1. Planning for quality @ NHSL Quality Academy
To reduce GP workload by optimising a process for a General Practice based Pharmacist doing prescribing related tasks.
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Andrew Mackay, Murray Rodin,
Hamish Reid, Jo Smail

2. Project background: Why?
The opportunity to integrate pharmacists into primary care teams has the potential to release significant amounts of GP time.
Workload analysis shows that clinical administration is the biggest demand on GP time after face to face care.
Clinical pharmacists working at the top of their licence can be the most appropriate professional to carry out many tasks related mainly to medication that are currently carried out by doctors.
Projects in Wales and London have experience in this development and have identified specific areas in which doctor time can be saved.
Pharmacist resources already exist within NHS Lothian as a consequence of Prescription for Excellence and Primary Care Development Funds.
Further pharmacist resource is likely to become available in the future, it is hoped that this project will offer HSCPs and NHSL pharmacy department a model for deploying this resource
Perhaps a sketch of the process map as an alternative to the pareto analysis
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3. CURRENT SYSTEM PROCESS MAP 1
Med Rec
Hospital Requests IDLs
District Nurses Pharmacy Request
Midwives (Polypharmacy Review)
Produces Script GP

4. Project background Special Requests at Tranent Medical Practice for week of 14th to 18th November 2016
Perhaps a sketch of the process map as an alternative to the pareto analysis
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5. Prescription Requests Tranent Medical Practice 20th September to 14th October 2016

6. Time Taken to do Special Requests

7. What are we trying to achieve?
By March 2017 all practices will have a clinical pharmacist in place carrying out tasks which reduce the clinical administration burden for GPs.
We aim to reduce the amount of time spent by doctors on prescription related tasks by 30-50%.
We expect that the pharmacists will add value to routine GP prescription work by virtue of their professional expertise in improving prescribing quality and cost effectiveness.
Run chart = display median value. Aim for 10+ points. Adjust y axis to spread data over vertical axis
SPC (Shewart) chart = display mean value with control limits. Aim for 20+ data points
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8. Driver Diagram
Aim
Primary Driver
Secondary Driver
Interventions
To reduce the time GPs spend dealing with non- face to face prescriptions at Tranent Medical Practice by 30% by March 2017
Improved repeat prescription system
Introduction of standardised protocol for clinicians
Implement new protocol from start of November
Increase number of items put onto repeat prescription
Increased use of CMS system
Put new scripts onto repeat for appropriate number of issues
Polypharmacy medication reviews
Support from new Integrated Care Pharmacist
Medicines Reconciliation
Support from Integrated Care Pharmacist
Support from member of admin team
Improved systems for patient recall
Improved coding of conditions
Check if all relevant READ codes present when doing medication review
Clinicians reminded to add appropriate READ code when issuing new script
Introduction of new GP tab on Vision to encourage generic coding at presentation
Practice coder now adding more codes before clinician processes letters
Improved involvement of patients
Introduction of new Birthday month annual reviews
Introduction of improved CKD recall system
Improve communication with community pharmacy
Enabling patients – use of House of Care model, sharing of information.
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10. How will we know a change is an improvement?
Outcome Measure
Process Measure
Balancing Measure
Use of a clinical pharmacist could save up to 10 sessions a week of doctor time
Clinical pharmacist integrated into the practice team
Improved quality and cost effectiveness of prescribing
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11. How will we know a change is an improvement?
We will repeat our tally charts of prescription related activity once the pharmacist is fully integrated.
These will look at activity through the different routes specified in the process map above and indicate effectiveness of integration.
Improved quality will always happen with increased input of a pharmacist on prescribing.
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12. It isn’t over!
Current clinical pharmacist availability is limited. More pharmacists will be needed to achieve the hoped-for savings in GP time.
Pharmacists cannot yet sign electronic prescriptions. This should be resolved soon.
Continuing liaison between NHSL pharmacy department / HSCPs / GP practices is needed to ensure ongoing governance and professional support for practice-based pharmacists in this developing role.