Article by Clare Morrison, Senior Clinical Quality Lead and Lead Pharmacist (North) at NHS Highland
As pharmacists across Scotland consider how the new GP contract will be implemented, it is already close to reality for our pharmacy team in the North of NHS Highland.
The Caithness Pharmacy Model began in 2014 when times were tough. GP shortages hit this remote area early and practices had already developed advanced nurse roles: it was a logical next step to consider what pharmacists could do.
Meanwhile, our existing pharmacy team had hit a watershed. We had just published research which demonstrated that pharmacist reviews made medicines use safer. In addition, integration of health and social care had already happened in NHS Highland, so the time was ripe for change.
Our aim was to create a model that improved the quality of medicines management and reduced GP workload. It meant a shift from a traditional prescribing support role to delivering patient-facing pharmaceutical care. We created two roles: a Specialist Clinical Pharmacist and an Advanced Pharmacist Practitioner.
Specialist Clinical Pharmacists support patients who need a high level of input to ensure their medicines are safe and effective. These tend to be frail patients, such as those in care homes or receiving care at home support, and form the top 10% of a practice’s population.
The Specialist Clinical Pharmacists work across a locality, and are closely aligned with local NHS integrated teams and virtual wards. They see patients who are at risk of hospital admission, are just out of hospital or who have had a fall. They are independent practitioners who identify and resolve medicines issues: their most common interventions are reducing doses or stopping medicines that have become inappropriate due to a patient’s frailty.
Meanwhile, Advanced Pharmacist Practitioners are responsible for medicines management in a single GP practice, including:
- Providing medication reviews – checking medicines are safe and appropriate, and maximising serial prescribing.
- Dealing with medicines actions on discharge and clinic letters.
- Responding to acute medicine requests.
- Providing intensive medicines support, usually titrating doses.
Key to the development of the Caithness Pharmacy Model was taking a quality improvement approach. Each element of the roles was tested and refined before becoming part of the pharmacist’s permanent job.
We have gone a long way to realising our initial aim: GP time has been saved and quality has improved. But there is more to do. All practices in Caithness and Sutherland receive Specialist Clinical Pharmacist input, but only three have an Advanced Pharmacist Practitioner, limited to date by funding. The technician role is also in the pipeline. So not quite the complete story, but the Caithness Pharmacy Model has made a good start.