On 31 January, NHS England announced a new general practice funding contract that will pay for 70% of a practice pharmacist’s wage for each surgery during the deal’s first 12 months.
Funding will be provided for 20,000 more staff including pharmacists, physiotherapists, paramedics and physician associates so that GP practices can work collaboratively with other healthcare professionals within primary care networks (PCNs).
The news was met with concern – the National Pharmacy Association (NPA) said in January that the contract ‘intensifies the risk’ of community pharmacists migrating to practices and NPA chief Mark Lyonette later warned that pharmacists working in networks could ‘overtake’ community pharmacy.
Pharmacists working within practices in this way have been referred to as ‘clinical’ pharmacists. But, as all pharmacists are clinically trained, what makes them different from their community colleagues?
1. They are independent prescribers
Based on the Royal Pharmaceutical Society’s (RPS) job specification for practice-based pharmacists, NHS England’s five-year framework for GP contract reform – published on 31 January – states in its role description for clinical pharmacists that ‘they will be prescribers, or training to become prescribers’.
2. They take charge on chronic diseases
The role description says that clinical pharmacists will have a ‘patient facing role’ and will ‘clinically assess and treat patients using their expert knowledge of medicines for specific disease areas’.
They will also take responsibility for managing the care of their practice’s patients with chronic diseases, the document adds, and liaise with specialist pharmacists for issues such as mental health.
3. They reduce polypharmacy
Clinical pharmacists will ‘undertake clinical medication reviews to proactively manage people with complex polypharmacy’ and ‘provide leadership on person-centred medicines optimisation’, the document says.
This will include the elderly, people in care homes, those with learning disabilities or autism and people with multiple long-term conditions such as chronic obstructive pulmonary disease (COPD) and asthma. For patients with learning disabilities, this will follow the Stop Over Medication Programme (STOMP).
Patients will be supported to ‘get the best from’ their medication and reduce waste, and clinical pharmacists will ‘promote self-care’, the document adds.
Pharmacists working in practices will also tackle over-medication including inappropriate antibiotics use by ‘ensuring prescribers in the practice conserve antibiotics’ in line with local guidance.
4. They don’t just work on ‘primary care’
The framework’s role description doesn’t limit clinical pharmacists to a primary care role, despite placing them in practices and primary care networks.
The document says these pharmacists will help ‘address both the public health and social care needs of patients in the network and help in tackling inequalities’ as well as taking a ‘central role’ in clinical research with medicines.
5. They bridge the gap between sectors
This week, it was reported that networks will also be required to work with non-GP providers such as community pharmacies from 2020.
NHS England’s role description for clinical pharmacists says they will ‘have a leadership role in supporting further integration of general practice with the wider healthcare teams, including community and hospital pharmacy’.
It adds that they will ‘develop relationships and work closely with other pharmacists across networks and the wider health system’.
NHS England hopes that the role will ‘help manage general practice workload’, as well as improve access to and safety and quality of care for patients.
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