Quite incredibly a GP asked me about employing a practice pharmacist. He had heard a lot of rumours and a practice nearby had just appointed one. The starting point was the question why. But an answer about additional skillmix, improved quality of patient care had little real impact so we started a different discussion:
- Your practice gets 100s of letters and communications every day – perhaps 25 of these include additions or changes in medicines – do you put them on your clinical system yourself and do you ever feel that you need to check something? Do you have the time?
- You issue 200 repeat prescriptions a week – each – do you ever wonder if they are OK, need reviewing or checking – is your system robust and reliable?
- Do you ever spend time talking to patients about their medicines, sorting our queries, drug shortages or completing more structured medication reviews?
- Do you have care homes with residents that might benefit from a medication review – some ‘deprescribing’ or setting up medicines action plans to avoid admissions?
- Are you up to date with shared care arrangements and feel certain that high risk medicines are properly managed?
- How many of your consultations are with patients with acute common conditions that could be managed by a pharmacist within the practice?
- Do you have to complete audits/reviews as part of your contract or additional services?
- Do you need help to achieve full QoF points or perhaps LES or DES payments? Are you missing out on potential income?
- Are you fed up with being roped in to give flu or other vaccinations when it is busy?
- Are you worried that the CQC are going to ask difficult questions about medicines management and expect to see evidence of delivery?
- Are there chronic disease areas where the addition of a clinical pharmacist to the current team, might mean that they can manage a larger percentage of patients without referral to you? What value would an additional independent prescriber bring to the service?
- Are you just tired of being in the practice late, unable to recruit GP help, can’t find practice nurses and not enough time to spend with patients that need your expertise. Is it just not fun anymore?
If you have answered yes at least 10 times, then convert the above into a job description. Add some skills and knowledge, perhaps a few competencies – working in a team, but independent thinking – you know the sort of stuff. Think of a salary scale – perhaps band 7 or perhaps 8a if they have areas of specialism or are an independent prescriber. Write an advert and give it to your CCG – put it in a journal or on line. Ask the head of medicines management to help select and interview or another practice pharmacist and just get on with it. Open the interview with ‘what do you think you can contribute to my practice’ and you are away.
The only remaining question – is one going to be enough?