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

2. 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

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

4. 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

5. 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

6. 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

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

8. 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

9. 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?

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

11. 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??

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

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

14. Vision

15. 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

16. Docman

17. 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

18. 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

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

20. Reviews Synchronise medication Housekeeping of repeat master
Link medication to conditions

21. 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

22. 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

23. 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

24. 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.

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

26. Example: Cost efficient prescribing

27. Patient has seretide inhaler:

28. 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?

29. Sirdupla is a generic version of seretide

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

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

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

33. 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

34. Questions?

35. 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
@SadiaQMancPharm