Urgent fixes are needed to the pharmacotherapy service in Scottish GP practices to ensure recruitment and retention of pharmacists, positive patient care and a reduced GP workload, the Royal Pharmaceutical Society (RPS) Scotland and the British Medical Association (BMA) Scotland have said.

The service was introduced in 2018 to embed pharmacists, pharmacy technicians, and pharmacy support workers in GP practices to provide pharmacy and prescribing support for patients.

However, in a joint statement, RPS Scotland and BMA Scotland have said that further investment is required in workforce, skill mix, training and development, and infrastructure.

‘These challenges are undermining the professional role of some pharmacists and have prevented workload reduction for GPs which would help to free up time to perform their role as expert medical generalists.

‘These issues need to be addressed urgently to ensure that roles are and remain attractive, to recruit and retain pharmacists and pharmacy technicians, provide positive patient care, free up GPs to spend more time as EMGs, and build a sustainable pharmacotherapy service,’ they said.

Improve skills mix

In particular, RPS Scotland and BMS Scotland said that an appropriate skills mix ‘has not been established in many areas’.

‘Pharmacists should be focused predominantly on patient-facing clinical roles and responding to medicines-related enquiries from GPs, the wider multidisciplinary team and patients’, they said.

But ‘it continues to be the case that some pharmacists are undertaking work that would often be more appropriately provided by pharmacy technicians, pharmacy support workers or practice administrative staff, resulting in an underuse of pharmacists’ clinical skills,’ they said, reiterating an issue previously raised in December 2020.

They recommended that roles be more clearly defined and workforce planning be prioritised to identify and fill gaps in service delivery, adding that a shortage of pharmacy technicians and pharmacy support workers was preventing pharmacists from being able to perform more patient-facing clinical roles.

‘We urge Scottish Government to reconsider its recent decision to reduce funding for training pharmacy technicians,’ RPS Scotland and BMA Scotland added.

Improve processes and systems

They also said that ‘efficient and effective prescribing management processes and systems’ were needed, warning against inefficiencies and potential risks where effective systems were not in place.

The organisations urged all practices to adopt the toolkits produced by Healthcare Improvement Scotland to improve the processes for acute and serial prescribing, and said that pharmacy teams should lead the implementation of these processes.

Additionally, they urged the Scottish government to prioritise the implementation of electronic prescribing systems, which they said should reduce the burden of repetitive tasks for both pharmacists and GPs.

The RPS and BMA Scotland also said that hubs, from which pharmacy teams provide pharmacotherapy services to multiple practices, should be used as part of a tandem model with GP practices, in which hubs focus on the delivery of the Level 1 and 2 service, and pharmacy teams within practices focus more on delivering the Level 3 service.

They emphasised that it was ‘essential’ for pharmacy professionals to deliver clinical care directly within practices in order to build high trust professional relationships (which deliver effectiveness, patient safety and quality outcomes), as well as build good relationships with multidisciplinary team working across health and social care and pharmacy teams in community pharmacy and hospital.

Improve alignment with community pharmacy

The statement also suggested that community pharmacists could take on some aspects of the pharmacotherapy service, such as extending the Medicines Care and Review service.

‘As a minimum, stronger links between pharmacists in GP practices and community pharmacy practice should be achieved to deliver seamless care for patients.

‘Longer term, closer alignment of the community pharmacy and GMS contracts may be useful,’ RPS Scotland and BMA Scotland said.