Proactive care is a team sport and pharmacists are a key player

General practice pharmacist and practice partner at WellBN, Brighton, East Sussex, Shilpa Patel, on the key role pharmacist play in proactive care

In primary care, we’re used to reacting to problems as they arise. Proactive care flips that script: it’s about spotting risk before a crisis, optimising medicines to prevent harm, and coordinating a team that acts together for the patient’s best outcomes. As a pharmacist partner in a Sussex GP practice, I’ve seen how small, consistent actions can transform care pathways, reduce avoidable attendances, and empower patients.

What proactive care means

In a practical sense, proactive care for pharmacists means treating medication optimisation as a daily habit rather than a series of isolated tasks. It starts with a willingness to review every patient’s medicines for safety, effectiveness, and adherence, not just during routine dispensing or clinical checks, but as a core element of care planning. Deprescribing where appropriate and simplifying regimens to support routine use are essential moves, especially for patients living with polypharmacy.

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The approach also relies on proactive outreach: using practice data to flag high‑risk individuals—older adults with complex regimens or patients recently discharged from hospital—and arranging timely reviews before problems escalate. Integrated care planning follows naturally, with pharmacy input embedded into MDT discussions and digital handovers so plans are harmonised across professionals. At the heart of it all is patient activation: giving patients clear, actionable information so they can participate meaningfully in decisions about their medicines and health. Finally, the best intentions can be undermined by inefficient systems, so sustainable workflows—templates, checklists, and standardised handovers—are crucial to making proactive care ordinary rather than an extra task.

Proactive care in action

I’d like to share a story illustrating how these principles work in the real world. Mrs S, a patient in her late 70s with multiple chronic conditions, was recently discharged after a hospital stay for a bleed. Her medicines were complex, and both adherence and medication-related risk worried the team. I led a pharmacist-focused medicines reconciliation and a risk assessment that looked beyond drugs to social factors—home support, mobility, and nutrition. The process began with a structured medication review to identify duplications, unsuitable agents, and potential interactions. We deprescribed a proton pump inhibitor that wasn’t contributing to symptom control and simplified several regimens to once-daily dosing, reducing regimen complexity and supporting adherence.

A personalised discharge plan was shared with Mrs S, her daughter, and the district nurse, ensuring changes were understood and actionable. Proactive follow‑up followed: a two-week phone check, then a home visit to confirm adherence and address barriers. We also introduced a simple, non-pharmacological nudge—a patient-facing reminder card for medications and a brief coaching call to troubleshoot issues with a pill organiser. Eight weeks on, Mrs S reported fewer side effects and better symptom control. Clinically, her blood pressure stayed within target ranges and her renal function trajectory stabilised as medication choices aligned with her current needs. Most importantly, the team learned how to spot early warning signs that would prompt timely escalation, reducing the risk of an avoidable hospital readmission.

Why this works hinges on multidisciplinary integration: pharmacy is embedded in planning and execution, not an afterthought. It relies on data-driven care, with targeted reviews based on risk stratification that make the best use of time. It rests on patient-centred communication—clear explanations and practical support that bolster confidence and adherence. And it stands on sustainable processes: templates and handover notes that keep proactive care as part of daily workflow rather than a separate initiative.

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How to practice proactive care

Start with your priorities: which areas would benefit most from proactive care—polypharmacy, falls risk, diabetes control, or vaccination gaps? Propose an MDT approach, perhaps a monthly proactive care huddle to review high‑risk lists and plan follow-ups. Creating simple tools—a medicines review checklist, a patient-facing action card, and a discharge-follow-up template—can make the difference between a one‑off intervention and a lasting change in culture. Measuring impact is essential, too: track process measures such as the number of reviews completed and time to follow‑up, alongside outcomes like adherence, hospital admissions, and patient satisfaction.

Pharmacists in primary care

Pharmacists in primary care are participating in population-health reviews, contributing to safe prescribing for older patients, and piloting collaborative discharge pathways with local hospitals. Tapping into these networks helps practices share learning, standardise approaches, and spread successful tools—without reinventing the wheel. Notably, last year’s Investment and Impact Fund (IIF) scheme helped push forward some of these proactive approaches by funding targeted medication reviews and early-intervention pathways, reinforcing how a coordinated investment in proactive care can translate into tangible patient benefits.

Proactive care is a team sport and pharmacists are a key player. Pharmacists bring a practical lens to medicine optimisation and prevention, helping to keep plans coherent across disciplines, support safer prescribing, and ensure that every patient interaction counts toward better health outcomes.

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