Getting started as a clinical pharmacist

rachel_hall-150by Rachel Hall, clinical pharmacist

I’m a clinical pharmacist and partner at the Old School Surgery in Bristol, an inner city practice with more than 15,000 patients.

Getting started as a practice pharmacist
During my training, I worked for one day a week at the practice, specialising in treating patients with type 2 diabetes. This work convinced the partners they needed a permanent clinical pharmacist, rather than taking on a salaried GP.
An audit of my work with type 2 diabetes patients showed that 82% had reduced glucose levels within a year of their first consultation. That was a big factor in being taken on full-time, initially on an employed basis and eventually as a partner. It showed what I could achieve.

Patients’ reactions
When I first started you would get the odd patient who would go and see the doctor a couple of days after seeing me to check what I had done. That doesn’t happen now. At first I would have to spend time explaining my role to patients; now it’s the norm. It’s rare you will get people querying why they have to see the pharmacist nowadays. Patients know they can see their GP, one of the nurses or a pharmacist – they know they will be directed to the right clinician to meet their needs.

I am fully embedded in the practice. Patients will ring up and ask specifically for me, and often I can deal with queries over the phone. There are some patients with diabetes who have never seen a GP in all the time they’ve been with the practice because I have managed them in their entirety.

Managing a caseload
My initial focus was on patients with long-term conditions which weren’t being managed and controlled effectively. In the past these would often have been referred by practice nurses to the GPs. Over three days each week I see about 35 patients in person and carry out between 10 and 20 phone consultations, significantly reducing GP workload.

People tend not to come in with just one thing wrong with them. If there’s other things I may be able to help them or, where appropriate, refer them to the GP or signpost them.

A clinican and part of the team
I will only work within my area of clinical expertise and am fully aware of any limitations in my knowledge. The important thing we have learnt at the Old School Surgery is not to work in isolation. To help this all the clinicians now meet each lunchtime to talk about any tricky cases we have. We have open discussions and everyone gives their opinion. We all learn a lot from each other.

I now also make secondary care referrals for a range of conditions, including heart failure, cancer, chest pain, rheumatology and endocrinology. I’ve never had a secondary care physician querying why a clinical pharmacist is making a referral to them. I’m accepted as a clinician now which is fantastic.
I’ve also made a video with NHS England about my work.  If you’d like to know more please take a look.

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