Supporting GPs through community pharmacies
James Roach, director of the Integrated Care Partnership in West Essex, reveals that fully deployed community pharmacy models could release 18 million GP appointments per year.
Working with the National Pharmacy Association, an innovative GP practice (Jaunty Springs) and community pharmacy in Sheffield (Basegreen Pharmacy), I evaluated an integrated primary care model which, as the outcomes suggested, has significant potential if scaled up.
There are currently 11,500 community pharmacists, each one serving approximately 5,000 people. This evaluation demonstrates that even if every pharmacy was to provide just one day of clinical support to general practice each week, it would release in excess of 18 million GP appointments per year, which is the equivalent of 1,200 WTE GPs.
In almost all cases, access to a pharmacy will be far easier than a GP. Over 1.5 million people walk into a pharmacy every day, which equates to 136 patients being seen without an appointment every single day.
Outline of the integrated service delivery model (Jaunty Springs and Baseline Surgery)
The community pharmacy accessed the GP practice’s SystmOne from the pharmacy consultation room, utilising the existing N3 connection for virtual review booking of patients and updating of the patient record in real time. In-depth medicines data analysis was led by the community pharmacist.
Patients were given the choice of healthcare professional in either the practice or undertaking a consultation with the community pharmacist in their consulting room. They had access to the full community pharmacy team, which consisted of two community pharmacists (one of whom was an independent prescriber), two dispensers, and 1.5 WTE accuracy-checking technician and medicines counter assistant. This team, working in tandem with the general practice team, generates a high-quality, seamless integrated care service for the patients. This model also brings the additional benefits of utilising existing patient and professional relationships and breaking down silos within the health system, which combined have led to improved trust and confidence in the clinical input of the community pharmacy team.
The community pharmacist undertakes direct consultations with patients in the community pharmacy or in relation to the elderly in their place of residence.
Key benefits to the health system
This approach created more capacity in primary care through a highly scalable model. It also reduced average waiting times to be seen in a primary care setting, which then reduced pressure on the whole GP team. As a result, average waiting times at the GP practice are lower than the local and national average.
It also supported patients in taking their medicines; supported the quality and safety of prescribing within the practice; and eliminated prescribing errors at source, and in real time, by allowing the community pharmacist to access the full GP record and make changes.
The model increased support for frail elderly patients in their own home, and those residing in nursing homes on the registered list; as well as critically changed patient behaviour, making pharmacy first port of call for a range of conditions.
- More than 1,000 interventions were carried out by the community pharmacist during a nine-month period (36 four-hour sessions);
- From the pilot it was demonstrated that every four minutes of pharmacist time saves approximately two minutes of GP time, whilst also improving quality;
- For every day of dedicated community pharmacist support for general practice, one whole session of GP clinical time is created, meaning an additional 25 patients can see their GP every week.
Small steps can make a big difference
Operational integration between community pharmacy and general practice can be delivered through existing IT capabilities, supported by a template Memorandum of Understanding to govern data-sharing between practices and pharmacies and a shared care arrangement. This is possible without the need for legal or structural integration. The evaluation has established critically that:
- Read-write access to GP clinical systems is already feasible within a community pharmacy setting, and adds significant value;
- There is real potential in using community pharmacy differently to explicitly support general practice, and to provide better and more integrated care for patients;
- The availability of routine access to the GP clinical system is the key enabler to unlocking the potential of community pharmacy to deliver more advanced and holistic clinical care in a different setting.
Integrating primary care under a single purpose
The evaluation details no service specifications, because there are none. The modus operandi is integrated care because a holistic approach is the best for the patient and, in the long term, for the health service. Through alignment of priorities, sharing of information and respect for the skills and clinical competence of the community pharmacy team, there is a real opportunity for primary care to come together almost as a single organisation with a single purpose.
Changing patient behaviours
A notable feature of the Jaunty Springs integrated care model is that the vast majority of the interventions were made from the community pharmacy consultation room, rather than on the premises of the GP practice, with patients being booked directly to see the community pharmacist. The GPs and community pharmacists involved has been key in changing patient behaviours in terms of how they access core services.
But above all, it’s been great for patients in the area who have benefitted from the improved access to medicines support. We have adopted the successful principle that any patient that could be well managed by the community pharmacist should be referred there to reduce practice workload, improve the patient experience, and encourage positive attitudes towards self-care.