Getting the Chemistry Right
Building the Workforce – the Future of General Practice
Here Dr Ajit Kadirgamar discusses a road map to help GPs keep on track with ensuring efficiencies work hand-in-hand with delivering successful patient outcomes
Today’s consumers of care are very different to those from a decade and more ago. Today, people expect to interact with services through technology, outside of core operating hours. People’s requirements have also changed, increasingly needing care for long-term conditions. These patients account for 50 percent of GP appointments. Across the system, care for people with long-term conditions is thought to consume 70 percent of health and social care spending. Add on to this the estimation that 340 million consultations are undertaken every year, which is up 40 million since 2008. Currently, GPs frequently handle all appointments regardless of need and severity, meaning GPs are overloaded, and ultimately the overall care provided can take a long time to deliver.
To change this approach, alternative solutions are being sought to widen the care delivery model. One such approach is the development of clinical pharmacists in the area of primary care. Enabling pharmacists to provide consultations with patients around their health conditions, complete secondary care discharge medication reviews, review outpatient letters alongside what we know they already provide in terms of personal medicine advice, prescription organising and smoking cessation tips, will not only help GPs in their quest to provide the best patient care, but will also enhance the quality of medicines management and therefore reduce unnecessary A&E attendances and hospital admissions.
As a follow on from this approach, The Practice Group is developing a strategy to enable GPs to operate at the top of their skill set and experience, so they only see patients who need those attributes. The approach involves developing the role of the pharmacist within general practice to:
- Target hard to reach patients with long-term conditions with the aim of increasing medication compliance and knowledge;
- Introduce health promotion sessions throughout the year, either as group sessions or 1:1s, between patients and pharmacists;
- Promote medicine compliance through individual and group sessions with pharmacists;
- Increase access to healthcare services through a change in skills mix within surgeries. Pharmacists will consult with patients in a number of ways including face-to-face, via the telephone and through electronic means such as Skype and email;
- Enhance continuity of care and case management for those patients with poly-pharmacy, vulnerable and elderly patients;
- Provide additional care home support including the review of all new residents within the care home and biannual reviews of all other residents to reduce negative drug interactions and unnecessary poly-pharmacy. As an example, a pilot ran by The Practice Group regarding additional care home support showed a 17% reduction in general prescribing, with a significant decrease in the use of specials and a reduction in the dosages of anti-psychotic prescriptions.
To effectively manage these changes, pharmacists will need to be trained to take on tasks including prescription queries from patients, reception staff, clinical staff and pharmacies; the review of secondary care discharge medication and outpatient letters; dealing with requests from external agencies and for acute medications not on repeat prescription from patients; care home medication reviews including appropriate interventions immediately without needing a GP review; maximising the use of systems and technology and educating patients, carers and staff around medication ordering, use and compliance.
The aim of these changes is to reduce A&E admissions through better management of medicines, particularly for those with long-term conditions. Additionally, The Practice Group is working with the CCG to review the possibility of savings from avoided A&E attendances and hospital admissions being reinvested into the pharmacists, developing business cases where appropriate.
In terms of the benefits, these changes will affect patients through increased continuity of clinical care, more frequent and comprehensive medication reviews, improved efficiency in assessing medication, the promotion of better compliance, an improvement in clinical outcomes and avoidance of unnecessary side-effects and interactions.
From a GP surgery perspective, the benefits will include an increase in shared workloads, reduction in GP locum costs and increased job satisfaction. For the NHS, the benefits will be more cost-effective prescribing, meeting national quality standards and a reduction in costs and overall burden thanks to a reduction in reactive urgent care.
In summary, we need to have a wider variety of healthcare individuals on the frontline with our GPs. Clinical Pharmacists are a great example of a group that could help more with increased training and scope. By taking approaches to make this happen, as suggested here, we will not only assist our GPs’ workloads, we will also improve patient care and value to the NHS in the longer term.