Introduction Pharmacists employed in the GP clinical pharmacist NHS England programme are encouraged to complete online activity recording. One of the activities records how they are working with community. Improved working with community and communication across interfaces to improve patient experience is a key priority for the NHS England GP clinical pharmacist programme. Results Entries made by GP clinical pharmacists were grouped into themes as detailed in the table below. TABLE 1: Activities reported by GP clinical pharmacists Activities N Percentage Introductory meeting to explain role and discuss collaborative opportunities 102 77.3 Regular meetings/conversations with clinical pharmacist to discuss problems/solutions 45 34.1 Liaising about initiating/altering patient medication or switches for out-of-stock meds 37 28.0 GP pharmacist established as dedicated key contact for CP queries (direct phone/email provided to community pharmacist) 30 22.7 Referral/signposting to community pharmacist for NMS/MUR/EPS 27 20.5 Dealing with NMS/MUR forms from community pharmacist 14 10.6 Identifying together potential patients for community services, eg repeat dispensing 11 8.3 Working with community pharmacist on joint campaign/project/audit 8 6.1 Total respondents = 132 Total in phase 1 cohort = 461 Response rate = 29 percent A selection of the reports are below, they describe the experiences and proactive work that many pharmacists have initiated with community. Example comments by GP clinical pharmacists I have regular contact with the local, I have created a dedicated prescription team within the practice and the have a direct number on which they can contact this team with prescription queries. If I am initiating a new item and I feel the patient needs further reinforcement of information about this new prescription, if it falls within NMS, I will ask the pharmacist to engage the patient on the NMS. I am in the process of training staff in the practice to start repeat dispensing process; I will also liaise with our main and help them to prepare and train for the change.
I have attended meetings with two local Boots pharmacies on 29 June 2016 and 30 June 2016, one of which is attached to the surgery. In this meeting I explained my role and also how I was hoping to be able to support their work. We discussed repeat dispensing and have decided how we can work together to increase the number of patients using this service. I spoke about my plan to promote NMS to the prescribers at my surgery as I feel it is something they could refer patients to. I have also attended a meeting with the Boots that provides hub dispensing to many of our blister pack patents. As this is in another area the prescription clerks had not met this team so I took them with me. During the meeting we discussed changing our blister patients to EPS which would decrease the lead time on prescriptions and therefore the number of amendments which have to be made to the blisters before they reach the patient. We discussed ordering of PRN medication. This meeting was particularly important for the prescription clerks who have to work closely with this team but had never met them. I regularly visit the three main community pharmacies near my surgery and discuss if there's anything we can do to help each other. So far, I have started including additional information on prescriptions when medicines are requested by consultants, or when a prescription is likely to generate an obvious clinical query/interaction that has already been considered (eg, when a drug interaction is unavoidable). I have also asked our reception team to not direct people to go to a community for the minor ailment scheme, but to ring them in advance. This prevented patients from having a wasted journey to a when they were inappropriately referred and then having to return to the surgery. As we are all keen to expand batch prescribing, we are working together to identify patients who are potentially suitable for this type of prescribing. They are also providing me with a list of all patients who have a blister pack. I have provided an extra person for pharmacists to contact when they have clinical queries about a prescription. With access to clinical records, I can work through a problem before contacting the prescriber to inform them of the problem and offer a potential solution thus saving the GPs time. September 2016: Met with two different local community pharmacists and staff. Discussed my role and asked what services they provide; problems experienced both sides; have been communicating via e-mail and face-to-face. They identify problems eg excessive issues of medication; queries with doses; duplications and I review patients and systems and communicate to reception staff. I have discussed early ordering of meds with community. If I have difficulty accessing a patient (telephone number unobtainable; letters not responded to); I asked community for help in alerting patient to see practice clinician for review of medication. Made aware of CCG cost-saving measures gave list of drugs so they can ensure sufficient quantity of supplies. MURs recommendations are sent to me for patient review. Discussed face-to-face a complex reducing regimen of a drug for a mental health patient to ensure they understand plan for prescriptions. Liaised with community pharmacist to rectify a prescription for sodium bicarbonate liquid for a child (specials item) and the correct controlled drug for a graduated oral syringe dose for a child in school as per school nurse regulations. Had to understand problem and explain to GP to prescribe as requested. February 2017: community pharmacist had a script for a previous dose of atorvastatin but patient claimed records had not been updated with higher dose as per patient s discharge letter. I sorted out prescription for correct dose of drug after checking notes and had this script faxed (Friday afternoon) to community pharmacist for immediate dispensing and ensured previous script cancelled.
At our practice we were struggling to cope with the number of asthma reviews that were needed to be done due to the problem of being down to one practice nurse who also had to manage diabetes reviews. I held a meeting with the next door and agreed an action plan with them where they would speak to all the patients who were on inhalers as part of their repeats. They would then discuss compliance and inhaler techniques with the patient and go through the 3 QOF asthma questions. Any patients that required to be seen urgently were flagged to the surgery using a pre-designed asthma referral form. This helped build patient confidence in the as well as improve the link between the surgery and the. I visited Lloyds at the ICC on 8 March 2017 to discuss MURs. The meeting involved me introducing myself and my role to the community pharmacist/staff at the. We discussed how we can maximise patient benefit and how we can help our service users feel that they are getting the most benefit/support from all healthcare professionals that are in good accessibility to them. I explained to the pharmacist if they have any queries with regards to patients that they can contact me via email or leave a message for me at the reception desk at the surgery I work at. We have a problem where some pharmacists don't necessarily inform us of the outcomes of the MURs that they have conducted. I reiterated the importance of this to the pharmacist; sometimes the patient may inform them of a matter that is significant to their health which we may not necessarily know about, so the earlier we can catch this, the better, and the outcome will be for the patient in the long run. In essence we mainly spoke about increasing the communication and removing barriers between the practice staff and staff to improve patient outcomes. I meet with community every week. The two practices I have are attached to pharmacies which get the bulk of the prescriptions from the surgery coming to them. I have introduced myself to the staff in both of them and set up an open line of communication between myself and them to discuss any issues the may have and any issues the surgery may have. I met with the pharmacist on 22 March 2017 to discuss the new ordering scheme that the CCG is rolling out, of which the surgery I work in is amongst the test pilot sites. This is to stop pharmacies ordering medication on behalf of their customers. The patient will now have to do it themselves. This is being done with the aim of reducing wastage of drugs. The staff are very concerned about the disruptive impact this may have and the customers may not be pleased. We have discussed this and have agreed to try and work together to minimise any problems should they occur. Another area where I work on a regular basis with community is undertaking all MUR review sheets that come into the surgery from community. I have introduced myself to the local pharmacies in the area - they are now aware of who I am, what my job role entails and how to contact me directly if required I will take medication for disposal to the local pharmacies following a home visit. Any patients experiencing problems with the I will try to act as mediator or find patients an alternative community.
I have met with the local community pharmacists, introduced myself and provided contact details so that I can support with queries or issues. I have signposted patients to community for support and been a cheerleader within the practice for the services that community can provide. I hope to work with community to support the AMR agenda and improve antibiotic use locally, specifically with UTIs in care homes and respiratory COPD rescue medicines. I have visited the local pharmacies near my GP practices to introduce myself and let them know I am available to help. I have given them my mobile number to be able to contact me directly if needed urgently so far this has been abused and I'm not inundated with messages! We also agreed they can text eg can you call when free? or I have a script to be sorted ASAP (no patient details). I also have a Whatsapp group with that includes the pharmacists, manager and pre-reg. This group helps me as we can message eg is there a problem with x medicine, do you have stock? or do you know when x is available?. It works the other way too as they can let me know we have problems with medicine A but is available in eg 40mg as capsules etc. I can also message eg can you send costings for a special order medicine?. Recently we did this for a naproxen suspension. One also have a 'Debbie List' which they collect info on items patients want removed their repeat template, synchronisation prompts or other amendments needed for the repeat template. I periodically either collect this (as next door) or they will send across to me. I need to encourage the other pharmacies to be pro-active in these tasks. We are also as a surgery group working collaboratively with local community to link asthma reviews to the surgery. This is currently a work in progress. Introduced myself and role to manager of independent chemist next door to GP surgery and multiple down the road. Arranged meeting to introduce and explain role with chemist that deals with lots of our daily/weekly/monthly meetings. Arranged extra training for community pharmacies on repeat dispensing via EPS as it took some learning from both sides to get head around the new process. Send and receive referrals for patients who may need extra support eg compliance aids, NMSS, carousels, telephone prompts, delivery etc. Discuss specials/unlicensed ordering with community pharmacists. Refer patients for MUR/NMS if appropriate such as inhaler technique or new medicine counselling. Look to help implement referral to scheme between secondary care and community pharmacies. Discuss medication availability/liaise with community pharmacist and wholesalers on stock shortages/supply problems/cost. Help patients self-manage their conditions with community by recommending use of OTC/P products. Look for training on continence products eg catheters and accessories as a learning point for both community and GP pharmacists. Ongoing two-way communication and referral of patients for advice from community pharmacists on supply problems, new devices or for further specialist clinical pharmacist input. Several members of the practice team have met with members of the team from the that serves most of our patients. We have agreed that I will meet the manager once weekly over the next few weeks as the implementation of patientled repeat dispensing commences on 1 April 2017. We will also be reviewing how we can work closer together. One of the first pieces of work that we will work on together will be identifying patients suitable for EPS repeat dispensing.
I have introduced myself to the community pharmacies local to the practices that I work in. When I develop my role more around repeat prescriptions and prescription queries I think this relationship will naturally build. Initially wrote out to all community pharmacists in the locality to introduce myself and give contact details. Recently a community pharmacist flagged a patient on combination of simvastatin 40mg and amlodipine who needed a review. Statin was changed but as a result we did a search and identified 20 patients who were still on the combination. These patients have now all been reviewed and statins changed in line with MHRA advice. I am now the point of contact for MUR and NMS reviews. All recommendations are reviewed by me and followed up by most appropriate person. The pharmacist is also sent a reply to confirm the outcome of their advice/recommendations where appropriate. Personally went and introduced myself to the managers of the three main pharmacies. Addressed their concerns regarding medication queries which the doctors at times don't come back or prescriptions are generated in relation to their questions but they are not informed. Made suggestions as to a good working relationship and how any queries to be referred to me where the surgery staff would task them to me and I will keep the concerned well informed. Informed the pharmacies to be sending me a list of all patients whose uncollected meds they remove from their shelves so that I can review the patients for compliance. Work in partnership with NMS and MURs. Made suggestions on repeat requests and not to automatically place requests on patients behalf and if doing so, to call patient to confirm if meds needed. I have met with two local community pharmacists and discussed how we could work closer together. I will undertake an audit about MUR feedback and work with the practice to improve referral. Some MUR feedback is now being directed to me by local community pharmacists. I have written some guidance for reception staff about where queries should be directed - in future, receptionists may signpost patients to community for some information about medicines. Proactively promoting the NMS to patients for whom I am starting new medicines. Liaised with local pharmacies to direct MUR forms for my attention to ensure actions are considered and acted upon where appropriate. Participating in PharmOutcomes project which aims to electronically refer and share information from MURs. 9 January 2017 introduced myself to the five pharmacies in the area, advised happy to help with any queries and discharge summaries; spoke about sending NMS and MURs direct for my attention, and equally when I am prescribing I will signpost for NMS/MURs back to community; spoke about my wish to implement repeat dispensing and how it will benefit surgery and patients, but also by reducing workflow.
Having introduction meetings with local community pharmacists to improve interface. All multi-compartment compliance aid problems to be referred to GP pharmacist to reduce errors. Identified a point of contact for the community pharmacies to raise any medication related issues with the practice pharmacist. Created agreement with local community pharmacist for patients to be referred to the new medicines service by the practice pharmacist. Allowed for stock availability problems to be raised with practice pharmacist to solve queries more efficiently. Surgery has developed a specific ' hotline' number for community pharmacists to use to bypass the usual main line. We have introduced emailing pharmacies as a way of not clogging the phone and allowing a smoother working process. We are holding quarterly meetings with our local community pharmacists and their teams as a way of communicating any in-house problems or things we are focusing on changing. Good way of ironing out any common theme problems between us and them. Also giving a brief topical update eg dry eye syndrome. This is discussed in advance and agreed by the community teams. Discussion GP clinical pharmacists are working with community, to promote the services offered by community, improve systems and initiate joint working.