1. Barnet CEPN Prescribing Clerk Training Session 7

2. Plan Feedback from pharmacy visits Roles and relationships
What have you learnt?
Roles going forward

3. Community Pharmacy Visits
In your groups of 3-4 please discuss for 10 minutes
What you learnt about the role/roles of staff in the pharmacy?
3 things that surprised you?
3 things you will now do differently as a result of your visit?
How has your relationship with your community pharmacist changed since visit?
If there is one thing from your time spent in the community pharmacy that could be shared with other Barnet community pharmacies, what would it be?
Feedback from group
Surprises
Surprised how busy pharmacies were/multitasking
Surprised at the number of services pharmacy offer-> MUR, travel clinics, minor ailment consultations, stop smoking, ear piercing, dossett box assembly, methadone service, allied services (podiatry, physiotherapy)
Surprised at the amount of record keeping -> CD recordkeeping
Surprised that most pharmacies have a back office and a big storage area
Pharmacies actually make loss on some prescribed medication – not aware aware of this before
Working differently
Waste -> many uncollected prescriptions, patient returns, expired stuff. Scope to work with pharmacies to try and reduce these
Dossett boxes -> this is like a small factory within pharmacies. Probably need surgeries, pharmacies (and CCG) to work together to ensure appropriate use of Dossett boxes
Work with pharmacies to identify patients suitable for eRD
Better signposting to pharmacy as now aware of services offered
Medication reviews could be done in pharmacy?
Relationship with pharmacy now
Most of you felt that you have improved your relationships with the pharmacy teams and some of you are now the ‘pharmacy liaison’ clerk for the practice!
kPharmacies know their patient well

4. Roles and relationships within the surgery
Spend 2 minutes thinking about your relationship with your colleagues
In the last month, give an example of a query/issue you have discussed with each staff member listed below? What went well and what can be improved?
Admin team,
Practice manager,
Practice based Pharmacists,
GPs Prescribing leads- GPs
CCG Practice Support Pharmacists
How have the skills you have learnt from the training enhanced your communication skills?
Feedback from group:
No specific examples but:
Now more confident to approach the CCG pharmacist with appropriate medication related queries
Cascading some of the repeat prescribing training down to the rest of team including PM and prescribing leads including the PBP
More working with PBP to improve repeat prescribing process
Better relationship with pharmacy team –face to a name

5. Changes to practice Form 2 circles, 1 minute per topic to discuss
How could you encourage more use of EPS in your practice ?
Which three new things about eRD have you learnt that could change how you work?
What EMIS tips have you / will you share with your practice colleagues?
If you had one thing you could share about Medication reviews – what would it be?
Safe prescribing: What in the next month could you do to influence safer prescribing in your practice?
Vulnerable Groups: Name 3 vulnerable patient groups
Wastage: What changes could you share to reduce medication wastage in your practice?
Communication skills: When dealing with challenging situations with patients regarding scripts what one thing have you / will you do differently?

6. How can you encourage more use of ‘EPS’ or ‘Patient Access’ in your practice ?
Feedback from session
Patient information leaflets
Longrove Surgery – shared a PIL to attach to paper prescriptions asking patients to nominate a surgery
Text messaes
Pharmacies nominating patients
Keeping targets of signup. Month on month increase
With Patient Access-> having a dedicated team at the surgery helping patients sign up. Having open day for signing up Patient Access
Involving the Patient Participation Group (PPG)

7. Which three new things about eRD have you learnt that could change how you work?
Feed back from Group:
Can stop the tokens from printing by pressing store button just before issuing the script
NHSBSE can provide a list of patients that may be suitable for eRD
Pharmacies have to ask patients a set of questions to check for compliance /safety each time patients come to collect their prescription- However, we need a system whereby these messages can be forwarded to surgeries
Patients can collect ‘extra’ month supply if needed – eg holiday supply
Can reduce workload

8. What EMIS tips have you / will you share with your practice colleagues?
Feedback from group:
Variable repeat
Grouping by BNF drug groups
Alphabetical grouping
F12 protocols

9. If you had one thing you could share about Medication reviews – what would it be?
Feedback from group:
A repeat is not for life
Important to assess if still need for medication and if still safe and appropriate for patient
Use reviews to help sync medications
Greater awareness of high risk drugs
Provides an opportunity for patient to discuss any issues about their medication
Over and under ordering -> could be a red flag ?vulnerable patient

10. Safe prescribing: What in the next month could you do to influence safer prescribing in your practice?
Feedback from group:
Identify patients who are over ordering or under ordering their medications. Work with PBP /prescribing lead to check if there is an underlying issue behind these
Uncollected prescriptions at surgery-> identify if there is risk to patients
Work with pharmacies to identify patients who are not collecting their prescriptions
More care when processing prescriptions for vulnerable patients

11. Vulnerable Groups: Name 3 vulnerable patient groups
See later slides

12. Wastage: What changes could you share to reduce medication wastage in your practice?
Feedback from group:
Working with pharmacies to identify patients who are not collecting their medications – and exploring why- compliance issues?
Getting more patients to sign up to Patient Access- this way patients will only order what they want or need- hopefully!
Patient education -> signage in waiting room/website -> Encouraging patients to only order medications they need, discourage hoarding . Patients often feel they have to order everything on their script- educating them that this is not the case
Using variable repeat to highlight medications ordered monthly which should only be ordered when required and not monthly. Discussion with patient as to why being ordered monthly

13. Communication skills: When dealing with challenging situations with patients regarding scripts, what one thing have you / will you do differently?
Feedback from group:
Taking time to listen to patients
In their shoes…
Asking a colleague to step in if the situation is getting out of hand

14. EPS and ERD 2/3 of prescriptions are repeat prescriptions
Based on patient on choice
Use of prescription tracker to send script back to spine if necessary
Educate patients on the benefits/work with PPGs
Use of patient access

16. Emis Tips How to list drugs to prevent errors
Acute/repeat/repeat dispensing/variable repeat/hospital only
Use of the grouping tab: acute/repeat/drug/emis drug group

17. See above medication can be on:
Normal repeat- most medications will be on normal repeat
Repeat dispensing—This is when batch prescriptions are issued
Variable repeat- good to separate medications that are not needed every month on variable repeat- eg creams, salbutamol inhaler

18. See above – use the drop down menu and choose EMIS drug groups

19. Medication reviews

20. Medications reviews Drugs that need frequent monitoring eg
Lithium, Warfarin INR, Methotrexate
Yearly review is minimum
A repeat is not just for life!
Important to monitor any adverse effects
Important to ensure ongoing effectiveness of medication

21. Vulnerable groups Elderly Dosset boxes / MARS
Residential home patients - which are your local residential homes ?
Dementia
Housebound patients
Polypharmacy: More than 6 items on their repeats.
People with Mental health
Learning Disabilities
Others include:
Children with long term conditions/ special needs

22. Wastage How to deal with over ordering?
Speak to community pharmacist – who is ordering?
Alert GP (do they need a review?)
Ask the patient for reason
Tell PSP – they may be able to look into it for you
Care homes – ensure 28 days only
Dosette boxes – 28 days

24. Communication skills
Try not to get angry towards the patient (it can be hard)
Keep your voice calm
Try to find a workable and realistic solution
Sometimes patient may understand the reason for delay – helpful if you can explain
Ask for help when needed
Don’t take it personally

25. Job Role
Following this training how would you describe your ideal job?
What are the essential skills?
What are the desired skills?
How has your role changed since starting the training?
What would help you achieve the desired job role?
What are the barriers?
Feedback from groups- Job role:
Essential skills -> Organisation skills, attention to details, good communication skills, reliability, consistency, team worker, flexibility
Desirable skills-> Related knowledge fields, previous experience, computer skills/EMIS skills, multitasking, confidence

26. Next Session Joint session with community pharmacists
Community pharmacist feedback from visits
NHSBSA speaker – ERD and EPS
Summary and further feedback!
Next Steps