Role of PCN pharmacists?

My consulting company Howbeck Healthcare has been asked by some of our client PCNs and Federations to help them with the process of finding and appointing a PCN pharmacist re the new role in the DES.

One of the first questions asked by practices is what role can the PCN pharmacist take and how will that help us?

Below is a crib sheet we have produced for them that includes a list of jobs/tasks we think they can do that will help the PCN and practices as well as some thoughts on things to think about.

Howbeck Healthcare supplies consultancy services to GP practices/ PCNs/ GP federations and other NHS bodies. We have a preferred list of PCNs and Federations on a retainer basis who use our services but we are also available for one off pieces of work. Please contact our business manager lisa@howbeckhealthcare.co.uk if you are interested in finding out more about how we could help you

PCN Pharmacist Role – Points to consider / checklist.

Task : agree the service model – how the PCN utilises the funding ‘offer’.

There are a number of options: our view is that only one of these is a realistic option (the last one),

• The available hours (1 WTE) are split pro-rata across the network practices for each practice to use individually.
• The available hours are split across those network practices that want a pharmacist – i.e. not necessarily all practices.
• The available hours are allocated to one / two practices on the basis that other practices will have pharmacists from the network in future years.
• The available hours are used by the network to provide a network wide role. (preferred solution)

Task: agree if any Pharmacists from the NHSE schemes are going to be transferred into this scheme.

The rules are so complex – I wouldn’t propose that this is an option.

Please remember existing Pharmacists will be on baseline so you can’t substitute.

Task: agree the practice / network contribution. (the 30%).

Agree the funding that is not covered by the reimbursement – expenses/ grade drift / etc.

Options:

•                   Follow the model i.e. split pro rata.

•                   Paid for through the £1.50p

Task: agree how time is flexed to deliver Network savings / meet network priorities.

For example: is it appropriate for the Pharmacist to spend more time in one practice if this practice has a greater need?

Task: agree plans for future years.

Are future funds going to be used for Pharmacists or other roles? If Pharmacists how are these roles to be used?

Task: setting Expectations of the role for:

•                   Practices

•                   Pharmacists

Education for wider practice team on this new role work with teams to help appropriate signposting and embedding of role

Clarify proportion of time expected to be patient facing vs administration to ensure fits with both practice and pharmacist expectation

Task: ensure the right candidate for the role

The pace and working environment of primary care can be different to that in some other sectors of pharmacy .

Task: determine how the role will fit with the current local MMT support?

Avoid duplication of effort / tasks.

Task: work out how you will you measure success?

•       KPIs (what/when)

•       EMIS templates to allow search and reporting of interventions / patient contacts

•       Patient satisfaction questionnaires

•       Practice satisfaction questionnaires

Task: determine how the pharmacist will get the required supervision and peer support?

•       Use existing Pharmacists within the PCN footprint?

•       Seek CCG support?

Task: determine who will provide indemnity cover? (this maybe a non-issue)

•       What is covered under the new scheme?

•       What is covered by the practice?

•       Will the network cover personal indemnity costs incurred by post holder (?£800 per year).

Task: determine training requirements

This is a huge issue likely to be Intense in the first 18 months – ensure pharmacists aware at interview stage.Time out of practice is significant and needs to be communicated early on to stakeholders.

Non-medical prescribing training is an additional training need and requires GP supervisor and a number of hours shadowing which again reduces working time

If the best candidate has already completed the majority of training, who will accredit this previous learning?

Feedback from practices where the role hasn’t worked, recommend considering a clause in their contract to stay for a proportion of time after completion of training, given the investment in time by the GP supervisor / time out of practice

Task: determine the Role

Options for work that could be carried out across the whole Network – i.e. Our preferred option.

1)     Standardising systems across the network

•       Repeat prescribing systems – audit and improve repeat prescribing systems in each practice.

•       Increasing use of repeat dispensing.

•       Drug monitoring schedules/systems.

•       Produce EMIS protocols to streamline processes

•       Eclipse reports

•       Implementation of safety alerts – management of a standard system

2)     Management of controlled drugs

3)     Helping support with DM indicators through meds optimisation e.g. (meeting BP and HbA1c targets)

4)     Facilitating the QI Prescribing Safety elements of QOF for this year across the practices

5)     Focus/support for national service specs in contract – standards 1 (med reviews) and 7 (CVD prevention)

6)     Running clinics as a central function, e.g:

•       Anticoagulation in AF

•       DMARDs (and management of repeat scripts/monitoring)

•       Opioid dose reduction

•       Polypharmacy reviews (not in nursing homes as will the MOCH team be working on these??)

•       High risk scripts such as warfarin.

7)     Ensuring delivery of PCN level prescribing incentive schemes (likely in future).

8)     Extended hours//hub working. Pharmacists could take part in hub working in hours/ext hours to provide choice of venue/time for pts e.g. for hypertension checks/etc

9)     General QOF     Support to achieve targets with a medicines focus and areas of clinical speciality.

10)  Quality Improvement:

•       Supporting development of clinical pathways

•       Improving prescribing – both quality and cost-effectiveness

•       Evidence based interventions: (based on findings from audit/data already available), focus effort to support standardising care across the network e.g. anticoagulation in AF, reduction in opioid prescribing, antibiotic stewardship, polypharmacy medication reviews, implementation of NICE guidelines.

11)  Care homes work:

Determine whether the PCN has access to a MOCH Team? If not, would the PCN want the Pharmacist to support care homes? Medical information resource.

12)  For patients, clinicians and administration staff, education and training role for:

•       Reception / Prescribing Clerks.

•       Prescribers and Nursing Team

13)  Liaison with other sectors of pharmacy

•       Community Pharmacy

•       Hospital Pharmacy.

14)  Facilitation of peer discussions to agree network formulary / care pathways

15)  Medical information resource for:

•       patients,

•       clinicians,

•       administration staff.