It’s all about skill mix

I have heard this term four times in the last week as I nodded sagely to their comments. It was strange because it was doctors talking about pharmacists. So perhaps the message is getting out? Here are the examples:

Talking about the provision of out of hours.

  • we were a seaside town and many of the patients attending out of hours had medication related problems and many were away from home and had minor problems
  • and it was just difficult and expensive to get enough regular doctors

So we have a pharmacist on duty every evening who can deal with those problems. That’s right we have a nurse, a pharmacist and a doctor and patients are triaged appropriately. We are working on the next stage where we triage some patients back to community pharmacy before they attend our service.

Talking about managing long term conditions.

  • We had a significant number of patients who did not hit reasonable and, in our opinion achievable, hypertension targets despite the best efforts of the nurse and GP
  • We already had access to a pharmacist who run our whole repeat prescribing system, ensuring patient safety

So all patients that were considered uncontrolled we referred to the pharmacist. She took part in a recent study which won the Pharmaceutical Care Award in 2013 where 58% of uncontrolled patients hit NICE targets. It is obvious to us that the issue was either medicine selection or compliance. We achieved great success and avoided many secondary care referrals

Talking about ‘Pharmacy First’ schemes

  • We used significant numbers of acute and routine appointments, seeing patients that our local community pharmacist could have dealt with

I know that a lot of patients come to see me when they could have seen the community pharmacist. So the PCT introduced a ‘minor ailment’ scheme. There was quite a lot of publicity and we noticed the difference. We work very closely with our local community pharmacist and support him in dealing with some patients. Their pharmacy is literally a stone’s throw away and our patients have to pass his door to come to the practice.

We have started asking the question ‘what did the pharmacist say’ and I think that the message is getting through. We have fewer minor ailments in our clinics and better access for patients with long term conditions.

Fighting flu

  • We missed our target for the under 65s
  • Despite sending out letters and pestering people we still missed our targets.
  • The winter flu campaign already causes significant disruption to the practice and we have significantly more to do this year

It wasn’t as if we hadn’t tried. We wrote letters, made calls, but many of the patients under 65 did not respond. We did ask a few why and it was a whole mixture of things. Well last year we reached out to our community pharmacist who was being commissioned by the PCT. Every patient under 65, picking up their medicines was asked about flu. They were either given the vaccine on the spot or booked into our clinic. We had the names, dates of birth and batch number of immunised patients every day. The community pharmacist also focussed on healthcare and social care workers and helped with the residential homes.

OK we missed our targets again, but only by a whisker. This year I feel confident that we will hit them comfortably.


So, with resources tight, goals and targets being stretched, the need to do more for no more money – it’s all about skill mix – ensuring that the right people do the most appropriate jobs in a joined up manner.


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