For our Pharmacist in Practice series, The Pharmacist spoke to Laura Buckley, a primary care network pharmacist in East Yorkshire, about the key needs of the ageing population in her local area, as well as her hopes for an increased practice pharmacy workforce.

How long have you been working in general practice and what were you doing before?

I have been in general practice just under three and a half years and I was a community pharmacy manager for a few years before that. So, it was quite a big change for me to move into general practice.

What attracted you to working in general practice? 

I think it was a combination of things really. I wanted opportunities for clinical development. In my role at the time, I just felt like I didn't have those opportunities. So, I decided to move into general practice for more clinical development and also multidisciplinary working, because you need to work with nurses, advanced practitioners, physios – and you work with a much wider team. And in community pharmacy, there were times where I felt quite lonely. It was just something that I wanted to do really, and I thought ‘I'm going to give it a go and see what happens’. And I have loved it ever since.

Do you have any areas of special interest or any particular projects that you’re working on?

I originally wanted to specialise in mental health. I'm not a mental health pharmacist, but that was originally something I considered doing. And my focus on prescribing was anxiety and depression. But what that actually has served to do is really support me in my foundation knowledge because I do a lot of work with opioid and opiate de-prescribing and working with patients with – it tends to be like your opiates and benzodiazepines dependency. I work with a lot of these patients to support them in safe de-prescribing and actually trying to manage chronic pain a little bit better. That's one of my interests.

I guess my other big interest would be those with significant polypharmacy and frailty. It's quite a big thing in this area because we have quite an elderly population where I live.

The kind of polypharmacy that I am talking about is patients on 10 or 15 medicines. So, patients who take lots of medicines for lots of different conditions, and they see me as a pharmacist, and I will review the appropriateness of those medicines for them, with them. There is always a shared approach to making decisions about medicines. We'll look at whether any of those medicines are suitable to be stopped; if they can be stopped safely, and if the medicines they are taking are appropriate to continue on, or whether they need to be changed or reduced.

It is quite a big process, especially in these kinds of complex patients, and it can take a lot of review. So, it might not just be a one-off review, it might be a series of reviews, which means that the burden of medicines often can be reduced, which makes their quality of life better and actually reduces their risk of harm from medicines as well.

Are you currently undertaking any training?

No, simply because I literally started a new job [this week]. So, I've just moved roles, and I've moved from being a general practice pharmacist, to a primary care network pharmacist. So, I'm just getting to grips with a new role.

However, I have some ideas for things I would like to do, and courses that I might consider doing. But I think for the next few weeks to months, it will be just a case of settling in.

This isn't the first time I've been a primary care network pharmacist, it's the third time. So I'm coming back at this role with a lot more experience and with the knowledge of what to expect.

And I think for me, what attracts me to the PCN world is the variety that it offers, and actually the large number of teams that you can work with.

However, I did very much enjoy being a general practice pharmacist. It was a bit more intimate. And actually, I felt a huge part of the team. I think it's just that I wanted to try something different.

I have done my prescribing course. And I also did the CPPE primary care pharmacy education pathway – I finished that last year.

What does your job look like day-to-day? 

I'll be getting involved in lots of different things, depending on what my network requires. So, it could be anything from structured medication reviews, to working on specific pieces of work. So I'm looking at patients on maybe high risk medicines: it might be chronic disease reviews. In the past in general practice, I've played quite an integral role in the Covid-19 vaccinations as well.

You get involved with education as well: looking at other members of staff. I work a lot with pharmacy technicians as well. I also do a lot of prescribing audits and things like that. It very much depends on what the practices need from me. The role is so varied that it could be that I might end up getting involved with care homes and doing care homes ward rounds. It just depends on how things pan out in the next few weeks. But those are the kinds of things I have done before in other roles too.

What is the biggest patient need in your area and how does that influence your work?  

We have quite an ageing population in certain areas within East Yorkshire. It kind of comes with the territory that frailty and polypharmacy are issues within that.

But we also have quite a high rate of prescribing of opiates. So that's another piece of work that I would be interested in doing as well.

What are the main challenges now and going forwards in the coming years in practice pharmacy?

I think we need more pharmacists. The numbers of pharmacists that we need and the skill set of pharmacy. Practice pharmacists are becoming more common. But we're expecting that now that in the coming years pharmacists are going to be graduating with prescribing ability, the upskilling of pharmacists and the development of pharmacists within general practice – I'm hoping that it's going to continue.

But it means that we need a framework in place I think for pharmacists going forward as to how we're all going to fit in within the general practice workload and also how we're going to develop our in-house [staff]. So, when new pharmacists are coming through, I think some areas maybe don't have as many pharmacists. I know certainly where I am, we aren't as pharmacist heavy, if you see what I mean. It's something that we need in this area, and for development of, and how that's going to work within the general practice placements, and things like that is something that we need to work on. I'd like to see more pharmacists in general practice and I guess, more opportunities for development within those practices.

What kind of development opportunities do you think practice pharmacists could get?

Increasingly, we have pharmacists that are doing courses. So, we've got advanced practitioner pharmacists, so opportunities for that. Existing pharmacists who aren't prescribers, there is more funding for pharmacists to upskill into prescribing now anyway. But it would be good to see pharmacists developing more advanced skills, and maybe pharmacists with special interests as well – certain areas that they want to work on. Those who have particular specialties, that is in their area, that will be really good to see.

Biggest opportunities for the sector in the next five years?

I think, for the profession as a whole, to see pharmacists in the coming years that will be graduating as prescribers will make a huge transformation to pharmacy and pharmacists as we know them.

So, you obviously have people like myself, who now who prescribe routinely. But I think as more and more pharmacists are prescribing, I think that the clinical interventions and the work that we do, will continue to develop and become more advanced, and therefore there will be more opportunities for pharmacy technicians to do more specialist work as well, because pharmacy technicians are professionals in their own right anyway and they're already doing specialist work. And I think there will be a lot more opportunities for pharmacists and pharmacy technicians to work together as well.

How do you work in a team with your practice colleagues? 

It very much depends on what I'm working on. I will often work alongside GP with some of the more complex patients. It might be that I'm providing them with advice relating to medicines, or they might be supporting me, if I have a query about how we can manage a condition better.

In general practice, you very much work alongside each other, mutually providing each other with that kind of advice and support. Same with the nursing team, in my last role I had a really close working relationship with the nursing team. I might ask them about a particular area that I wasn't sure about, and they might come to me for medicines-related advice.

And musculoskeletal practitioners, we have in some of the practices as well. That's not an area that I profess to be equally confident with, and they've often provided me with a great deal of support when it comes to patients where I think, ‘I'm not sure if this patient needs an assessment’, I might just bounce off that question and ask.

The fact that we're also accessible to each other in general practice means that advice is readily given and received. Patients get a much better service, simply because there are more professionals available at any one time to give that advice.

How do you work with community pharmacists? 

I wouldn’t be without community pharmacists. In my last job there wasn't a day that didn't go by where I didn't have to speak to a community pharmacist. We worked quite closely with them with relation to managing supply issues.

Often, because I'm not hands on with medicines now, it might be that I might need to make a query about like the form of a medicine and just ring and ask quick queries about that. But also sometimes, if I had potentially had concerns about a patient or the community pharmacist had concerns about a patient, one might want to communicate with each other, to discuss those concerns, and to see if there is something that, for example, they could do or I could do to improve things for a patient – whether that's a medicines management issue, or whether it's a social concern. I might potentially have more resources to offer patients social support from a GP practice perspective and they've maybe reported their concerns to me, or maybe I would ring and say, ‘Well, I'm not sure this patient's taking their medicines, are they routinely picking medicines up from you? Have they reported any concerns?’ and more from that kind of perspective.

And actually, in the last couple of years, I have had a few instances where I've needed to almost do a dual consultation in that I've been fortunate that I've been able to do a consultation with a patient, with their community pharmacist present. And there has been a couple of occasions, and that's made a huge difference because we've been able to resolve issues like supply issues and issues that the patient's having with managing their own medicines at home.

Anything you would like to add?

I think I guess my one thing that I find is that patients don't often understand the role of the pharmacist in general practice. But that also applies to other healthcare professionals who have maybe not worked with a pharmacist in GP before. And the opportunities for pharmacists in general practice are huge. There are so many different pieces of work we can get in involved with.

In general practice there's never a shortage of workload and things to do. And it is so varied that there's something for everybody. If anybody was thinking of going into a career in general practice, I absolutely would advise them to look into it and look at their options for it.

What do you like to do in your time off?

I write novels in my spare time. I am little bit of a hobby writer, I suppose. I run a blog and in the last couple of years, I've self-published two romantic comedies. I've always liked writing and have always been interested in it. And I think at some point, maybe even when I'm retired, I might just give it a go.