Kingswinford and Wordsley PCN set up a lipid clinic that is run by pharmacists. It represents a forward-thinking, patient-centric approach to healthcare that transforms the way those with lipid imbalances are managed. Lead pharmacist Sarah Baig and PCN clinical director Dr Balraj Mavi, explain more.

In recent years, healthcare has shifted towards more collaborative models to optimise patient care. While pharmacists have always played a pivotal role in medication management and supporting health initiatives, as healthcare evolves, so too can the responsibilities of this group of professionals.

With the changes in the initial education and training standards for pharmacists, there is an increased opportunity for pharmacists to demonstrate their prescribing skills.

One such example is a lipid clinic set up by Kingswinford and Wordsley PCN, which is run by pharmacists.  It has been developed and is overseen by the PCN clinical director, Dr Balraj Mavi.

Aims

The NHS Long Term Plan set a goal to prevent 150,000 heart attacks, strokes, and dementia cases over the next 10 years by improving the detection and management of high-risk conditions. For cardiovascular disease (CVD), raised cholesterol levels, particularly low-density lipoprotein (LDL) cholesterol, are a major risk factor.

Kingswinford and Wordsley PCN sought to create a model to improve the management of this risk by making better use of pharmacists.  The model involves pharmacists taking on the critical task of diagnosing, monitoring, and managing lipid disorders under the guidance and training of a GP lead and clinical director of the PCN.

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By combining the skills of a pharmacist with the guidance of a GP, the lipid clinic offers a comprehensive and cost-effective solution for managing lipid disorders.

Method

The project took place across all five GP practices in Kingswinford and Wordsley PCN.

In this clinic setup, a GP’s expertise in diagnosing and managing lipid disorders serves as the foundation for training the nine pharmacists and one pharmacy technician. The GP – Dr Balraj Mavi - ensured that the pharmacists are well-equipped with the necessary skills to interpret blood results, understand the complexities of lipid metabolism, and prescribe the appropriate medications.

The training process involved a mix of clinical education, hands-on experience, and case discussions. The pharmacists were taught how to evaluate lipid profiles, interpret the results in the context of a patient’s overall health, and recommend lifestyle changes alongside pharmacological interventions.

Additionally, pharmacists were trained to adjust medications based on individual patient needs and monitor their effectiveness over time, providing evidence-based optimal treatments.

We carried out searches on the EMIS system to identify patients for using UCL partner searches for Cohorts 1-4a and a further search to identify patients eligible for Vazkepa, who have raised triglycerides. The lipid clinic contacts are predominantly conducted via telephone consultations.

The project was funded by the PCN with additional funding sought from pharmaceutical companies.

Outcomes

Since the project began in July 2024, it has seen 800 patients from a PCN population of about 50,000.

One of the significant advantages of having pharmacists run the lipid clinic is the cost-effectiveness it offers. As highly trained healthcare professionals, pharmacists can offer lipid management services at a fraction of the cost of those provided by either a hospital specialist or a GP. For example, the hourly rate of a ARRS pharmacist in our PCN is roughly 60% of the cost of a salaried GP, making the lipid clinic a more affordable option for ICBs. Primary care often shows significant efficiencies in operative ability compared to secondary care structures.

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Additionally, by focusing on prevention and early intervention, the clinic helps reduce the overall burden on the healthcare system by preventing complications associated with lipid disorders, such as heart disease and stroke.

What sets this lipid clinic apart from traditional healthcare models is the level of personalised care patients receive.

Pharmacists can provide one-on-one consultations, offering patients a detailed understanding of their lipid levels, risk factors, and the importance of treatment adherence. They educate patients on the lifestyle changes - such as diet, exercise, and smoking cessation - that are vital in managing lipid levels and improving heart health.

Patients also benefit from longer appointment times, allowing for more thorough discussions about their treatment plan. This extra time helps address concerns, clarify misunderstandings, and ensure that patients feel empowered to take an active role in their health journey.

Future

These lipid clinics illustrate the potential for pharmacists to enhance their contributions within primary care healthcare delivery. They also highlight the effectiveness of a collaborative, team-based approach in improving patient care outcomes.

With evidence of LDL lowering being directly linked to improved cardiovascular outcomes, we are hopeful that we will see a reduction in major cardiovascular events.

As healthcare systems continue to evolve, there will likely be a greater emphasis on collaborative care models that allow pharmacists to take on more responsibilities in managing chronic conditions, especially in specialised areas like lipid management.

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The GP-pharmacist partnership provides high-quality care for patients and empowers pharmacists to expand their expertise and contribute even more to patient wellbeing. This innovative approach is paving the way for a more integrated and holistic approach to healthcare, improving outcomes for individuals dealing with lipid-related health issues.

This model is one to watch as it has the potential to revolutionise how chronic conditions, including lipid imbalances, are managed in the future. At present, we are performing weekly searches to identify high cardiovascular risk patients from lipid results and provide same-week consultation across the PCN to ensure guideline-driven care. As a PCN, we plan to use the same model to develop long-term condition disease management for asthma, COPD and diabetes.

This article was first published by our sister title Pulse PCN