I am thrilled that NICE are proposing tighter blood pressure targets within the QOF. There is only one economic way for GP practices and the NHS to achieve this – by employing clinical pharmacists in general practice.
A recent study won a Pharmaceutical Care Award this year explains why it is so important. This study looked at the effect of independent prescribing pharmacists on the management of uncontrolled hypertension. By uncontrolled, we mean patients that despite the best efforts of the GP and practice nurse they had failed to reach their target BP. After 6 months in the pharmacist clinic 79% of these patients were below 150/90mmHg and 58% were below 140/90mmHg (n=229).
For one, I am not surprised by the results. I would suspect that many of the problems are related to medicines selection, side effect monitoring and compliance/adherence. And these represent the specialist knowledge and skills of the pharmacist. I would also suggest that with increasing experience in the field the success rate might grow. Hypertension is not the only area that this expertise will help – asthma, COPD, diabetes, pain and several other examples are out there. There are also poly-pharmacy review clinics to deal with the patients with multiple medication issues and specialist compliance clinics.
This is a massive learning for the NHS who needs to better control patients within primary care and avoid referrals to specialists where it is really not necessary.
The argument becomes stronger to employ a clinical pharmacist within a GP practice. It gives an appropriate level of care between the nurse and GP and the specialist GP and consultant.
But why would a GP consider employing a clinical pharmacist? There are several good reasons:
- They are available – there are highly trained pharmacists available on the market where there is a lack of GPs and practice nurses
- They are inexpensive – really inexpensive compared to salaried GPs and at the current market price, not much more than a practice nurse.
- They have the expertise – two of the main problems are medicines selection and patient compliance – this is their strength.
- They are highly organised –can be used to ensure compliance with CQC registration requirements around medicines management and implement and monitor safe prescribing systems in the practice
And they can do so much more to make the prescribing and clinical management of the practice work more efficiently and effectively to improve practice profitability and outcomes
Here are a couple of quotes from Doctors who already have a clinical pharmacist as a ‘managing partner’ and ‘QOF lead’:
“She is the ‘engine room’ of the practice, bridging the gap between strategic, organisational and clinical priorities and their implementation” Dr Dev Malhota
“Because of my high admiration of her work, my GP partner and I didn’t hesitate to offer her employment” – “She stepped into a new role as the lead clinician in our QOF” “We would not be able to achieve the high standards which have typified our practice without her input” Dr Alan Gardiner
They employ pharmacists – they see the value – they gain the benefit – why don’t you?