Misuse of Drugs Act. To devise strategic reports and action plans through analysis of Prescribing Information System (PRISMS) and Scottish Prescribing Analysis (SPA) prescribing data, and searches in the electronic General Practice Administration System for Scotland (GPASS) to effect change in areas of prescribing concern for individual practices, with additional focus on their financial position To be involved in identifying, developing and then conducting agreed clinical audits and reviews within practices as part of integrated projects across NHS Borders as well as practice-specific medication audits, individually negotiated with each practice To identify and action or suggest action in priority areas for practices within the quality and outcomes framework of ngms relating to prescribing and medicines management. To input into individual practice prescribing plans and review of their medicines management systems, including assistance in achieving prescribing incentive scheme targets; advise on implementation and action changes where appropriate To clarify and reinforce to primary care professionals prescribing recommendations in national policies (e.g. Scottish Intercollegiate Guideline Network (SIGN) and NICE guidance), evaluate local relevance and provide local interpretation where necessary. To reinforce local recommendations relating to prescribing including compliance with the Borders Joint Formulary. To identify significant primary care prescribing issues for the Primary Care Prescribing Group to assist with strategic planning for the prescribing support team To identify hospital led influences on primary care prescribing for the prescribing group to facilitate integrated approaches to achieve co-ordinated and consistent prescribing in NHS Borders To expand prescribing support to new areas, including community hospitals, care homes

4 and non-medical prescribers in a range of locations To develop the role of the pharmacist in a primary care setting e.g. supplementary prescribing, intermediate care. To identify suitable issues for NHS Borders prescribing bulletins with authorship as appropriate To develop and lead on certain areas of the work programme. To support the implementation of the new community pharmacy contract and work with local community pharmacists to integrate services locally. To undertake any other duties assigned by the Senior Pharmacist, Medicines Management and/or Lead Prescribing Support Pharmacist considered commensurate with the post. c) Financial and Physical Resources To be responsible for monitoring and interpreting individual practice prescribing expenditure To be responsible for monitoring prescribing of non-scottish Medicines Consortium approved medicines, high cost drugs and extraordinary prescribing, feeding back anomalies of concern to practices and working with practices to action any necessary amendments to prescribing practice To be responsible for devising, negotiating, implementing and monitoring action plans to reduce inappropriate prescribing and expenditure whilst improving the quality of patient care. To promote the prescribing incentive scheme to practices to optimise medicines use within the available financial resources. To be responsible for educating all prescribers in managing the financial risk of practice prescribing budgets through providing regular reports and identifying any anomalies. Action plans are then formulated to remedy problematic prescribing To identify for the Prescribing and Medicines Management team innovative ideas to progress the prescribing incentive scheme in order to: maintain the motivation of prescribers to change practice to maximise clinical outcomes from drug expenditure To undertake drug use review and drug expenditure review as part of the audit cycle. To advise on the safe and secure storage/handling of medicines, including controlled drugs, to minimise waste. d) Staff, Human Resources, Leadership, Training To contribute to the organisation of prescribing study days for health care professionals in NHS Borders. To provide education and information to healthcare professionals on rational and evidence-based prescribing, including presentations at practice meetings To provide presentations on specific therapeutic areas to defined groups of staff e.g.nurse prescribers. To provide assistance to Senior Pharmacist, Medicines Management and Lead Prescribing Support Pharmacist for local events and facilitate evenings where appropriate. To provide training to practice teams and community hospitals regarding prescribing systems and other medicines management issues. To contribute to the prescribing and medicines management bulletin which is used as a tool to update prescribers on current issues, advice and policy. To provide presentations at other forums and patient groups on prescribing and medicine management related topics where requested e.g. Guid Fettle, Breathe Easy group e) Information To retrieve pharmaceutical information and evidence from the internet, specialised on-line and inhouse databases, standard texts, up-to-date guidelines from authoritative bodies (e.g. SIGN) and other reference sources in order to provide tailored specialist medicines and pharmaceutical information to GPs, members of the primary healthcare team and patients in individual surgeries either proactively or in response to queries. To use highly specialised and variable data sources [e.g. on-line Prescribing Information System (PRISMS), quality and outcomes framework, audit results] to analyse information, interpret results and, provide meaningful feedback to members of the prescribing and medicines management team, general practice (at practice visits and away days) and other members of the healthcare team. To provide prescribing analysis as requested, understanding the limitations of the data and summarising sometimes complex data in a way that will enable clinicians to review their prescribing. To monitor changes to prescribing practice and report on the findings to general practice and members of the/prescribing and medicines management team. To use practice based computerised system (GPASS) to input necessary clinical information into clinical records and templates To set up and use spreadsheets, databases and presentations, and use word processing skills.

5 To provide written or verbal reports to the Lead Prescribing Support Pharmacist on work undertaken and progress made towards any targets set and agreed. f) Research and Development To design and undertake clinical audit of medicines management systems where appropriate e.g. adherence to SIGN guidance, adherence to local Medicines Policies and the Borders Joint Formulary To plan, devise and undertake clinical audits relating to prescribing to improve evidence-based, rational prescribing. 6. SYSTEMS AND EQUIPMENT The post holder: must be computer literate in Microsoft Word, Excel, Outlook, PowerPoint and must be able to retrieve information from internet software, medical literature search engines and elibrary in order to provide written material to support information provided to healthcare staff and patients as detailed in part 5 must be able to use the main prescribing support computer system used in Scottish General Practice, namely GPASS (General Practice Administration System for Scotland) and also have some knowledge of DocMan and SPICE which operate in conjunction with GPASS must be able to interpret prescribing data provided by the Information and Statistics Division, Edinburgh, in the form of PRISMS (Prescribing Information Systems) and as SPA (Scottish Prescribing Analysis) to produce a comprehensive report for Practices on any aspect should have a good understanding of the General Medical Services (GMS) contract and preferably the associated electronic support systems (QMAS) should be able to use other office based equipment in order to facilitate the dissemination of information; e.g. computers, printers, photocopier, telephone systems and data projectors, all of which vary between practices should be able to use clinical equipment and pharmaceutical devices where necessary in the clinical environment 7. DECISIONS AND JUDGEMENTS The postholder : is an independent practitioner who is responsible for managing their workload and prioritising their prescribing support work without regular need to consult their line manager but who will work to the agreed integrated project plans, but with individual variation if appropriate to the area of practice must have a highly specialised level of clinical judgement, developed through knowledge and experience, to enable them to interpret and implement clinical guidelines on an individual patient basis, and be able to judge the threshold at which clinical significance is reached and therefore that an intervention is necessary should identify any emerging budgetary issues and investigate likely factors, advising on suitable actions where feasible and appropriate should prioritise requests for information /advice by prescribers should be able to judge when to take appropriate action to minimise non-compliance with the formulary and feed back any hospital-generated issues should take responsibility for minimising use of non-scottish Medicines Consortium (SMC)-approved drugs and unlicensed medications in allocated practices should be capable of taking responsibility for drug changes within practices, working to an agreed protocol should be capable of critical appraisal of published medical papers should be an active member of the prescribing support team in the development of the prescribing and medicines management strategy for implementation across NHS Borders. should identify pertinent issues of Borders-wide importance and relevance for dissemination via prescribing bulletins There is frequent: Requirement to read and analyse patient records, make recommendations and reports to GPs and implement agreed changes. Requirement to analyse and adjust patients medication and treatment regimens

6 Requirement for the analysis of facts requiring decisions that are not always straightforward. Requirement for the absorption, evaluation and dissemination of information to appropriate parties in a manner they can understand. Freedom to Act The postholder works autonomously as the sole provider of prescribing support to the allocated practices, and as such are accountable for: their own professional actions, organising their own work and managing their workload on a daily basis identifying and prioritising prescribing support need for individual practices 8. COMMUNICATIONS AND RELATIONSHIPS The post holder: must liaise, collaborate and negotiate with the primary care mulitidisciplinary team regarding the optimal pharmaceutical care of individual patients. This involves conveying highly complex scientific and clinical information, which may be of a contentious nature.the multidisciplinary team consists of General Practitioners (in particular prescribing lead GPs), practice and treatment room nurses, health visitors, district nurses, business and practice managers, reception staff, community pharmacists, community psychiatric nurses, social services, visiting consultants and ancillary staff must have highly developed communication skills to facilitate negotiation with relevant prescribers to effect change in prescribing habits, to maintain cost-effective, rational, evidence-based use of medicines should develop a good relationship with the local community pharmacist(s) to promote integrated approaches to on-going prescribing review, especially with regard to the new pharmacy contract should carry out domiciliary medication reviews with patients and carers and support and advise them in their use of medicines contacts secondary care professionals to resolve prescribing or medicines management queries arising at the interface between primary and secondary care should support other prescribing support staff by sharing ideas and working methodology and to be a supportive team member needs to be able to communicate their practice prescribing data requirements to the Health Intelligence Officer must maintain regular contact with the secretarial staff of the primary care pharmacy office should communicate with other relevant health professionals about drug changes, altered or discontinued medications etc should have the ability to engage empathetically with patients and their carers on wide-ranging medication related issues, from adverse effects, to medication changes, difficulties with supply/drug withdrawals and addiction issues including those whose medication has been changed for economic reasons. contacts Medicines Information professionals, pharmaceutical companies and national resources to facilitate provision of medicines information in an appropriate form and at an appropriate level for health professional and patient/carer enquirers may have to deal with persistent representatives from pharmaceutical companies. KEY WORKING RELATIONSHIPS Lead Prescribing Support Pharmacist, Senior Pharmacist, Medicines Management; members of the prescribing support team, members of the Primary Care Prescribing Group, Community Services Pharmacist and technicians, Senior Pharmacist, Primary Care, Senior Pharmacist, Clinical & Development, clinical pharmacists at BGH, Lead Clinical Pharmacist at BGH, general practitioners, practice and business managers and surgery staff, multidisciplinary members of primary healthcare teams, community pharmacists and their staff, social services and care home staff. 9. PHYSICAL AND EMOTIONAL DEMANDS OF THE JOB The nature of the post is peripatetic. Whilst the post holders visit their allocated practices regularly, their work base within the practice has to be flexible and adaptable, sometimes changing workstations several times during the working day due to space pressures. This involves obvious stresses and challenges.

7 Movement between work bases requires carriage of relevant folders, paperwork, and laptop on a regular basis from office to car to home and to work placements and the weight of items carried often amounts to 12 to 14 kg There is a regular need to drive safely throughout Scottish Borders to carry out practice-based work/audit and to hold/attend meetings, sometimes outside normal working hours. The post holder could spend the larger part of the working day using a computer screen and/or medical notes to gain necessary information, with working patterns interrupted by various health professionals and patients seeking prescribing advice. Available space and printer access varies so that adaptability is a key component. Time management is complex due to the diverse pressures and demands from a wide spectrum of personnel. Emotional effort is required in dealing directly with patients, carers and relatives in implementing medication changes and reviews. It is also required in influencing the prescribing practice of a range of prescribers including independent practitioners, to diplomatically resolve differences of opinion with healthcare staff, presenting potentially unpopular and challenging prescribing data with the aim of negotiating a change in prescribing behaviour. 10. MOST CHALLENGING/DIFFICULT PARTS OF THE JOB Negotiation with prescribers: Negotiating with GPs and secondary care doctors, in particular to reach a consensus of opinion on important clinical decisions involving changes to their prescribing habits, many of which can be contentious. Mental Effort Required for the majority of the working day in, for example, answering queries from GPs and other healthcare professionals, analysing prescribing data, analysing clinical records, reading and understanding scientific papers, contributing to meetings, writing protocols/guidance relating to medicines, maintaining and utilising up-to-date clinical knowledge to effect change. Time management: Prioritising workload and achieving rapid recall of on-going work when moving between several sites spread over a considerable geographical area each week. Isolation from other members of the pharmacy team Because of the large rural area of the Borders communication has to be by or telephone which is time consuming but crucial to maintain contact. Monthly meetings help in resolving some of this, however. Working closely with the integrated pharmacy team is crucial in meeting pharmacy objectives, as well as medicines management and prescribing support objectives, whilst making the most efficient use of available resources Communication with patients Explaining the reasons for cost-driven medication changes in a sensitive and empathetic manner and responding to concerns appropriately. Also the requirement to counsel patients and their carers on wide- ranging medication related issues, from adverse effects, to medication changes which may be needed for various reasons, including difficulties with supply/drug withdrawals and addiction issues

8 PERSON SPECIFICATION Prescribing Support Pharmacist band 8a Criteria Essential Desirable Education/ Training MSc Pharmacy Honours degree: or equivalent if graduating before 2001, Supplementary or independent Registered member of General Pharmaceutical Council prescriber Post-graduate diploma/ MSc in Clinical Pharmacy or equivalent experience gained by working in clinical /prescribing support posts Knowledge and Experience Highly specialised clinical and pharmaceutical knowledge Experience of training healthcare Commitment to continuing education and team members continuing professional development Experience of Understanding of national policies impacting on prescribing and medicines management services working with a primary care organisation / GPs Knowledge of primary care prescribing issues and impact on Health Board budgetary issues and providing prescribing advice Able to analyse prescribing data in electronic and paper format Experience of hospital and Minimum 5 years post-registration experience in relevant field community pharmacy Work in a multidisciplinary healthcare team Clinical audit Managing change in a complex environment experience Experience of hospital or community pharmacy Experience of project Understanding of primary care structure, general practice and their interface with secondary care management Skills and Abilities Excellent written and oral communication skills Managerial Experience of oral presentations to a variety of experience audiences Medicines Ability to implement change by negotiating, facilitating and influencing others by means of Information experience

9 highly developed interpersonal skills Ability to use Ability to apply highly specialised clinical PowerPoint and knowledge to practical situations Access Critical appraisal and analytical skills Familiarity with GP Computer literate in Word, Excel, and computer systems internet ECDL qualification Time management skills with ability to be flexible and to plan and prioritise workload across a number of allocated practices, which are geographically separate. Organisational skills to co-ordinate practice meetings with appropriate provision of supporting information suitable for a range of personnel Ability to lead individual practice teams to develop and action prescribing projects Ability to work independently and within a team Personal Attributes Other Requirements Demonstrate a high degree of accuracy and good attention to detail Highly self-motivated and able to work on own initiative Flexible approach to working in different practices and able to adapt to different work environments Ability to work under pressure and prioritise work to meet deadlines Conscientious Must have a driving licence and own method of transport

10 TERMS AND CONDITIONS Grade and salary: Hours of work: Annual leave: Band 8a 39,239-47,088 per annum pro rata Fixed term for 6 months, 37.5 hours per week 27 days per annum pro rata, Details of other types of leave entitlement (such as sick leave) are set out in the Agenda for Change handbooks. Public Holidays: Superannuation: 8 days per annum on dates designated by NHS Borders Details of other types of leave entitlement (such as sick leave) are set out in the Agenda for Change handbook. The post-holder is entitled to join the NHS superannuation pension scheme. If Unsuccessful: If you have NOT heard from us within 4 WEEKS of the closing date, then we regret that your application has not been successful on this occasion. However, we appreciate your interest in working with NHS Borders and your time and effort in completing the application form. We would welcome your application for future posts. Equal Opportunities: In NHS Borders, we believe that all staff should be treated equally in employment. We will not discriminate against any member of staff, or job applicant, on grounds of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex and sexual orientation. Trade Union membership. Disclosure checks: We carry out criminal record checks on new staff who fall within certain staff groups within NHS Borders, through Disclosure Scotland. We send out Disclosure Forms to all shortlisted candidates for these staff groups, and ask for these to be completed and returned at interview. If a successful-atinterview candidate forgets to bring their completed form to interview, then they will be required to return the form (and proofs of identity) within 7 days, otherwise the provisional job offer will be withdrawn. Unsuccessful candidates forms will be shredded. The Rehabilitation of Offenders Act does not apply to this post. Tobacco policy: We have a Tobacco policy in place. When selecting staff, we do not discriminate against applicants who smoke, but staff must observe our policy on smoking. Hepatitis B: We offer Hepatitis B immunisation through our Occupational Health Service (OHS). If you think you may be at risk of contracting Hepatitis B through your job, you should ask for this immunisation at OHS. If your work involves exposure-prone procedures, you must keep to the document Protecting Health Care Workers and Patients from Hepatitis B, and the NHSiS Management Executive Directive on this issue. You must be immune to Hepatitis B, and if you cannot prove that you are immune, OHS will investigate to find out whether you are Hepatitis B positive or not.

11 Health and Safety at Work: You must take look after the health and safety of yourself and anyone else who may be affected by what you do at work. You must also co-operate with us to make sure that we keep to legal and organisational safety regulations. You can get more information from the NHS Borders Health & Safety Adviser. The closing date for completed application forms is: 5pm on Wednesday 3 July 2013

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