By Ryan Smith, pharmacist.
Under the revised GP contract, the additional roles reimbursement scheme provides PCNs with 100% funding (capped) to add pharmacists to their teams, and uptake is expectedly high. I’m writing this piece to support practices to make better decisions along the way – the advice may seem obvious, but I have seen some pharmacist hires go badly, when they had every chance of succeeding. As a pharmacist and an advocate of pharmacists in general practice, I think that by following some basic rules you can allow your pharmacist to thrive and integrate well, becoming a key member of the multidisciplinary GP team.
1. Understand what you want your pharmacist to do and ensure you hire appropriately
There are so many facets to this rule.
Level of experience
Firstly, set out clear objectives and expectations and hire a pharmacist who can do what you need them to do. Be prepared to adjust your expectation if the right candidate does not fit your initial profile, and set a development plan to support them to get there.
If a pharmacist doesn’t already have a background in minor ailments then they may not be able to slot into that role too quickly. Education should be coupled with supervised practice to ensure competency in an area. You may well find a pharmacist who is, for example, the diabetes or respiratory expert that you need – but be sure to ask at interview.
Are they an independent prescriber (IP)? And do you actually need an IP? In my experience, lots of practices think they need an IP and they don’t, while others hire an IP who then never uses it in their day-to-day role. Again, be sure to clearly outline the role that you see a pharmacist undertaking and ensure that it matches their skillset.
Progression and team dynamics
A key question when building a PCN pharmacy team is, how will it fit together? It is healthy to have a range of skills, specialisms, and levels of experience. The ARRS is set up to support development and your non-IP members of the team will become IPs over the course of 18 months. Having a staged development plan and mixed abilities will support a good balance, as well as ensuring that there is room for growth in the team.
As your experienced pharmacists may move on over time, it’s also wise to have a crop of pharmacists who can progress and grow to replace leavers. Progression supports employee satisfaction and retention, keeping your costs low and service continuity high.
2. Competency is key
It is imperative that your pharmacist has the right supervision and support from either a senior pharmacist within the team and/or their GP mentor Competency is a funny thing, you often don’t know you’ve strayed outside until someone holds an objective mirror to your work. For this reason, it really needs to be an ongoing conversation with total honesty. I’ve witnessed pharmacists taking on too much, under pressure to deliver in a new role in general practice, little experience under their belt and a will to improve. Quite a dangerous pattern of practice can emerge if the right support framework is not in place, so a baseline competency assessment should be undertaken when a pharmacist commences in role. The CQC lays out expectations for clinical supervision, so ensure you read and adhere to these.
3. Interpret data carefully
Data in general practice can be a great tool to guide pressure point analysis and allow you to direct your pharmacists’ training accordingly to offer best value to the team. Where practices seek to measure the value of a pharmacist in the team, setting out with the right parameters is important.
A crude measure that I’ve seen go badly wrong (and this seems to have been repeated many times over, so apologies if you’re reading this and have applied the same logic!) is a measurement of the number of tasks/prescriptions completed by a pharmacist.
Measuring the quantity of patients reviewed, medications reauthorised or tasks completed may be valuable as part of an overarching picture of competency, proficiency and accuracy, if set against a backdrop of error rates and other qualitative measures. However, in isolation if you tell yourself that speed of work is what you are pushing your pharmacist on -this is really not the way to go. Complexity of work is classically overlooked on this point too, so ensure that you have a full picture when appraising their development and contribution.
Bear these rules in mind and you should be on your way to creating a sustainable environment to allow your PCN pharmacists to grow into their new role, and add optimal value to your practice team.