My journey as a pharmacist started over 9 years ago as a secondary care pharmacist. Until more recently, a pharmacist’s training and experience would have predominantly been in community or hospital pharmacy. In recent years I completed a Postgraduate Diploma in General Pharmacy Practice (PG Dip GPP) and gained prescribing accreditation. This has allowed me to transfer my skills across to primary care.
The role of pharmacists in primary care
The impact of pharmacists within the primary care setting is becoming more apparent. On a day-to-day basis, pharmacists working within primary care are expected to deal with a wide range of medication related issues. Medication reviews can often be challenging, so having a structured approach to dealing with medication certainly helps to make the process easier. Primary care provides pharmacists with the opportunity to manage and take charge of improving outcomes in patients with co-morbidities, especially those that are on several medicines, known as polypharmacy.
Patients with complex co-morbidities usually require care from a range of clinical specialists, and communication between this network of clinical specialists is essential. A breakdown in communication can lead to confusion and misinformation, causing errors and overprescribing. Without adequate review or having systems in place to ensure treatment regimens are appraised holistically, changes to medication are often overlooked.
Structured medication reviews (SMRs) improve outcomes by addressing overprescribing and the prescribing cascade (a term for the process whereby, the side effects of drugs are misdiagnosed as symptoms of another problem, resulting in additional prescriptions; further side effects and unanticipated drug interactions, which itself may lead recursively to further misdiagnoses and further symptoms). From the 1st October SMRs have been included as a requirement in the Primary Care Network Directed Enhanced Service (PCN DES) contract from NHS England and NHS Improvement.
Structured medication reviews having an impact
Feedback from patients has been overwhelmingly positive, with a lot of patients expressing that their understanding of their medications has improved as a result of undergoing an SMR with a pharmacist. As the SMR requirement is new, on 30th July UCLPartners ran a webinar on SMRs with pharmacists and GPs from across the region, exploring a variety of different themes to help contextualise the processes involved in carrying them out. The webinar reinforced the use of different tools available to pharmacists, such as the anticholinergic burden calculator (e.g. www.acbcalc.com/ or https://medichec.com/ ) and STOPP/START, to help optimise and reduce the burden of medications.
SMRs benefit patients and showcase pharmacists’ skills as part of the wider primary care team, to ensure patient safety whilst also reducing the burden on GPs. The role of pharmacists in primary care is ever-evolving; going forward initiatives such as SMR should be embraced, but it is important that the system carefully balances this with adequate staffing and training to ensure pharmacists can truly make inroads into improving patient outcomes.
Find out more about UCLPartners’ work to support primary care teams caring for people with long-term conditions here. To register for future webinars, visit our events pages.