Easy wins in General Practice A workshop to allow new pharmacists to establish trust and credibility in first months of general practice Sadia Qayyum Sadia.qayyum@manchester.ac.uk @SadiaQMancPharm

Learning outcomes Develop a strategy to integrate into a new team Discuss structure and hierarchy of a GP practice Recognise importance of formulation of a clear job role and to manage expectations Recognise limitations and when to refer Formulate a relationship with a mentor Understand the role of a practice pharmacist in developing an SOP when dealing with medication requests Promote collaboration with GPs and other health care professionals to improve patient outcomes Consider high impact cost saving prescribing changes

Temperature check- Ideas? Concerns? Expectations? How are you feeling? Do you have any… Ideas? Concerns? Expectations?

Agenda Background: changes in pharmacy workforce Structure of General Practice surgery Roles of practice pharmacist Integrating into a team Communication in General Practice Job descriptions Know your limits Structured working Quick wins Questions & Answers

Background: changes in pharmacy workforce More pharmacists are working in diverse roles Shortage of GPs due to retirement and lack of recruitment Funding from government to use pharmacist as a resource Pharmacists have skills that can be applied through general practice The role of pharmacists in general practice has received increasing attention with the RPS. RCGP and NHS alliance coming out in support and promoting the role that pharmacists can play

Structure of General Practice surgery Who is practice manager? Do you have a line manager? Who do you report to? How are you allocated your workload? Who do you handover to? If you are new to a practice and they have never had a pharmacist before, it is understandable if people are wary at first until the get into their comfort zone Its not always the doctor that you will be reporting to!!! And the practice manager may feel undermined if communication doesn’t occur through the correct channels

Integrating into a team Ideas? Concerns and barriers to integration?

Integrating into a team Orientation process Introductions and meetings with others Tour of the practice Create a support network Mentors Approachability Friendliness Building trust and a rapport

Communication in practice Who is your line manager How often will you meet you line manager? How will you receive updates and feedback? How can you give updates and feedback? Are you included in practice meetings?

Job description Clear job role Defined and achievable targets Realistic expectations Devise an action plan Review and feedback regularly

Role of practice pharmacist Prescription requests Medication queries Make cost saving changes Order routine bloods Conduct medication reviews Reduce wasted medication Hold patient facing clinics And more…………. Pharmacists have a broad skill set and this can be used within the practice team Where do you fit in??

Training needs Accessing Vision/Emis or other practice system Docman Current formularies Practice targets and aims

Access to records Vision/EMIS Detailed patient records Medical reviews Medication history Repeat medication ‘repeat master’ Patient details Preferred pharmacy

Vision

Docman Access hospital letters Discharge notes Referrals Any other documents scanned into the system We can access all that we need regarding the patient quickly and efficiently

Docman

Prescription requests Patient Hospital Pharmacy Opticians Prescription request Private hospital Graham: - Advise them to " Play to their strengths" and tackle these area first. Sort out common issues/analysing data/sort out common switches for both safety and cost saving i.e Amlodopine & Simvastatin: Dual antiplatelets Duncan: - Have a look at Repeat Rx policies and protocols with a fresh pair of eyes: General policies and protocols involving medicines: CQC: Pick an audit DMARDs: NOACs, High Risk meds: Trawl for unlicensed meds that the practice may have taken on unwittingly Tip don't highlight problems without offering a solution. External supplier Nurses Nursing homes

Structured working Create and follow an SOP Devise a formulary for the practice Achieve QoF targets Manage expectations from all parties What is expected of you What do you expect from your employers When to refer

Reviews Annual Blood Pressure measurements Routine bloods for >40yrs old Lipids FBC Iron, folate HbA1c (diabetes) TSH (Thyroid stimulating hormone)

Reviews Synchronise medication Housekeeping of repeat master Link medication to conditions

Hospital Discharges Which department? What happened? Any medication changes? Change repeat master Leave review dates Follow up bloods if necessary Leave clear notes as appropriate

Repeat medication requests Reviews with GP Anti-depressants: 3 monthly BP/bloods: annual Asthma/COPD: annual OCP: annual review and BP check Leave clear notes as appropriate

Acute Medication requests Who is making the request? Why? Is a review needed? Previous use of medication Request frequency: Does it need a review by GP? Does it need adding to repeat master? Leave clear notes as appropriate

Other requests/issues Who are they from? Why Acute or to add to repeat master Audits: inhalers etc Post dating rx Change rx to generic Follow script switch guidance Leave notes as appropriate with review dates Graham: - Advise them to " Play to their strengths" and tackle these area first. Sort out common issues/analysing data/sort out common switches for both safety and cost saving i.e Amlodopine & Simvastatin: Dual antiplatelets Duncan: - Have a look at Repeat Rx policies and protocols with a fresh pair of eyes: General policies and protocols involving medicines: CQC: Pick an audit DMARDs: NOACs, High Risk meds: Trawl for unlicensed meds that the practice may have taken on unwittingly Tip don't highlight problems without offering a solution.

Know your limits Build trust with your team Ask for feedback regularly Give feedback on prescribing habits you’ve noticed (good and bad!)

Example: Cost efficient prescribing

Patient has seretide inhaler:

Script switch can change this to generic If this software is unavailable, what other switches can be made? Can you target specific high cost items?

Sirdupla is a generic version of seretide

Total Savings: Cost saving per patient: Monthly: £8.75 Annually: £105 A quick win is always appreciated!

Example: Saving GP time Rx requests: as a pharmacist what would you do? What would you check?

Example: Saving GP time This patient had been on Naproxen for four months with no PPI Omeprazole 20mg OD commenced

Quick Wins What are your ideas? Target an expensive drug and change to generic Pregabalin dose optimisation Inhaler request audits Complete medicine reviews to gain QuOF points Check NICE guidelines are followed Routine bloods and BP check

Questions?

Sadia Qayyum Sadia.qayyum@manchester.ac.uk @SadiaQMancPharm Thank you for your time! A workshop to allow new pharmacists to establish trust and credibility in first months of general practice Sadia Qayyum Sadia.qayyum@manchester.ac.uk @SadiaQMancPharm